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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 registered
nurses (APRNs), AACN is keenly aware of the direct link between
graduate-prepared nurses and both patient safety and positive
outcomes.
Within the APRN community, Clinical Nurse Specialists
(CNSs) play a unique role in the delivery of high quality
nursing care. These clinicians are experts in evidence-based
nursing and practice in a range of specialty areas, such as
oncology, pediatrics, geriatrics, psychiatric/mental health,
adult health, acute/critical care, and community health among
others. In addition to direct patient care, CNSs also engage
in teaching, mentoring, consulting, research, management and
systems improvement. Able to adapt their practice across settings,
these clinicians greatly influence outcomes by providing expert
consultation to all care providers and by implementing improvements
in health care delivery systems. AACN supports the full definition
of the Clinical Nurse Specialist outlined in the American
Nurses Association's 2004 publication titled Nursing: Scope
& Standards of Practice. (See Attachment A).
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 (Fulton & Baldwin, 2004). 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. (See Attachment B.)
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.
Approved March 13, 2006
References
American Nurses Association. (2004). Nursing:
Scope & standards of practice. Washington, DC: American
Nurses Association.
Fulton, J.S. & Baldwin, K. (2004, January/February).
An annotated bibliography reflecting CNS practice and outcomes.
Clinical Nurse Specialist, 18(1), 21-39.
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. Washington,
DC:
American Association of Colleges of Nursing.
Attachment A
The American Nurses Association's definition of a Clinical
Nurse Specialist:
Clinical nurse specialists (CNSs) are registered
nurses, who have graduate level nursing preparation at the
master's or doctoral level as a CNS. They are clinical experts
in evidence-based nursing practice within a specialty area,
treating and managing the health concerns of patients and
populations. The CNS specialty may be focused on individuals,
populations, settings, type of care, type of problem, or
diagnostic systems subspecialty. CNSs practice autonomously
and integrate knowledge of disease and medical treatments
into assessment, diagnosis, and treatment of patients' illnesses.
These nurses design, implement, and evaluate both patient-specific
and population-based programs of care. CNSs provide leadership
in advancing the practice of nursing to achieve quality
and cost effective patient outcomes as well as provide leadership
of multidisciplinary groups in designing and implementing
innovative alternative solutions that address system problems
and/or patient care issues. In many jurisdictions, CNSs
as direct care providers, perform comprehensive health assessments,
develop differential diagnoses, and may have prescriptive
authority. Prescriptive authority allows them to provide
pharmacologic and nonpharmacologic treatments and order
diagnostic and laboratory tests in addressing and managing
specialty health problems of patients and populations. CNSs
serve as patient advocates, consultants, and researchers
in various settings.
Source:
American Nurses Association. (2004). Nursing: Scope &
standards of practice. Washington, DC: American Nurses
Association, p. 15.
Attachment B
Working
Statement Comparing the Clinical Nurse Leader
and Clinical
Nurse Specialist Roles: Similarities, Differences and Complementarities
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