The case for clinical nurse specialists

The CNS consortium includes, front row, from left, Theresa Nowak, Maria Raines, Carolyn Hughes, Sarah Pangarakis, Niloufar Hadidi, Melissa Fritz and Stacy Jepsen. Back row, from left, Beth Keating, Liz Kozub, Mary Fran Tracy and Megan Oldenburg. Not pictured, Ellen Dyer, Wendy Ulferts and Grenellie Walock.

They improve patient outcomes, reduce nurse burnout and save health systems money — yet many nurses have not heard of them. The clinical nurse specialist (CNS) may be health care’s best-kept secret and a growing consortium of leaders from Minnesota health systems and the University of Minnesota is determined to change that.

The versatility of the clinical nurse specialist role — while a significant asset — often complicates a concise definition of its comprehensive professional scope.

At the University of Minnesota, Doctor of Nursing Practice students in the adult/gerontological clinical nurse specialist specialty take a three-credit course with 15 modules dedicated solely to understanding what a CNS does.

“Every module is specific to one function,” says Specialty Coordinator Niloufar Hadidi, PhD, APRN, ACNS-BC, FAHA. “That’s how complex and how impactful the CNS role can be.”

That complexity has left the CNS role widely misunderstood, which is leading to concerns in nursing education and the workforce. 
To address that, representatives from Allina Health, CentraCare, Children’s Minnesota, Essentia Health, HealthPartners, M Health Fairview, North Memorial Health and Ridgeview have joined with the University of Minnesota to form a CNS consortium aimed at promoting the critical role of the CNS and ensuring it remains a cornerstone of Minnesota’s health care delivery.

For many frontline nurses, the hurdle to the CNS career path is simply a lack of awareness. Melissa Fritz, DNP, RN, ACNS-BC, CENP, FAONL, chief nursing officer at Methodist Hospital, recalls her own journey to becoming a CNS.

“I was approached by a CNS at my hospital who asked if I had thought about the role because I was interested in education, quality and research,” says Fritz. “At the time, I really honestly didn’t know what a CNS was.” Today, she’s excited to share with others how dynamic the role can be and explain its three spheres of influence -- patient/family, nurse/nursing practice, and organization/system.

“Many nurses think about the nurse practitioner role because they want to provide direct patient care,” Fritz explains. “What we want to drive home is that a CNS can do that direct care, but you also get to do the programmatic work. Your days are so different. You will never be bored, and you will always be needed.”

A force multiplier for clinical and financial health

While the role may be difficult to define in a single sentence, its impact across a unit or an entire health system is unmistakable. Maria Raines, DNP, APRN, ACNS-BC, CENP, sees CNSs advancing care, advancing practices and advancing policies at M Health Fairview, where she serves as vice president and chief nursing officer.

“A CNS role brings a value to the organization to advance quality and safety and to advance customer experiences,” says Raines. “They are helping us look at where do we have some gaps in practice or where do we have some knowledge and skill gaps.”

The CNS role is also crucial for developing and retaining staff.

“Their role is a secret sauce for empowerment,” says Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer and senior vice president for patient care services at Children’s Minnesota. “They help nurses see themselves as professionals, helping them remain competent and see the value of the nurse in the outcomes they help with for our patients. Any unit that does not have a CNS for an extended period of time, I start to see that confidence and competence start to erode because they don’t have that guide or coach at the unit level.”

Raines agrees. “All the literature shows that having that expert who can help navigate complexity really helps with burnout,” says Raines, who has been a CNS for over 20 years. “The engagement nurses feel when they know they have someone to help them navigate the complexity of their patients is invaluable.”

Academic-practice partnership raises CNS visibility

Minnesota’s CNS consortium was born out of a realization that the future of CNS degree programs couldn’t be taken for granted and that a more intentional, collaborative approach between academia and clinical practice was needed. For Hadidi, the consortium has created an opportunity to bring health systems into the conversation to ensure the program stays vibrant and aligned with health care needs.

“We are really equal partners in this,” Hadidi says. “The academic community and the health system need to partner for the shared interest. This is a workforce issue and a care issue that impacts everybody at every level.”

Among the consortium’s first priorities is raising awareness among frontline nurses, encouraging them to see the CNS track as a viable and rewarding career path. A video is currently being created for use within systems and at nursing conferences. The group also is creating standard position descriptions with similar language and is promoting CNS internship positions within their systems.

“Our goal is to give voice to the importance of this role and the value that our CNSs bring to health care organizations,” says Raines.

National Association of Clinical Nurse Specialists