Who Is A Clinical Nurse Specialist

Clinical Nurse Specialist (CNS) is a registered nurse who holds a master’s or doctoral degree in nursing with expertise in a clinical nursing speciality; uses in-depth knowledge and skills, advanced judgement and clinical experience in a nursing speciality to assist in providing solutions for complex health care issues (CNA, 2008). This is an era of revolution; the field of nursing is not an exception to face the evolution of new nursing roles. As the nurse achieves greater knowledge, educational qualifications and experience which, brought in advanced practices in nursing, Clinical Nurse Specialist role was born silently. The Clinical Nurse Specialist role was introduced to the Canadian health care system in the early 1970’s (RNAO, 2012).

What Education and Training is needed to become a Clinical Research Specialist?

The CNS must have in-depth knowledge of nursing science and fine skills along with clinical judgement. Hence, only baccalaureate degree in Nursing is not enough. To become a CNS, one should have a master of nursing degree in any speciality. Since the CNS role is an advanced practice role, a master of science in nursing degree or PhD is required. There is a national initiative to move the preparation of all advanced practice nurses to the Doctorate in Nursing Practice. Society for Clinical Nurse Specialist Education. (2013).

What Role the Clinical Nurse specialist plays?

The CNS Assesses the client, plan interventions, implement. She evaluates patients, nursing personnel, and organization/network domains. She helps RN and RPN in dealing complex cases. She also provides support to nursing staff members, consulting, participating in multidisciplinary activities, designing and evaluating programs of care, and working on projects at the unit, department, division, institution, or network levels (Society for clinical nurse specialist education, 2013). Canadian Nurses Association recognises that CNS, employers, educational institutions, nursing associations and regulatory bodies and governments share the responsibility to further integrate the CNS role into the health care system (Canadian Nurses Association, 2009).

Clinician Role

An in-depth knowledge and skills are necessary to provide expert client centered nursing care. The CNS should also have thorough understanding of other sciences too. For example, anatomy, physiology, microbiology, pathology. The CNS deals with complex health care scenarios and provides high standard care within her clinical speciality (college of registered nurses of Nova Scotia, 2008).

Consultant Role

ARNLL (2007) describes that the advanced knowledge, skills and judgement help the CNS a lot in dealing with challenging and diplomatic situations. She provides consultations to clients, nurses, other health care providers, health care organizations and policy makers.

Educator Role

The CNS promotes learning environment for clients, their families, nurses, students, and other health care professionals. She also helps RN and RPN in direct patient care by providing clinical teaching, promoting evidenced based practice, and providing resources that will meet nurse’s learning needs (ARNLL, 2007).

Researcher Role

Nursing research helps to strengthen the evidence based practice and to re-polish body of knowledge, and also to improve nursing skills.by facilitating the understanding and application of research, the nurse strengthens the link between research and clinical practice. (RNAO, 2012)

Leadership Role

This is an important role the Clinical Nurse Specialist must play efficiently. The CNS provides clinical leadership by acting as a resource, facilitator, coordinator, role model and advocate. She provides an important clinical leadership role for the nursing profession and broader healthcare system; yet the prominence and deployment of this role have fluctuated in Canada over the past 40 years” (Lucosius et al., 2010, p. 141).

Place of Employment

Most of the CNS works in various settings of hospitals and clinics according to their field of experience and education. More critical patients are dealt by the CNS along with RN/RPN. For example, Cardiac care Unit, Neonatal Intensive Care Unit, Palliative Care Unit, Pediatric ICU, surgical unit etc.


As the clinical nurse specialist is a well-educated and higher responsible position, the CNS has been paid in bulk across Canada. In Ontario, the importance of CNS in the nursing field has been well recognized; the remuneration varies from hospital to hospital. An average salary of $110,278.41 paid annually in Ontario (Public Sector Salary Disclosure, 2011).

Collaboration within the Nursing Team

The Clinical Nurse Specialist works along with the members of nursing team such as Registered Nurse, Registered Practical Nurse, Nurse Practitioner, Personal Support Worker etc. The CNS helps other nurses to solve complex scenarios in the practice setting. She educates the new staffs and provide guidance whenever required. The CNS also takes management role to assign patients and to manage the Nurse-Patient ratio. She provides support to nursing staff members, consulting, participating in multidisciplinary activities, designing and evaluating programs of care, and working on projects at the unit, department, division, institution, or network levels (Society for clinical nurse specialist education, 2013).

Value and Contribution of Clinical Nurse Specialists to Client-Centered Care.

The core of Nursing is patient care; hence the CNS participates vigorously in giving nursing care to patient. The CNS provides Client centred care which involves advocacy, empowerment, and respecting the client’s autonomy, voice, self-determination, and participation in decision-making. She utilizes her special knowledge to give comprehensive care to critically ill patients who needs more care. Figure 1 (Fulton, 2010) shows the clinical nurse specialist practice Conceptualized as core competencies in three interacting Spheres Speciality Practice

Patient/ Client

Organizations &


Nurses &

Nursing Practice

Speciality Skills/ Competencies

Speciality Standards of Practice

Speciality Knowledge

actualized in speciality practice and guided by speciality knowledge and speciality standards.

Figure 1. Core CNS practice competencies

Services provided by CNS to promote health and improve quality of life.

Advances practice of nursing by implementing innovative alternative solutions that address complex system problems and/or patient care issues. She serves as clinical expert in the delivery of perioperative patient care. Assists with the provision of surgical and medical care in accordance with facility, state, and federal regulations. She integrates research into the perioperative clinical environment through the implementation of evidence-based practice. She also develops, coordinates, implements and evaluates educational programs for perioperative patients and their families, staff, and the community. As part of a multi-disciplinary team, acts as a change agent to develop system performance standards to improve perioperative patient outcomes (CCI, 2012)

Regulated Health Profession

What is a self-regulating profession?

According to the Office of the Fairness Commissioner’s (OFC) website, as of 2010, there are 40 regulatory bodies in Ontario that share the following characteristics: The authority of the regulatory body comes from an Ontario statute. Professionals need the authority of the regulatory body to practise their profession in Ontario, to use a professional designation, or both (ORAC, 2013). Professional self‐regulation is the regulation of a profession by its members. This primary purpose of professional self-regulation is protection of the public from harm. Professional self‐regulation is characterized by professional conduct and competence, fairness, transparency, accountability and public participation. In professional self‐regulation, the regulatory body is accountable for ensuring members are competent and act in the public interest in providing the services that society has entrusted to them. Individual members are personally accountable for their practice through adherence to codes and standards and maintaining competence and conduct (SRNA, 2007).

What is the purpose of Registration?

The primary purpose of registration with a regulatory body is protection of the public from harm by enforcing the nursing standards and regulations. If the nurses are left free to practice without any rules and regulations, it might adversely affect the public. The regulatory body assesses nurse’s education, knowledge and competencies before giving license to practice. It also monitors for right conduct and behaviour of the registered nurses and registered practical nurses.

Why is Regulation important in health care?

Professional regulation for any profession is important to boost the positive health outcomes. The regulatory bodies such as College of Nurses of Ontario, regulates professional conduct and competence. The regulatory body ensures that all nurses applying for registration are qualified, competent and ethically sound. Adherence to the principles of fairness, transparency, accountability and public participation build public confidence and trust and ensure that the work of the profession is in the public interest. Public representation and open communication are key public accountability mechanisms (SRNA, 2007).

What are the Standards of Practice are and their purpose in self-regulation?

Standards of practice are the outline given by the regulatory body which contributes to the protection of public. They inform nurses of their accountabilities and the public of what to expect of nurses. These standards apply to all nurses regardless of their role, job description or area of practice. Practice guidelines help nurses understand their responsibilities, and to make safe and effective decisions in their nursing practice. (CNO, 2009)


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