Specialization is as much a hallmark of clinical nurse specialist (CNS) practice today as it has been for the past 50 years. Specialization is a concentrated area of expert clinical practice with focused knowledge and competencies. The specialty area may be broadly or narrowly defined, well-established or emerging. 1,2
Identifying CNS Specialties
Typically, a CNS specialty is identified in terms of: population, type of problem, setting, type of care, and disease/pathology. 1,2
One characteristic of specialization in a practice discipline such as nursing is the division of a general area of practice along logical lines. Specialization involves combining various aspects of knowledge and practice competencies with a narrow and deep focus. 3 Oncology, cardiology, and neurology, for example, are specialties with a distinctly narrow and deep knowledge focus. Pediatric oncology and cardiac rehabilitation combine two areas of knowledge-pediatrics and oncology, cardiology and rehabilitation-to create a specialty with depth of focus so that relationships among specific phenomena can be studied.
Adapting Specialties
The impetus for specialization arises from scientific and technologic discoveries united with continuously evolving health concerns in society. Specialties are, therefore, adaptable. Today, we need CNSs in HIV/AIDS care, but 50 years ago, CNSs were needed for polio care. Specialization gives the nursing profession the ability to address the full scope of health concerns by expanding and contracting specialties. Specialties are determined by society and reflect nursing's implicit contract with the public to meet their needs.
As specialists, CNSs are clinical experts in the diagnosis and treatment of illness, and the delivery of evidence-based nursing interventions. They possess advanced knowledge of the science of nursing with a specialty focus, and apply that knowledge to nursing assessments, diagnoses, and interventions. 1,2 Specialization is built on the generalist practice foundations of baccalaureate nursing education. 1 CNS specialty practice results when a nurse moves from the generalist focus of the undergraduate degree to an advanced level of nursing (graduate level) with a specialty focus. Thus, a CNS is first a generalist with the ability to understand and appreciate the complexity and compounding nature of multiple problems that a patient may experience. For example, a CNS with a specialty in wound care is able to understand the etiology and contributing factors influencing wounds from multiple causes-diabetes, vascular insufficiency, trauma-because the CNS is first a generalist.
CNS specialization assures that a portion of the profession has in-depth knowledge and advanced competencies in emerging and narrow health concerns. Generalist preparation cannot adequately address specialty competencies, thus a smaller group of advanced practice specialists, CNSs, deliver and direct care to clients and translate nursing's phenomena of concern into specialty interests.
One characteristic of specialization in nursing is the division of a general area of practice along logical lines.
State nurse practice acts grant nurses an independent and autonomous scope of practice that differentiates the practice of registered nursing from the practice of other licensed health professions. 4 We are just beginning to spread our wings and discover how much of nursing's autonomous terrain is undeveloped. A graduate degree is the way in which CNSs acquire tools to explore this uncharted area. It's our responsibility to develop specialty practice in nursing's autonomous domain. Indeed, CNS specialty practice helps to assure nursing's viability for now and the future.
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