1. Hader, Richard RN, CNA, CHE, CPHQ, PhD

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Where have all the clinical nurse specialists (CNSs) gone? Vanished are those professionals who contributed enormous talent to the clinical area. It begs the question, did we cause the extinction of one of our most vital resources?

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Our clinical partner has fallen victim to reengineering, downsizing, and poor role implementation, which resulted in the rapid descent of enrollment in graduate nursing programs. In the mid- to late 1990s, institutions began eliminating the CNS role from their budgets because of a financially driven, competitive market, coupled with shrinking reimbursement. Financial pressures forced hospitals to make tough decisions, often "slashing and burning" positions to maintain a positive bottom line. Consequently, CNSs reinvented their professional portfolios to market their skills differently to healthcare organizations. Graduate nursing students saw the role's limited career prospects and chose to pursue other clinical, administrative, or educational concentrations in their studies. Economics dictated a national closure of many of these programs, resulting in a severe shortage in the clinical setting. The reversal of this trend is imperative to help alleviate the void created by this invaluable practitioner's absence.


Embodying a number of roles, CNSs act as educators, researchers, consultants, and expert clinicians. As educators, they keep seasoned staff abreast of best-practice protocols, guidelines, and current advances in evidence-based practice. These experts work side by side with novice nurses to ensure competence, model effective organizational skills, and share expertise both in the classroom and at the bedside. They act as mentors to new nurses, easing the transition from student to practice professional.


CNSs embrace the need for research at the level of direct patient care. By role-modeling ways to use discovery techniques, they help staff nurses develop the skills to find answers to their most troubling clinical questions. Partnering with staff to resolve clinical challenges is a method CNSs use for consultation and collaboration. These seasoned experts provide insight, knowledge, and skill to help improve patient care delivery.


Vacancies in these unit- or clinical service-based roles have necessitated filling CNS positions with nurses who haven't received enough education to properly perform the many facets of the job. Nurses who have stepped into these positions face enormous challenges, as they must meet the ever-growing demands of their staff nurse colleagues while simultaneously delivering care to higher-acuity patients. It becomes incumbent upon the institution to provide opportunities for nurses to further their professional development so they can meet the CNS role's complex demands.


As organizations struggle with maintaining retention, it will become increasingly important to provide support for the bedside nurse. This role can decrease staff nurse stress by providing a timely and appropriate response to clinical challenges. The support will even be greater as the healthcare team prepares to meet the care requirements of the aging demographic.


CNSs can act as a resource to help facilitate collaboration among healthcare delivery team members. Using the CNS skill set, you can better coordinate care through a more effective patient disposition, resulting in a positive economic incentive for your healthcare organization, your payor, and your patients. Investment in this role will prove fiscally responsible and beneficial if the position is implemented in a manner that allows the expert to perform his or her responsibilities in an autonomous manner.


Academic programs need to consider bringing back the CNS curriculum. As your healthcare organizations realize the need to reimplement this role, there will be great opportunity to sustain a career as a CNS.