Advanced Practice Corner: The unique role of the CNS

May 02, 2019

Four advanced practice nursing roles were formalized in the 1900s, with nurse midwifery (CNM) and nurse anesthesia (CRNA) leading the way early in the century.   Following their innovative advanced practice example, the Clinical Nurse Specialist (CNS) role was developed in the 1950s with the Nurse Practitioner (NP) role following in 1965.  Today, advanced practice nurses share a nursing heritage, strongly rooted in nursing theory and innovation, which guides our common practice. The CNS role is distinct from the other advanced practice roles, but frequently misunderstood, possibly because there are many institutional and regional differences.

What distinguishes the CNS from other APRN’s?

Our CNS colleagues earn either a master’s degree or Doctor of Nursing (DNP), followed by certification by the American Nurses Credentialing Center (ANCC) and/or licensed as a CNS by their state board of registered nursing.  Core clinical practice for a CNS includes clinical expertise, education and research activities, consultation, and leadership with a goal of improving outcomes in patient care.  CNS practice is expansive, focusing not only on direct patient care, but management, process improvement, systems evaluation and strategies for improving nursing care.  In addition to overseeing patient care, they are often found in collaborative, educational, and research positions and may practice either in the hospital or ambulatory setting.

Similar to the NP, the CNS role is typically specialized by population (adult, gerontology, neonatal, pediatrics), clinical specialty (cardiology, mental health), or context (home health, acute care, public/community health.) They must recertify every five years, completing rigorous continuing education requirements to remain current in their field. 

But what do CNSs do in our clinics, communities and hospitals?

Diane Dale, RNC-NIC, C-NPT, MN, has been practicing as a CNS for 28 years in the San Fernando Valley.  After graduating from the UCLA School of Nursing, she remained in California, joining Providence St. Joseph 19 years ago.  She currently works at Providence Tarzana Medical Center where she specializes in neonatology and pediatrics.  Her role includes multidisciplinary rounding, consultation with nurses, providers and families, staff education and many quality improvement projects.  “The CNS role requires collaboration, clinical expertise, an interest in education and desire to engage in process improvement,” states Diane.  She notes the CNS role is well-supported in the State of California with formal licensure and a mandate by California Children’s Services (CCS) to include CNS caregivers in neonatal and pediatric ICU settings to support these vulnerable patients and their families.

If you’re interested in learning more about the CNS role in your practice setting, consult your state’s Board of Nursing and local academic programs.  Each of the PSJH states license and regulate the CNS role differently.  Both local and online academic programs offer master’s and doctoral CNS pathways in various specialties.  If you enjoy patient care, education, and systems leadership, a CNS role might be a great fit for you!