The American Association of Colleges of Nursing (AACN) is committed to advancing professional nursing roles and highlighting the connection between well-educated nurses and quality health care. As a leading supporter of academic institutions that educate advanced practice nurses (APNs), AACN is keenly aware of the direct link between graduate-prepared nurses and both patient safety and positive outcomes.

Within the APN community, Clinical Nurse Specialists (CNSs) play a unique role in the delivery of high quality nursing care. These expert clinicians provide care in a range of specialty areas, such as cardiac, oncology, neonatal, pediatrics, geriatrics, psychiatric/mental health, medical-surgical, critical care, and community health among others. In addition to direct patient care, CNSs also engage in teaching, consulting, research, management and systems improvement. Able to adapt their practice across settings, these clinicians greatly influence care outcomes by providing expert consultation for nursing staff and by implementing improvements in health care delivery systems.

Further, the growing body of research on CNS outcomes shows a strong correlation between CNS interventions and safe, cost-effective patient care. CNS practice has been directly linked to reducing hospital costs and lengths of stay, reduced frequency of emergency room visits, improved pain management practices, increased patient satisfaction with nursing care, and fewer complications in hospitalized patients (Wheeler, 2000; Wheeler, 1999; Rizzuto, 1995; Boyd et. al., 1991). Given this strong connection to patient safety, AACN encourages hospitals and other health care providers to expand the use of Clinical Nurse Specialists and to engage these clinical experts to a greater extent throughout the health care arena.

AACN believes that Clinical Nurse Specialists play an important role in the provision of nursing care that does not duplicate the emerging role of the Clinical Nurse Leader (CNL). In terms of focus, CNLs are educated as generalists while CNSs are prepared for specialty practice. The CNL operates primarily on the clinical microsystem level involving small, functional front-line units, while the CNS is engaged not only within the microsystem but also at the systems levels within three spheres of influence: client, personnel and organizational systems. The CNL coordinates and implements client care, while the CNS designs and evaluates patient-specific and population-based programs. The CNL evaluates and implements evidence-based practice while the CNS has the added responsibility of generating new evidence. The CNS and CNL roles are distinct and complementary (Spross et. al., 2004). AACN envisions that these clinicians will work collaboratively to ensure that patients receive the best care possible.

The health of our nation rests on having an adequate supply of highly qualified nurses available to render care in many different capacities. Nurses are needed both at the point of care and in advanced practice roles to deliver care that is growing intensely more complicated. Essential within this nurse staffing mix is the Clinical Nurse Specialist whose role is fundamental to provide quality, safe and cost-effective specialty care across settings.

Please send any comments on this DRAFT position statement to Robert Rosseter at rrosseter@aacn.nche.edu by February 15, 2006.

Boyd, N., Stasiowski, S., Catoe, P., Wells, P., Stahl, B., Judson, E., Hartman, A. & Lander,
J. (1991, September). The merit and significance of clinical nurse specialists.
Journal of Nursing Administration, 21(9), 35-43.

Rizzuto, C., (1995, August). Documenting clinical nurse specialist role functions and
outcomes. Western Journal of Nursing Research, 17(4), 448-450.

Spross, J., Hamric, A., Hall, G., Minarik, P., Sparacino, P., Stanley, J. (2004, December).
Working statement comparing the Clinical Nurse Leader and Clinical Nurse
Specialist roles: Similarities, differences and complementarities. American
Association of Colleges of Nursing: Washington, DC.

Wheeler, E.C. (1999). The effect of the clinical nurse specialist on patient outcomes.
Critical Care Nursing Clinics of North America, 11(2), 269-275.

Wheeler, E.C. (2000). The CNS's impact on process and outcome of patients with total knee
replacement. Clinical Nurse Specialist, 14(4), 159-169.