A clinical nurse specialist (CNS) is an advanced practice nurse, with graduate preparation (earned master's or doctorate) from a program that prepares CNSs. CNSs are clinical experts in the diagnosis and treatment of illness, and the delivery of evidence-based nursing interventions. CNSs work with other nurses to advance their nursing practices and improve outcomes, and provide clinical expertise to effect system-wide changes to improve programs of care. The three domains of CNS practice, known as the three "spheres of influence" are the patient/family, nursing personnel and system/network organization. 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 domains of CNS practice, Sparacinio (2005) identified seven core competencies which are:
- Direct clinical practice includes expertise in advanced assessment, implementing nursing care, and evaluating outcomes.
- Expert coaching and guidance encompasses modeling clinical expertise while helping nurses integrate new evidence into practice. It also means providing education or teaching skills to patients and family.
- Collaboration focuses on multidisciplinary team building.
- Consultation involves reviewing alternative approaches and implementing planned change.
- Research involves interpreting and using research, evaluating practice, and collaborating in research.
- Clinical and professional leadership involves responsibility for innovation and change in the patient care system.
- Ethical decision-making involves influence in negotiating moral dilemmas, allocating resources, directing patient care and access to care.
In the Australian Health System, however, a clinical nurse specialist refers to a promotional position, rather than a qualification.
In the U.S. there is a nationally recognized CNS certification sponsored by the American Nurses Credentialing Center (ANCC) that can be taken once the master's degree is completed.