1. Muller, Anne C. MSN, RN, CRNP, CNS
  2. Strauss, Robyn MSN, APRN,BC, CVN, WCC

Article Content


The Hospital of the University of Pennsylvania (HUP) developed and implemented a "scorecard" for quantifying and measuring the unit-based CNS's contribution to quality care.



Within the current healthcare environment, there exists an intense economic competition for a limited amount of reimbursement monies.



One result of this pressure is the reemergence of a call for a measurement tool that accurately quantifies the broad range of Clinical Nurse Specialist (CNS) contributions to essential nursing initiatives, excellent patient care, and implementation of evidence-based research findings. This current healthcare climate, focused on the call from institutional and regulatory agencies for quantified outcomes measurement, necessitates that CNSs develop and maintain a wide range of competencies focused on patient and quality of care outcomes yet remain consistent with competencies unique to the role.



Following a review of the literature, possible barriers to implementation were identified and stakeholder opinions were solicited. After reviewing several business models, the scorecard was developed and piloted.



Metrics utilized include analysis of the delivery of care consistent with National Database of Nursing Quality Initiatives, staff development, evidence-based practice utilization, and retention of staff nurses. Quality patient care was a priority, integrated with the professional competencies of CNSs within the framework of Patricia Benner's model of nursing practice development. Applicability across care disciplines was determined while establishing meaningful comparative measures consistent with the traditional professional competencies of the CNS.



Measuring CNS's contributions to the clinical care environment is essential for establishing the contribution of the bedside. Tools adapted from the business community, such as a "scorecard" methodology, can be successfully used across multiple care disciplines and help support the role of the CNS.


Implications for Practice:

CNSs need to define their priorities and develop tools that quantify their essential contributions to quality clinical care.