I am soon to embark on a new phase of my nursing career. I recently graduated from my master's of nursing program, specializing as an oncology clinical nurse specialist (CNS). Once my Board of Nursing paperwork is completed, I’ll join the many nurse practitioners (NPs), nurse midwives, certified registered nurse anesthetists, and other CNSs as an advanced practice registered nurse (APRN).
Although I’ll soon be representing the CNS role, I still have trouble defining it, especially to my patients. This problem isn't unique to me, and it’s hurting the profession as a whole.
Why is the CNS role unclear?
- Unless someone has worked with one directly, they may not have even heard of a CNS. Not every institution uses CNSs, so exposure is limited, unlike NPs. The CNS’s duties are often behind-the-scenes, working on policies and quality improvement.
- The CNS role and educational background is complex, so it’s difficult to describe the profession in a simple sentence.
- Many CNS-educated nurses work in administrative or other clinical positions, without “CNS” in their job title, utilizing their CNS skills. People around them may not even realize that he or she is a CNS.
- The CNS scope of practice varies by state, as does reimbursement. A lack of consistency furthers CNS role ambiguity.
- The biggest problem, in my opinion, is that the nursing profession has too many cooks. Roles are being created to address problems that could be handled by the roles that already exist. CNSs are not used to the full advantage of their knowledge and scope.
So what does a CNS do?
I asked a few of my friends in the healthcare field “What comes to mind when you think of a CNS and what they do?” I got a variety of responses.
- “I don’t know, really. I've never met anyone in that job.” —RN
- “I picture an educator... One who educates staff as well as patients - more hands on with patients than a unit educator.” —licensed vocational nurse
- “Someone who nurses, doctors, and patients can go to when they have questions, need support, education, or expertise in the specialty they are in. [They] function as a knowledge base for everyone and are up to date on best practices for their specialty.” —RN
- “I think of nurses who are less involved in the clinical side and more involved in the administration/coordination of patients.” —2nd year resident
- “An expert resource for more complex patients, staff education, and research” —NP
- “Process improvement mainly—in a nutshell, that's their job focus overall, although they can have different roles.” —RN/CNS program graduate
CNSs do all of these things and more. CNSs are educators, consultants, leaders, and researchers. I find that each CNS position takes on a piece of each of these areas, like a pie, but each varies in the size of the slices.
The National Council of State Boards of Nursing created the APRN Consensus Model in an attempt to guide states in understanding APRN roles. Here is what they say about the CNS.
“The CNS has a unique APRN role to integrate care across the continuum and through three spheres of influence: patient, nurse, system. The three spheres are overlapping and interrelated, but each sphere possesses a distinctive focus. In each of the spheres of influence, the primary goal of the CNS is continuous improvement of patient outcomes and nursing care. Key elements of CNS practice are to create environments through mentoring and system changes that empower nurses to develop caring, evidence-based practices to alleviate patient distress, facilitate ethical decision-making, and respond to diversity. The CNS is responsible and accountable for diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities.”
It’s still wordy, but I think it’s the clearest description I’ve found. You can see how the CNS role would have to vary—no one could take it all on in one job.
What happens now?
As a new CNS, part of my responsibility is to market the role and publicize the benefits of having CNSs on board and using them to their full capability. Changes are happening—between the “silver tsunami” and increasing access to health care, APRNs are much needed to fill gaps in primary and specialty care. CNSs bring clinical knowledge to the table and are uniquely prepared to better the system while also enhancing patient outcomes. Cost is an important part of these transitions, and CNSs have a proven track record in terms of improving cost-effectiveness and efficiency in the healthcare system. The data exist to support the role, but CNSs must step up to promote the importance of their influence. Hopefully, I’ve managed do a bit of my part here.