Clinical Nurse Specialist Role and Practice in the United States of America

Abstract

In the United States, the clinical nurse specialist (CNS) is an advanced practice nursing role. Emerging in the 1960s in response to a recognized need for clinical experts in nursing care, CNSs practice in three interrelated domains—called spheres of impact. In the direct care sphere, CNSs provide care to prevent, remediate, or alleviate illness and promote health with a defined specialty population. In the nursing/nursing practice sphere, CNSs teach, coach, mentor, and lead nurses and nursing personnel in the delivery of evidence-based care for specialty populations. In the system sphere, CNSs lead organizational-level change, coordinate specialized care, and implement programs of care for quality improvement, patient safety, and improved clinical and fiscal outcomes. The National Association of Clinical Nurse Specialists (NACNS), founded in 1995, developed a model of practice including core practice competencies and expected outcomes for each practice domain. NACNS created recommendations for essential content in CNS graduate curricula to assure students develop requisite knowledge and skill practice. CNS practice is regulated as an advanced practice nurse, and CNSs are expected to hold professional certification as a CNS in a specialty population. Each of the 50 states regulates CNS practice, though with some variability. National regulatory guidelines are available presenting both opportunity and challenges for CNSs.