1. Saunders, Mitzi M. PhD, APRN, CNS-C

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A post-COVID nursing crisis has emerged. In recent findings, as many as 66% of nurses surveyed reported anxiety, burnout (60%), feeling depressed (43%), suffering emotionally (46%), and intent to leave or contemplating leaving the profession (63%).1 Clearly, nurses need more support. Clinical nurse specialists (CNSs) are the answer to this crisis. The CNS is instrumental in the development and support of key strategies that deal with the stresses that bedside nurses are facing. Clinical nurse specialists are the nurses' consultant, mentor, and advocate2-but we need more CNSs.


The National Association of Clinical Nurse Specialists (NACNS) reviewed their data on existing CNS programs and revised the program directory (PD) on the NACNS website. This review revealed that, of the more than 200 programs that existed in 2009, there are now only 78 programs. With the COVID-19 pandemic, the CNS role became prominent and hospital systems saw firsthand the value of the CNS. Now is the time for academic nursing programs to consider starting a CNS program or resuming a program. Program directors and CNSs aspiring to start a CNS program can face this challenge and grow the numbers of CNSs who can support nurses at the front lines of care. This article discusses the strategies that have contributed to the success of a CNS program since 2007. Important strategies for a PD to develop include marketing and recruitment, prospecting, program quality through consistent program evaluation and revision, robust engagement of alumni relations, and use of NACNS resources.



Never underestimate the importance of an informative and interesting website that is updated often. Highlighting your best assets on your webpage such as pass rates on the national CNS examinations encourages potential students to apply. The website should also include testimonials from former students. Most importantly, the website should provide the PD's telephone number so potential students can easily reach a real person to get questions and details clarified. Just about every nurse thinking they want to be a CNS needs to talk about it. There is not enough CNSs out there in practice for nurses to understand the role. In my experience, most just know they do not want to be a nurse practitioner. The PD needs to be available for that exchange of information with talking points about the role and how the possible applicant will function in the role. You need to get them excited about the possibilities. The biggest worry expressed by potential applicants is not finding a job as a CNS after they graduate. It is important to tell nurses in these conversations that once they learn the role and can articulate it, they will get their ideal CNS role. My experience demonstrates this being a reality among my graduates not to use it consistently when talking to potential applicants. Note that it is important to "talk" rather than have an email communication. They need to hear a voice and know they will be called back when they need you (now or later as a student). These are busy bedside nurses coming out of a pandemic, and nurturing them and making things as easy as possible and establishing a relationship is key. This is one of the most important first steps in a successful CNS faculty-student relationship.



Every PD should read Nick Murray's The Game of Numbers.3 This was a game changer in how I have maintained my CNS program numbers in the 40s on a consistent basis. What Murray teaches is to focus on the lead measure and the lag will come. In this case, it is all about the time and effort the PD puts into getting applicants for the program rather than a wait-and-see approach of who seeks information or applies to the program. What does that mean? The more phone calls made, the more information sessions that are conducted, the more guest lecturing in undergraduate nursing on the CNS role, the more outreach to alumni and current students to send prospective nurses, the more applicants received. It is work but well worth the effort.



If you do not have a quality program, then it will be difficult to grow your program. You need students who will talk the program up in a positive way-they are your best tool for recruitment. All CNS programs should be guided by the Statement on Clinical Nurse Specialist Practice and Education,2 and students should be supported in meeting the CNS competencies for full scope of practice. Recruitment of practice partners with certified CNSs on staff is needed to ensure robust clinical experiences. If the program is a DNP terminal degree, the healthcare system can benefit from the student developing their scholarly project based on a priority need. Not many resources are free, but services from an experienced PD to assist any PD who might need consultation on CNS curriculum should be sought out. Finally, metrics such as program pass rates on the national Adult-Gerontology Clinical Nurse Specialist examinations and program satisfaction are important to capture as a means to revise the curriculum as needed.



Keeping in touch with alumni from the program is very important for two reasons. First, if you have been engaged with every CNS student from start to finish, then you know each other well and those relationships do not end at graduation. Creating a listserv of graduates is an easy way to reach out via email communications periodically to "check in," share an important role article and/or a CNS job posting, and so forth. Sometimes these emails spark a 1:1 mentorship meeting with a former student or connecting one CNS with another for support. In addition, being a point person for new CNS jobs and getting the information out to all alumni is helpful. My students were so supportive when I lost my father 10 years ago and, last year, my mother. I render the same support and listening ear whenever I can. It has made my life richer having my students in my life who I consider friends/CNS colleagues. Second, they are your future CNS preceptors, and developing preceptor incentives can be helpful. These may include free continuing education offerings, taking a course, or other incentives. Payment for precepting is beginning to emerge, but CNSs do not precept for the money, so incentives that help them grow and thrive are often more welcome than monetary compensation. Remembering to send the "thank-you" letter with confirmation of precepted hours is also appreciated.



The NACNS has many resources and contacts to guide existing programs and those aspiring to start a program. The many toolkits and reports found at the NACNS website are useful when constructing learning modules. For example, the "Project Management & Dissemination Toolkit" is extremely popular among my CNS students.


In closing, it is the hope that all CNS programs can become full to capacity and that more CNS programs will emerge to replenish this vital role in healthcare. All PDs need to stay passionate about this amazing role (the CNS), and that joy is a great tool for attracting others to the profession. We need to work together to increase the number of CNSs in the workforce to support those bedside nurses and the health systems issues that we are facing.




1. American Nurses Foundation. Pulse on the nation's nurses survey series: Covid-19 two-year impact assessment survey. 2022. Accessed July 2, 2022. [Context Link]


2. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. 3rd ed. Author; 2019. [Context Link]


3. Murray N. The Game of Numbers. The Nick Murray Company Incorporated; 2010. [Context Link]