CNS practice model, population-focused care model, role transformation



  1. Catania, Kimberly MSN, RN, CNS, AOCN
  2. Askew, Taletha MS, RN, CNS
  3. Birkhimer, Danette MS, RN, CNS, OCN
  4. Courtney, Laurel MS, RN, CNS, AOCN
  5. Hanes, Deborah MSN, RN, CNS, CRNP
  6. Lamprecht, Misty MS, RN, CNS, AOCN
  7. Rettig, Amy MSN, MALM, RN, ACNS-BC, CBCN
  8. Vendlinski, Susanne MSN, RN, CNS, AOCN


Purpose/Objectives: The aim of this study was to describe how the clinical nurse specialist (CNS) role can be positioned to proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum. This model capitalizes on the spheres of CNS practice (patient, nurse, and organization) through the functional roles of the CNS (clinical expert, researcher, educator, and consultant) to maximize quality care.


Background/Rationale: The CNS practice in a Midwest comprehensive cancer center has been unit based, focused on nursing staff education, skills, and competencies. Practice varied based on the needs of the unit. With the aging population, rapid growth in research accrual, increasing referrals, and expansion of facilities and programs, a reexamination of CNS practice was undertaken.


Description of the Project/Innovation: Nursing administration and CNSs evaluated the efficacy of transitioning to a population-focused model. Some responsibilities transitioned to other roles, the reporting structure was changed, and the role was realigned to a specific disease focus that encompassed care across the entire cancer continuum.


Outcome: There was significant improvement in the areas of physician collaboration, autonomy, administrative support, teamwork, and contribution to the mission of the cancer program.


Interpretation/Conclusion: In this model, CNSs proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory, maximizing quality care and nursing-sensitive patient outcomes.


Implications: Healthcare organizations need to examine various roles for opportunities to focus on incorporating evidenced-based practices that will result in improved patient care and satisfaction.