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A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN), with graduate preparation (earned master's or doctorate) from a program that prepares CNSs. According to the APRN Consensus Model for Regulation (2008), "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 (p. 8) 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." (p. 9). CNSs are clinical experts in a specialized area of nursing practice and in the delivery of evidence-based nursing interventions.
CNSs work with other nurses to advance their nursing practices, improve outcomes, and provide clinical expertise to effect system-wide changes to improve programs of care. CNSs work in specialties that are defined by one of the following categories:
There are three domains of CNS practice, known as the three spheres of influence (NACNS 2004):
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.
Within the three spheres of CNS practice, Sparacino (2005) identified seven core competencies:
Although these core competencies have been described in the literature they are not validated through a review process that is objective and decisive. They are the opinion of some within the profession. A set of core competencies has now been described and validated through a consensus process (2008) that clearly defines the spheres of influence, the synergy model and the competencies as defined by Sparacino (2005). These core competencies are now expected to be used in all educational programs and will be revised in the coming years in order to be maintained as current and reflective of practice.
Historically, in North America, the CNS role developed within the acute care (hospital) setting. Currently, in addition to the traditional acute care setting, CNSs practice in a variety of non-acute care settings.
In the Australian Health System, however, a clinical nurse specialist refers to a promotional position, rather than a qualification.