1. Harwood, Kerry MSN, RN
  2. Apter, Janet MSN, RN
  3. Fulcher, Caryl MSN, CNS-BC
  4. Love, Alene MA, RN
  5. Stewart, Elizabeth MSN, RN

Article Content


The CNS role has been positioned within organizations in myriad ways. We have thoughtfully built a structure to support the CNS role within an academic medical center. This presentation will describe the structure, rationale, benefits, challenges, and lessons learned from a centralized department of advanced clinical practice.



Strategically positioning the CNS role can have positive outcomes for the CNS and the organization.



Factors identified as helpful in CNS role development include role models and peer support, tailored orientation, and ongoing educational opportunities (Bamford and Gibson, 2000). The structure of a centralized department of advanced clinical practice (ACP) using a team leader model has been instrumental in the ability to support and strengthen the CNS role.



Using a matrix management approach, each CNS has a CNS team leader as his/her primary supervisor and a dotted line relationship with leadership from the relevant clinical area. New roles are developed collaboratively, with significant ACP input into preparing the environment for the role. Annual development planning is done combining expectations of both the ACP Balanced Score Card (BSC) and the Clinical Service Unit (CSU). This structure has allowed us to (1) ensure appropriate scope of practice and consistency in job descriptions, (2) foster equitable salary setting, (3) promote effective interviewing techniques, (4) provide a tailored orientation, (5) provide structured development/continuing education opportunities, (6) foster collaborative goal setting and strategic planning, (7) advocate for advanced practice roles, and (8) promote collaboration and utilization of advanced practice resources. Some challenges have been identified, including (1) balancing organization-wide versus unit-based demands for the CNS's time and (2) clarifying role responsibilities between CNS and others involved in staff development.



The strengthening of CNS role socialization through centralized reporting has increased CNS satisfaction and leadership in the organization and promoted optimal role utilization and measurement of outcomes.



A centralized CNS reporting structure, utilizing CNS team leaders, can result in a highly functional, satisfying resource for the organization.


Implications for Practice:

This presentation will result in an understanding of matrix management within a service line environment and its benefits for the CNS role.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those 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 for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.