Clinical Nurse Specialists (CNS) became a recognized specialty in the 1950s as the first program was developed to prepare nurses with clinical expertise in psychiatric care. The focus has broadened to include clinical specialization in many areas of nursing. These specialists build on their experience as registered nurses as they share their expertise related to a specific population and health concern.


The Clinical Nurse Specialist (CNS) is one of four advanced practice registered nurse (APRN) roles. CNSs have practiced within the registered nurse (RN) scope of practice for over 50 years with a graduate (or doctorate) degree in nursing and expertise in a specific area of nursing.

The CNS is a clinical expert in a specialty area with a focus on quality and improved patient outcomes. The CNS core competencies or spheres of influence are found within the interacting domains of nurses and nursing practice, patient/family, and organizations and systems. Specialty standards and knowledge guide the CNS practice with outcomes as an integral part of each domain (Fulton, Lyon, & Goudreau, 2010).

The National Association of Clinical Nurse Specialists (NACNS) supports the value of these specialists by identification of these findings:

  • CNSs improved access to wellness and preventive services for people at risk for chronic diseases, such as diabetes and heart failure, through early identification of these individuals;
  • In private practice and as part of health care teams, CNSs implemented interventions that increased recognition of depression and provided effective behavioral health care to reduce depression;
  • CNSs providing prenatal home care improved outcomes for pregnant women at high risk for delivering low birth-weight babies;
  • CNSs effectively promoted self-care for patients with chronic conditions, reducing costs of treating the conditions and readmissions;
  • CNSs successfully led efforts to implement programs that dramatically reduced HACs in acute care settings;
  • CNSs implemented practices in acute care and community-based settings that significantly decreased patients’ length of stay; and
  • CNSs coordinated, implemented and evaluated plans that improved patient care and improved outcomes. (NACNS Board of Director’s Paper on the Cost and Outcomes Associated with the CNS, 2013).


Fulton, J.S., Lyon, B.L., & Goudreau, K.A. (2010). The nature of CNS practice. Foundations of Clinical Nurse Specialist Practice. Springer Publishing Company, NY.

Institutes of Medicine [IOM]. (2010). The future of nursing: Leading change, advancing health. Institute of Medicine. http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx

National Association of Clinical Nurse Specialists [NACNS]. (2013). NACNS Board of Director’s Paper on the Cost and Outcomes Associated with the CNS. http://www.nacns.org/