Different Roles of Clinical Nurses


Clinical nurse specialists (CNSs) are often asked to explain what it is that they do-even by nurses. As compared with a nurse practitioner who takes care of patients (easy to understand), a primary focus of a CNS is to take care of the nurses so they can take care of patients safely and efficiently using the best evidence available.

The major focus of the CNS’s role is to make sure that the stretcher-side nurses have the knowledge, skills, processes, policies, supplies, and equipment they need to provide safe and effective patient care.

Advanced practice nursing role

The National Association of Clinical Nurse Specialists (NACNS) defines a CNS as an RN with graduate education as a CNS in a specialized area of nursing practice. The clinical component cannot be underestimated because “Clinical expertise in a specialty is the essence of CNS practice”

Sometimes it is easier to describe what a CNS does not do: hiring, firing, disciplinary actions, scheduling, budgeting, and payroll are some key areas outside of the traditional CNS roles and responsibilities. However, the CNS often has input into hiring, firing, and disciplinary actions if clinical care is an issue.

Traditionally, the CNS role has been described as having four major components: expert clinician, educator, researcher, and consultant. Leader is one of the sub roles; however, leadership qualities are really an overarching attribute that enables the actualization of the other roles. In addition, the spheres of influence in which CNSs practice have been identified as patient, nurse/nursing practice, and organization/system.

Clinical nurse specialists provide direct patient care, serve as expert consultants for nursing staff and take an active role in improving health care delivery systems. Clinical nurse specialists often work in management positions and may also develop or work with a team to develop policies and procedures.

Clinical nurse specialists may also work with research—translating research findings into patient care, evaluating research proposals, overseeing design of evidence-based practice studies, applying research results to practice, or coming up with new evidence-based standards and protocols.

Education is a major role for the CNS, as they provide varying levels of instruction to diverse groups, such as patients, staff, family and caregivers, students and colleagues. The increased amount and availability of healthcare information from newspapers, websites and medical clubs often leaves patients confused and in fear. The CNS can educate clients and direct them towards relevant information, which fosters a sense of empowerment over their own healthcare and that of their families.

The role of collaborator is like the role of consultant, in that it classifies the CNS as a resource for staff and patients for knowledge concerning not only health/disease-related problems, but also for the promotion and maintenance of overall health.

Changes in health care delivery occur at a furious pace and CNSs are the masters of implementing change. These changes include the introduction of evidence-based practices and more effective and efficient ways to deliver safe care. The work of a CNS is collaboration in action-multidisciplinary and multispecialty teams are convened to address clinical care issues. They keep the emergency nurses of today current with changes in practice and help prepare the emergency nurses of tomorrow. An effective CNS can be a key factor in nurse satisfaction, which helps with both recruitment and retention of qualified emergency nurses, which saves money that would be spent for recruitment and orientation. More satisfied nurses may lead to more satisfaction among patients and that can result in increased patient volumes and reimbursement.

Future of CNS

The CNS is uniquely prepared to be the trans professional collaborator, change agent, EBP integrator, and patient/client outcomes driver who will ensure safety and quality outcomes for patients now and into the future. CNSs can only do that through recognition of their practice, acknowledgement of the educational standards they must meet, certification as a mark of excellence, and most importantly, through title protection and a defined and unique scope of practice that ensures public access to appropriately trained and qualified CNSs.

The future is bright for the CNS as their role is increasingly recognized and valued, and their goal of optimal patient/client outcomes in all settings is an imperative that will guide the CNS well into the future.