Interview with a Clinical Nurse Specialist

Who is a CNS and what are some of the roles played by a CNS?

A CNS is a medical practitioner, who provides expertise patient health care services in a specific health care area. The roles of a CNS entails working with other nurses by helping them develop their nursing practice, develop health care services outcomes, and provide clinical expertise for improvement of health care programs. In many cases, a CNS conducts research, manages other clinical nurses, as well as practicing medicine in a specialty defined by population (example, pediatrics or women’s health), type of medical problems (example, wounds and pain), disease (example, diabetes or oncology), settings (example, emergence room or long-term care) or type of care (example, rehabilitation or counseling) (Roberts et al., 2011).    

What are some of the qualifications of a CNS?

A CNS must be a registered nurse, with advanced experience in nursing practice. In addition, a clinical nurse specialist must be a holder of either a master’s degree or a doctorate in nursing program, whereby he/she specializes in one area of health care such as women’s health, children’s health, stem cell research, among other areas. Apart from academic qualifications, a CNS should hold the following core competences as required by the APRN. Every CNS should possess direct clinical practice. That is, he/she should have expertise in implementing nursing care, and conducting advanced evaluation of nursing outcomes. A CNS should also be competent in coaching. Since he/she is responsible of supervising other nursing practitioners, he/she should hold strong coaching skills in order to be able to provide model clinical expertise to other nurses in different health care areas. The role of supervising other nurses requires competency in collaborations. A CNS should be capable of building strong and multi-disciplinary teams in his/her area of specialty.

Due to the leadership role of a CNS, he/she should have the capability of making ethical decisions. This is important in tackling issues such as allocation of resources, directing patients’ care, and solving work-related dilemmas involving nursing practitioners. Besides, a CNS should be able to conduct clinical research, interpret the results of the research, as well as conduct collaborative research with other CNSs in other health care areas. Lastly, a CNS should have good leadership skills to be able to manage and implement planned change in a patient health care system (Sparacino, 2005).

How did you transit to the advanced nursing practice role?

I graduated from the University of California with a bachelors’ degree in nursing science. After that, I started as a pediatrician in one of the public hospitals in the country. I first joined as an intern, then became an assistant pediatrician, and eventually graduated to the position of a pediatrician. While working as a pediatrician, I became involved with the activities of the National Association of Clinical Nurse Specialists. I would attend their seminars and write articles, which I could submit for publishing in their journal. I later went back to the University of California where I advanced my studies by undertaking a masters’ degree in nursing science. I continued working as a pediatrician, although I was involved in a lot of research with a number of children’s health experts from other hospitals. The research helped to broaden my knowledge about children’s health. After eight years of nursing practice as a pediatrician, inclusive of three years of research, I was eventually given the position of clinical nurse specialist in the pediatrics department of the hospital where I work.

What are the success strategies of becoming a CNS?

What I can term as success strategy of becoming a CNS is possession of the required academic qualifications. Academic qualifications are very important because the American Association of Colleges of Nursing (AACN) requires that one must be a holder of a doctorate or at least a masters program in nursing. Therefore, even if one may possess all other qualifications that are required for the role of CNS, one cannot become one, if he/she does not hold a doctorate or masters in a nursing program. Besides, one should specialize in one of the health care areas such as children or women’s health, oncology, or geriatrics. This is to enable one to become a CNS in a given health care area because expertise in specific areas is required to undertake the roles of CNS.

Another success strategy of becoming a CNS is to demonstrate possession of the primary care competencies required for a CNS. These competencies center on health promotion, treatment, disease prevention, and health protection. The American AACN has established these competencies, and all major health care institutions have endorsed them. A practicing nurse can achieve these competences by conducting the primary care role very effectively. That is, effective assessment, evaluation, and documentation of the primary care administered to the patients. Furthermore, a practicing nurse should utilize the knowledge acquired in graduate school to make primary diagnosis, as well as identify complications in different types of illnesses. All this helps a practicing nurse to maintain competency in his/her work.

Collaboration is also another success strategy in achieving the role of CNS (Kefee, 2011). The AACN emphasizes so much on the importance of collaboration in delivery of primary health care. A practicing nurse should collaborate with other health care providers as well as medical practitioners from other healthcare professions. Emphasizes on collaboration is due to the fact that a CNS should be somebody who has ability to form healthy nurse-patient relationships, communicate well with the patients and other nurses, assume democratic approach in decision-making, and undertake patient advocacy effectively. Besides, for one to qualify to become a CNS, one should be a good teacher as well as a leader. This is to help him/her serve the leadership role of a CNS once he/she becomes one.

Ongoing education and research is also a success strategy for a CNS. Once an individual attains his/her master’s degree or doctoral in nursing, he/she should not relax after acquiring a CNS position. For effective execution of the roles of a CNS, one should advance his/her academic knowledge even further, in order to remain relevant in the field. As time goes by, different health conditions emerge and health care systems also changes. Ongoing education is important for effective execution of CNS duties and responsibilities. In addition, ongoing research with other nurses and medical practitioners assists a CNS to gain more experience in his/her field of specialization.

What have you learnt so far about the CNS role?

Since I started practicing as a CNS, I have learnt that good communication is very important for effective delivery of primary health care. As a CNS, I have to conduct well-planned communication with the patients as well as the nurses providing care to the patients. Lack of effective communication can result to misunderstanding between patients and nurses, thus diluting the primary health care goals of a CNS: to promote health, prevent illnesses, administer proper treatment, and protect health. I have also learnt that collaborative research is very important in this field. It helps one to remain updated on the developments taking place in one’s area of specialization, thus being able to execute the CNS roles effectively.

Based on your experience in this field, what are some of the challenges a CNS face in his/her practice?

One of the challenges that we face in our practice is the ‘end-of-life’ issue. Playing a part in ending somebody’s life is a very challenging thing. It is challenging because we have to ensure that whenever we have such cases in our facilities, the nurses follow the right procedure, and the circumstances surrounding such a case are lawful. At times, we have had to deal with patients and patients’ relatives who do not understand the legal implications of the end-of-life consent. Another challenge is refusal of care. Some patients willingly refuse to be administered with the correct health care for their health conditions. It is a challenge because we have to ensure that we fulfill our core mission: promotion of health.

What kind of support do CNSs require in facing these and other challenges in their practice?

The government, in liaison with the medical practitioners’ board should develop a clear policy framework, which provides nurses with clear guidelines about how to handle the end-of-life and refusal to care issues. In addition, CNSs should be provided with additional workforce, to help them administer health care in their areas of specialty more effectively. The health care facilities should be upgraded and equipped with the necessary equipments and apparatus, to enable nurses working with CNSs administer primary care effectively.


The interview has helped me understand more about the roles of a CNS. I have learnt that a CNS must possess good leadership, communication, decision-making, and collaboration skills. These skills are necessary because CNS is not just about managing other nurses working in a given field, but it is also about ensuring that health care is administered effectively. I have also learnt that success strategies in CNS entails ongoing education and research, collaboration with patients, nurses, and other medical practitioners, attaining the necessary academic qualifications  and use of academic knowledge and skills acquired from graduate school.

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