What is a Clinical Nurse Specialist?
A clinical nurse specialist (CNS) is an advanced practice nurse prepared at the graduate level. Other advanced practice nurse roles include nurse practitioner (NP), nurse midwife, and nurse anesthesia. A clinical nurse specialist is a multifaceted role including such exciting responsibilities as clinical expert, educator, consultant, change agent, researcher, and project manager. The way the CNS role is implemented is greatly influenced by the needs of the institution and the strengths of the CNS.
The following table summarizes a few of the differences in advanced practice nursing roles:
|Clinical Nurse Specialist (CNS)||Nurse Practitioner (NP)|
|Definition||An RN who, through study and supervision at a graduate level, has become an expert in a defined area of knowledge and practice in a selected clinical area of nursing (NACNS)A clinical expert who bases nursing practice on research and theory in a particular specialty area (e.g., critical care, acute care, gerontology)||An RN with specialized graduate education and clinical competency to provide health and medical care for diverse populations in a variety of primary care, acute, and long-term settings (AANP).|
|Similarities||Both require a Master of Science in Nursing. Both are advanced practice nurses (APN) along with nurse midwifes and nurse anesthetistsBoth the CNS and NP deal with case management, patient education, and patient advocacy|
|Roles||Direct Practice of NursingEducation: mentor, educator of staff and patients
|Direct Practice of Nursing and Medicine|
|Differences||A CNS is more active as a consultant, liaison, and advocate between the organization, patients, and patients’ family members. A CNS is frequently involved in management roles and the development of policies and procedures with a systems focus. CNSs practice advanced nursing.||The primary function of an NP is to provide direct patient care including delegated medical practice under the direct or indirect supervision of a physician.|
|Responsibilities||Assess, plan, and evaluate patients, nursing personnel, and organization/network domainsAffect patient care by intervening in complex cases, providing support to nursing staff members, consulting, participating in multidisciplinary activities, designing and evaluating programs of care, and working on projects at the unit, department, division, institution, or network levels
Intended to improve patient care and influence others
|Diagnose and manage acute episodic and chronic illness and emphasize health promotion and disease prevention. Order, conduct, and interpret diagnostic and laboratory testsPrescribe both pharmacologic and nonpharmacologic therapies
Teach and counsel individuals, family members, and groups
|Practice Location||Most practice in hospital settings||Most practice in ambulatory care|
Since the CNS role is an advanced practice role, a master of science in nursing degree is required. There is a national initiative to move the preparation of all advanced practice nurses to the Doctorate in Nursing Practice.
Nurse educators involved in CNS education are confronted by many challenges. These include but are not limited to confusion regarding the difference between a CNS and a nurse practitioner, curriculum development for the transition of CNS education to the DNP level, finding and developing clinical preceptors, marketing of the CNS role and program, and the shift to distance learning.
CNS preceptors are experienced CNSs who are willing to share their knowledge and skills with CNS students. They are strong advocates for the CNS role and vital in the CNS education process.
CNS students are students in a CNS program. They provide invaluable feedback regarding what works and does not work in the CNS education process. These CNS students are our future CNS preceptors and, quite possibly, CNS educators.