ambulatory clinical nurse specialist, clinical nurse specialist practice model, role transformation



  1. Negley, Kristin D. MS, APRN, CNS
  2. Cordes, Mary E. MS, APRN, CNS
  3. Evenson, Laura K. MS, APRN, CNS
  4. Schad, Shauna P. MS, APRN, CNS


Purpose/Objectives: This article describes how a large healthcare organization expanded the practice of clinical nurse specialists from the hospital to the ambulatory setting.


Background: Clinical nurse specialist practice traditionally focused on actualizing the 3 spheres of influence (patient, nurse, and organization) in the hospital setting.


Rationale: Changes in the healthcare system shifting patient care to the ambulatory setting created opportunities for clinical nurse specialists to improve patient outcomes in this setting.


Description: An innovation framework from the Mayo Clinic Center for Innovation based on inspiration, generation of ideas, experimenting, and diffusion was used to assess and prioritize the work of clinical nurse specialists in the ambulatory setting.


Outcomes: Clinical nurse specialists became integral members of hospital and ambulatory nursing leadership. In the ambulatory setting, they are partnering to standardize patient care, providing tools for nurses to practice to full scope, and identifying and providing solutions for patient safety issues.


Conclusion: Aligning clinical nurse specialists in the hospital and ambulatory care settings allows partnership with multidisciplinary teams to ensure that evidence-based practices and standardized care are infused across the continuum of care.


Implications: Evidence-based practices and standardized care encourage nurses to practice to full scope and focus on improved patient outcomes.