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Over the past several weeks, I have been reading Educating Nurses: A Call for Radical Transformation,1 the most recently published report from the Carnegie Foundation for the Advancement of Teaching. As I read through the report and the recommendations it contains, I reflected on my experiences while a student in a baccalaureate nursing program. That program was organized under the unification model, which combined teaching with clinical practice, research, and/or administration. Students were taught by master's and doctorally prepared clinical nurse specialists (CNSs) who held joint appointments as faculty in the college of nursing and as CNSs assigned to specific unit(s) in the medical center.2


This unification model of education and practice provided many benefits for the undergraduate nursing students and created a rich learning environment. The "practitioner-teachers" shared in-depth knowledge of their specialty in didactic classes and helped us to understand how to use that knowledge as the basis for our nursing care. This model ensured that students were taught up-to-date health care theory and science that reflected current nursing practice. In the clinical setting, the CNS teachers helped students to integrate knowledge from the classroom into clinical decision making and patient care. Concepts learned in the classroom were used and reinforced by the same instructors who, because they worked as CNSs in these units, had firsthand knowledge of the patients and their individual health needs. As a student, I personally benefited from interacting with these clinical experts. For example, I learned not only how to assess the needs of individual patients and make clinical decisions in a broader context but also how nurses interacted with other members of the health care team to provide holistic patient care. Most important of all, I learned what it meant to be a nurse and came to understand the significant impact of nursing interventions on patient outcomes.


The CNS practitioner-teachers were respected members of the health care team on the units. Nurses, medical interns and residents, and many others recognized the CNS practitioner-teachers as the "go-to" experts. I was awed by their expert knowledge and skill and inspired by the high quality of their practice.


Many characteristics of this learning environment are congruent with the effective educational practices cited in the recent Carnegie study. For example, the CNS practitioner-teachers provided an educational experience that shaped my professional identity; taught me the ethical responsibilities of being a professional nurse; helped me to integrate knowledge learned from science, behavioral and social science, and nursing classes into the clinical setting; and provided me with opportunities to learn how nurses interact and collaborate with other disciplines.


As I reviewed the major recommendations included in Educating Nurses1 and also read through the major messages contained in the recently released Summary of the February 2010 Forums on the Future of Nursing Education3, it struck me that CNSs have a unique and valuable skill set that we can use to transform the education of future undergraduate nursing students. Following are a few recommendations from these 2 recent publications on the future of nursing education and examples of how CNSs, employed as practitioner-teachers through education and practice partnerships, could assist in transforming nursing education.


* Teach collaboration within the profession and with other professionals in the health care team



Clinical nurse specialists are experts in collaborating with nursing staff, physicians, and other health care professionals. Clinical nurse specialists also lead multidisciplinary teams to develop and improve plans of care for individual patients and for specific populations to address clinical problems. As a clinical instructor, the CNS can teach students communication and other strategies that result in effective collaboration. Additionally, the CNS can model these behaviors and create opportunities for students to participate in multidisciplinary committees or meetings.


* Develop systems-level thinking that supports a safe environment and promotes a high quality of care



As guardians of safety and quality in health care institutions, CNSs are skilled in analyzing situations from a systems perspective for the purpose of improving patient outcomes and maintaining safe environments for patients and families. During discussions in preclinical and postclinical conferences, the CNS can guide development of systems-level thinking by helping students to think through system issues surrounding a specific patient situation or clinical problem, conduct root-cause analysis to identify underlying causes at the systems level, and develop system-level solutions to identified clinical problems.


* Promote development of the skills of inquiry, research, knowledge acquisition, and transfer



Clinical nurse specialists are skilled in acquiring knowledge and locating current sources of evidence to update nursing practice and develop solutions to clinical problems. Clinical nurse specialists can help to develop these skills in undergraduate nursing students by involving them in efforts to address a specific problem identified by students in their clinical rotation. Through these inquiries, students will learn effective literature search strategies, identify best sources for clinical evidence, and develop skills in evaluating evidence and using it to inform solutions. Thus CNSs will foster a thirst for lifelong learning, assist with developing a questioning attitude, and inspire new nurses to counter clinical questions by asking: "What does the evidence indicate?"


* Broaden the clinical experience so that it includes planning and delivering care for patients across the health-illness continuum, in both acute inpatient and community settings



As specialists who often work with defined populations of patients, CNSs are adept at assessing patient care needs across health care settings and coordinating care to meet those needs. As clinical instructors, CNSs can structure clinical experiences that will link students with patients throughout the continuum of illness and recovery.


* Develop skills to become agents of change



As problem solvers and clinical innovators, CNSs often lead practice changes within health care institutions. Many times, they also advocate for change by actively participating in professional organizations and meeting with government officials. Through role modeling these behaviors and involving students with them in these activities, CNSs will help new nurses to experience the change process in "real life" and to understand effective and ineffective change strategies.


Clinical nurse specialists possess a unique skill set that, if tapped, can transform nursing education.




1. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses. San Francisco, CA: Jossey-Bass; 2010. [Context Link]


2. Fisli BA. A History of the Rush University, College of Nursing and the Development of the Unification Model, 1972-1988 [unpublished doctoral dissertation]. Chicago, IL: Loyola University of Chicago; 1994. [Context Link]


3. Institute of Medicine. A Summary of the February 2010 Forum on the Future of Nursing: Education. Washington, DC: The National Academies Press; 2010. [Context Link]