1. Hoke, Linda PhD, RN, CNS, ACNS-BC, CCRN
  2. Feil, Michelle MSN, CRNP

Article Content


The objectives of this study were to address the role components of the clinical nurse specialist (CNS) aligned with the NACNS core content specific to CNS practice, a comprehensive program was designed to standardize role implementation across clinical settings, to create an infrastructure to sustain improvements in quality outcomes, and to mentor CNSs at a 700-bed Magnet-designated academic quaternary care institution.



Actualizing the CNS role through the NACNS "Vision of the Future for Clinical Nurse Specialists" provides effective means to ensure the success of CNSs and to provide the basis for advanced practice.



Few articles outline the implementation of comprehensive programs for advancing the influence and scope of CNS roles. Although efforts to establish titling protection have gained momentum, CNS positions remain open to master's prepared nurses, resulting in considerable variations in role expressions and expectations. With 30 unit-based and 5 departmental CNS positions, the majority with more than 5 years of experience, structure and processes helped to standardize roles.



A systematic approach to advancing the CNS role involved strategies to incorporate theoretical and scientifically based role development, improve critical thinking, support clinical inquiry, inform practice through outcomes measurement and reporting, and integrate evidence-based practices. Structured orientation, educational programs, leadership development training, and support for scholarship were accomplished through monthly meetings, structured forums, annual retreats, and tool kits.



Several outcomes were attributed to our work. Six CNSs led evidence-based practice groups with impressive improvements in National Database of Nursing Quality Indicators and National Quality Forum nursing-sensitive outcomes (eg, falls, blood stream infections). Clinical nurse specialists assumed leadership of major interprofessional practice initiatives. Seven CNSs progressed in our Clinical Advancement and Recognition Program. Substantial increases in scholarship occurred. Clinical nurse specialist retention and vacancy rate improved.



Standardizing the CNS role creates a defined structure and process that provides opportunities for CNSs to expand their scope of practice and influence sustainable improvements in clinical outcomes.


Implications for Practice:

A formalized CNS leadership model based on mentorship, role development, and advancement contributes to the success of CNSs in defining and achieving role expectations.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.