New Census Findings Highlight Issues Preventing Clinical Nurse Specialists from Ensuring Highest Quality Patient Care


Clinical nurse specialists (CNSs) tend to be concentrated in adult care or gerontology, work in hospitals that have or are seeking magnet status, and are responsible for two or more units in a hospital. These are among the key findings of the first-ever nationwide survey of CNSs, conducted by the National Association of Clinical Nurse Specialists (NACNS). As leaders in health care settings, CNSs provide direct patient care and lead initiatives to improve care and clinical outcomes, and reduce costs.
The survey included questions about CNSs’ employment, education, practice, and demographics. It reveals that the vast majority of CNSs (85 percent) work full-time and two-thirds (66 percent) work in hospital settings. Of those, more than two in five (44 percent) have responsibility across the entire hospital system.
The survey results also reveal issues that need to be addressed to allow CNSs to fully fill their role as advanced practice nurses who provide care to patients and ensure high quality, evidence-based, patient centered-care. Among those issues is prescriptive authority. According to the survey findings, only about a quarter of CNSs are authorized to prescribe medications. That authority is a matter of state law.
“We need to do more to break down barriers to CNSs’ prescriptive authority and allow CNSs to practice to the full extent of their scope of practice,” said NACNS President Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC. “CNSs can provide optimal patient care when they are able to choose to prescribe necessary medications, medical devices and lab studies.”
Another issue highlighted by the survey results is reimbursement. CNSs in independent ambulatory care practice, or who have hospital medical board privileges are able to bill insurance companies directly for their services, rather than through a third party, reducing insurance costs. According to the survey findings, only about one in eight (13 percent) of CNSs bill directly for the services they provide.
The survey also reveals that three in five (60 percent) of CNSs report that an MSN is the highest degree they hold. Roughly 13 percent hold doctorates (either PhDs or Doctor of Nursing Practice (DNP) degrees).
As a group, CNSs spend most of their time providing direct patient care (25 percent), consulting with nurses, staff and others (20 percent), teaching nurses and staff (19 percent) and leading evidence-based practice projects (14 percent).
The online survey was completed by 3,370 nurses who had completed or were enrolled in a CNS education program. It was conducted from June 1 to December 31, 2014. The survey is intended to provide a baseline understanding of the role of the CNS and how they are meeting the health care needs of the nation. NACNS will conduct the survey every two years.