clinical nurse specialist, cost savings, leadership, outcomes, professional development, restructuring, team development, value



  1. Fischer-Cartlidge, Erica DNP, RN, CBCN, AOCNS
  2. Houlihan, Nancy MA, RN, AOCN
  3. Browne, Kevin DNP, RN, CCRN


Purpose: This article will describe the outcomes associated with restructuring clinical nurse specialists (CNSs) into a centralized model with dedicated efforts focused on team and individual development.


Methods: A multiphase journey was undertaken to rebuild a team of CNSs after years of open vacancies and role confusion. After restructuring to a centralized model, a multiphase approach was taken that included innovative recruitment strategies, development of a talent pipeline through enhancement of student clinical placements, team and individual development activities, and value identification. Description of methods used for individual and team development is discussed in depth within this article, including achieving role standardization and optimization.


Outcomes: Numerous outcomes were associated with this effort and are described within this article. Among them were the hiring of 21 CNSs, increased representation on hospital-wide committees and councils, quantification of the work contribution of CNSs within the organization, and a $1 568 229.36 cost avoidance associated with CNS work efforts, all in the first 24 months.


Conclusion: As challenges facing the role put it at risk and healthcare becomes increasingly value based, the need for expert clinicians who can demonstrate their value becomes essential. Clinical nurse specialists and hospital leadership can benefit from exploring successful interventions to rebuild CNS teams to achieve these goals.