When I (GH) graduated with my BSN, I knew I wanted to advance my nursing education, but was unsure of which degree to pursue. After working as a nurse for a few years, I realized I wanted to obtain advanced clinical knowledge; however, the NP role did not meet my need to do more than direct patient care. Being heavily involved in shared governance groups at my hospital cultivated a baseline passion in me for improving patient care and outcomes. Like many others, I wasn't aware of the clinical nurse specialist (CNS) role, and after learning it embodied my passion, I knew this was my destined career path.
What we do. The CNS is one of four advanced practice registered nurse (APRN) roles (the others are NP, nurse anesthetist, and nurse midwife). The CNS role builds on the practice of the RN in complex patient situations to design, prescribe, and implement holistic plans of care. Simultaneously, the CNS scans the environment for issues that hamper the optimal delivery of patient care. Therefore, the CNS role has three spheres of impact: direct patient care/population health, nurse/nursing practice, and organization/system. This broader reach of the CNS from the bedside to the health care system can improve nursing care delivery to ultimately support the nurse. It is the CNS's impact on the nursing sphere that tends to draw nurses to this APRN role.
Another unique feature of the CNS role is versatility. For example, during the pandemic, CNSs moved into patient care roles to support nurses and designed new delivery care models to improve care. When CNSs are present, RNs have role models for professional nursing care as well as the support they need to cope with health care's many challenges.
Career opportunities. There are several paths to becoming a CNS. For nurses with a BSN, there are master's and doctoral programs. For nurses who already have a graduate nursing degree but want to add the clinical expertise of the CNS, there is a postgraduate certificate option. The three broad areas of study are neonatal, pediatric, and adult gerontology. The core components of the CNS's education are APRN-level courses in the three Ps (physical assessment, pathophysiology, and pharmacology), role-specific content courses, and a minimum of 500 clinically supervised hours. CNS students spread their clinical practicum hours between working directly with patients, families, and communities with complex needs and leading, implementing, and evaluating system-level leadership initiatives that impact the work of nurses.
Upon graduation, nurses can sit for national CNS certification through the American Nurses Credentialing Center or the American Association of Critical-Care Nurses. Passing a national CNS examination is necessary in most states to obtain an APRN-CNS license to practice and bill for services.
Challenges. The industry's biggest challenge is a shortage of CNSs. More CNSs are needed to meet the increasingly complex needs of patients, our nursing workforce, and health care systems as they move toward more value-based health care.
Connecting with colleagues. The National Association of Clinical Nurse Specialists (NACNS; https://nacns.org) is the official organization and authority on CNS practice. It is led by CNS experts who readily volunteer their time and expertise to mentor and educate other CNSs, and who guide the profession forward so all CNSs have the resources they need to function optimally in the role. The NACNS hosts a conference every year in March that is well attended by CNSs all over the country, as well as globally. The NACNS website has an abundance of resources, including courses and webinars taught by CNSs, so CNSs have access to the latest innovations for implementing evidence-based practice.
Interested nurses can learn more about how to become a CNS by partnering with the program director of a local or online graduate CNS program. A CNS program directory is located on the NACNS website. It's exciting to imagine the potential positive impact on patient outcomes as more nurses choose this specialty.