Clinical Nurse Specialist
Clinical nurse specialists (CNSs) are licensed regis- tered nurses with additional master's or doctorate level training in CNS. These advanced practice nurses are clinical experts in theory-based or research-based nursing, focusing on specific specialty areas.
A CNS is an advanced practice nurse. There are four categories of advanced practice nurses: nurse practitioners, certified nurse-midwives (CNMs), clinical nurse specialists, and certified registered nurse anesthetists. Advanced practice nurses typically are registered nurses (RNs) who have gone on to complete master's degree programs. CNSs have broadened patient care roles because of their advanced training and often provide direct patient care without supervision by a doctor. Sometimes, they have the authority to prescribe medications. This authority is granted on the state level and varies from state to state.
CNSs assume many roles within the health care delivery system. While many are in the clinical setting, others also work as educators, administrators, consultants, researchers, change agents, and case managers. CNSs can become specialized in the areas of adult psychiatry, child psychology, community health, home health, gerontology, and medical-surgical, as well as oncology, perinatal critical care, critical care, and rehab. Some in areas of specialty certification classify themselves as CNSs, and others use the umbrella term of advanced practice nursing. There are all kinds of other
certifications, including those of wound care nurses, case managers, and administrators, that CNSs might earn in addition to the certification as CNS.
In March 2000, the number of RNs prepared to practice in at least one advanced practice role was estimated to be 196,279, which is about 7.3% of the total RN population. The largest group among the advanced practice nurses was the nurse practitioners, followed by the CNSs. These two groups together made up about 80% of all advanced practice nurses. There were about 54,374 CNSs (up from 53,500 in 1996), which does not include those who were certified as both nurse practitioners and CNSs. While about 36.9% of the CNSs were employed in nursing, only about 24% were practicing under the position title of CNS. Nearly a quarter of CNSs reported working in nursing education positions.
The work settings of CNSs include all those settings where one would find nurses and other health care providers. CNSs work in the acute care, long-term care, and intermediate care settings. They work in clinical education within health care facilities, as well as in nursing education programs as faculty teaching nursing. Other settings in which CNSs work include outpatient and ambulatory care, private practice, home health, physician office practice, subacute care, government or military service, community health centers, health care administration, private industry (working for drug companies or manufacturers, in managed care, and other areas of the private sector), and nurse-managed centers, which are health centers completely run by nurses. Within these categories, CNSs work in assisted living facilities; specialized hospital areas, such as cardiac catheterization labs; correctional facilities; dialysis units; parish nursing; and psychiatric hospitals.
Education and training
First of all, nurses must have a baccalaureate degree, or its equivalent, to enroll in a CNS program. To use the title of CNS, the nurse must have a minimum of a master's degree from an education program that prepares CNSs. The training is graduate-level education. Some universities have a fast track program whereby they will accept individuals who do not have a baccalaureate and move them into a master's program. CNSs also take a certification exam in a specialty, offered by one of the nationally recognized certification entities.
CNS students go through advanced theory and practice training, revolving around the three areas of influence, that impact on direct patient care, others supervising direct patient care, and patient care systems. The general areas of learning that are included in this graduate education are theoretical foundations; phenomena of concern; assessment and intervention/design and development; clinical inquiry; technology, products, and devices; teaching and coaching; change, persuasion, influence, and negotiation; systems thinking, consultation theory; measurement; and evaluation methodologies. Under the umbrella of theory, CNSs learn to understand health, illness, and wellness as subjective experiences. They also learn to understand health behavior and health behavior change, as well as the theories of learning, stress, consultation, and organizational development. On the clinical side, CNSs focus on awareness, knowledge, and skill in cognitive work in the three spheres of influence. They learn about technology, products, and devices, as well as how to teach and coach patients and other health care providers.
The American Nurses Credentialing Center certifies CNSs as adult psychiatric, child psychology, community health, home health, gerontology, and medical-surgical CNSs. There also are other certifying bodies, including the rehabilitation nursing certification board, oncology nursing certification corporation, and American association of critical care nurses certification.
Advanced education and training
The master's-prepared clinical specialist can go on to get a doctorate. Each certifying body has its own requirements for recertification. State licensing boards may also have continuing education requirements.
The CNS at the doctoral level typically focuses on research. Although there is a research component to the masters, the doctorate training, more often than not, is a research degree.
The outlook is good for all types of nurses, especially those at the RN level or higher. It is projected that if current trends continue, demand will exceed supply of RNs by about 2010. It is possible that as many as 114,000 jobs for full-time-equivalent RNs are going to go unfilled nationwide by 2015. This is due to a growing elderly population with mounting health care needs, an aging RN workforce, the expansion of primary care, and technological advances that require more highly trained nurses.
Charge agents—Nurses who work to make changes within systems to improve the delivery of clinical care.
Nurse practitioner—An advanced practice nurse delivering front-line primary and acute care.
Occupational Outlook Handbook. U.S. Department of Labor. Bureau of Labor Statistics. Division of Information Services. 2 Massachusetts Ave., NE, Room 2860. Washington, D.C. 20212. (202) 691-5200. <http://stats.bls.gov>.
American Association of Colleges of Nursing. One Dupont Circle, NW, Suite 530. Washington, DC 20036. (202) 463-6930. <http://www.aacn.nche.edu>.
National Association of Clinical Nurse Specialists. 3969 Green Street. Harrisburg, PA 17110-1575. (717) 234-6799. <http://www.nacn.org>.
The Registered Nurse Population National Sample Survey of Registered Nurses—March 2000. U.S. Department of Health and Human Services, Health Resources and Services Administration. Bureau of Health Professions. Division of Nursing. <http://bhpr.hrsa.gov>.