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Clinical Nurse Specialists

What are clinical nurse specialists?
Clinical nurse specialists (CNSs) are registered nurses (RNs) who have:

  • A master’s or doctoral degree in nursing
  • Extensive nursing knowledge and skills
  • Clinical experience in a specialty area

Because the CNS practice is dynamic, competencies for the role will change over time in response to population health needs and evolving practice and health-care environments.

Where do clinical nurse specialists work?
CNSs work in every aspect of health care across the lifespan, from pediatric to adult long-term care. Kilpatrick et al. (2013) found that while most are in acute care, such as inpatient units and hospital-based clinics, CNSs may also work in:

  • Oncology
  • Cardiology
  • Gerontology
  • Mental health1

What kind of health-care services does a clinical nurse specialist provide?
The CNS provides many services across the continuum of care for all age groups:

  • Client level
    • Assesses risks and complications
    • Provides direct therapeutic interventions
    • Helps plan and coordinate care
    • Monitors outcomes
    • Advocates for individualized health and social services to meet client needs
  • Practice setting level
    • Leads quality improvement initiatives
    • Helps implement evidence-based practice within teams
    • Supports others to use best practice guidelines
  • Systems level
    • Helps influence healthy public policy
    • Advocates for the use of health promotion and client education

What roles do clinical nurse specialists have?
CNS’s varied roles can be broken down into five areas:

  • Clinician — providing expert care by conducting detailed assessments, creating care plans and intervening in complex situations
  • Consultant — using expertise in their clinical specialty to support all stakeholders (e.g., regulated nurses, policy makers and other health-care providers) and promote positive client outcomes
  • Educator — educating clients, nurses, students and other health-care providers on the use of evidence-based practice
  • Researcher — ensuring that their practice applies evidence-based care most effectively while being a leader in every aspect of research
  • Leader — promoting the advancement of their speciality and providing clinical leadership as an agent of change in their practice2

What are the benefits of clinical nurse specialists?
According to research, the great value CNSs bring to every setting include:

  • Better client and health-system outcomes related to health status, functional status, quality of life, satisfaction of care and cost efficiency
  • Lower hospital admissions
  • Fewer emergency-department visits
  • Shorter lengths of stay resulting in cost savings for institutions
  • Fewer readmissions
  • More innovation (including evidence-based practices) and work at advanced levels of clinical practice3

When did the clinical nurse specialist role begin in Canada?
CNSs first appeared in the 1960s following an idea developed in the 1940s to have advanced nursing practice roles in place to meet the complex needs of Canadians after World War II. With the expansion of health technology and complex care, the number of clinical nurse specialists rose quickly. In the 1970s, master’s programs for the CNS role were established and many organizations began releasing position statements. The early scope of practice for the CNS role focused on education and leadership, but it soon evolved into supporting the implementation of evidence-based practice.

How do the clinical nurse specialist and nurse practitioner roles differ?
While CNS and NP practice roles share many similarities, such as improving patient outcomes and obtaining advanced education, some confusion still exists about their differences. The following summary, adapted from Donald et al. (2010), helps to clarify some of the distinctions:4

Bryant-Lukosius (2004 & 2008) further clarifies the essential distinctions between the two roles through an advanced practice nursing continuum model, emphasizing how the CNS focuses more on supporting clinical excellence while the NP focuses more on direct patient care.

Bryant-Lukosius continuum model showing distinctions between the CNS and NP roles. The CNS focus on supporting clinical excellence includes professional development, organizational leadership, research and education. The NP focus on the practice role includes extended clinical functions that require extended class registration.

1 Kilpatrick, K., DiCenso, A., Bryant-Lukosius, D., Ritchie, J. A., Martin-Misener, R., & Carter, N. (2013). Practice patterns and perceived impact of clinical nurse specialist roles in Canada: Results of a national survey. International Journal of Nursing Studies, 50, 1524-1536. doi: 10.1016/j.ijnurstu.2013.03.005
2 Canadian Nurses Association. (2009). Clinical nurse specialist [Position statement]. Retrieved from https://cna-aiic.ca/~/media/cna/page-content/pdf-en/clinical-nurse-specialist_position-statement.pdf?la=en [PDF, 930.6 KB]
3 Canadian Nurses Association. (2012). Strengthening the role of the clinical nurse specialist in Canada [Background paper]. Retrieved from https://www.cna-aiic.ca/~/media/cna/files/en/strengthening_the_cns_role_background_paper_e.pdf?la=en [PDF, 1.1 MB]
4 Donald, F., Bryant-Lukosius, D., Martin-Misener, R., Kaasalainen, S., Kilpatrick, K., Carter, N., . . . DiCenso, A. (2010). Clinical nurse specialists and nurse practitioners: Title confusion and lack of role clarity. Nursing Leadership, 23, 189-201. Retrieved from http://www.longwoods.com/publications/nursing-leadership/22240