The Macmillan Pan-London Clinical Nurse Specialist (CNS) Development Lead (CDL) Pilot is a 3-year initiative designed to address workforce challenges in cancer nursing, including recruitment, retention and professional development. By embedding CDLs across London's five cancer alliances, the programme aims to enhance CNS career pathways and align with the national Aspirant Cancer Career and Education Development Programme (ACCEND) framework. The pilot responds to workforce pressures highlighted in the 2019 London Lead Cancer Nurse Forum report, which identified high vacancy rates, an ageing workforce, and the need for structured career progression. CDLs play a crucial role in supporting early-career CNSs, providing mentorship, fostering leadership skills, and ensuring standardised development opportunities. Early findings suggest that this model strengthens workforce sustainability, enhances CNS retention, and contributes to improved patient outcomes. However, logistical challenges, including geographical constraints, IT infrastructure limitations, and the need for long-term funding, must be addressed to ensure sustainability. The CDL pilot underscores the importance of strategic investment in CNS workforce development to safeguard high-quality, patient-centred cancer care. Lessons from this initiative may inform broader workforce planning strategies within oncology nursing across the UK.
Population aging and increasing disease complexity have increased the demand for specialized care provided by clinical nurse specialists (CNSs). However, Taiwan still lacks a comprehensive institutional framework, highlighting an urgent need to establish a structured CNS system to enhance the quality of care. This study was designed to develop a CNS system to strengthen the nursing profession and improve the overall quality of healthcare delivery. A mixed-methods approach combining a literature review, the modified Delphi technique, focus group interviews, and expert consensus forums was used to develop a locally adapted CNS framework for Taiwan. The CNS framework was developed through a rigorous and systematic process. Initially, three rounds of expert focus group discussions were conducted to identify core components and inform the development of a structured questionnaire. Subsequently, 30 expert panelists participated in two rounds of Delphi surveys to evaluate and refine the proposed framework. The finalized framework comprised 19 articles organized into six chapters and demonstrated a high level of consensus, with convergence rates of 94.0%-94.3% for feasibility and 93.6%-95.8% for appropriateness. The resulting CNS system structure consists of: general principles (3 articles), appointment (6 articles), core competencies and responsibilities (4 articles), selection (2 articles), continuing education (2 articles), and performance evaluation (2 articles). The CNS system developed in this study contributes substantively to expanding nursing roles and enhancing care quality in Taiwan. Future implementation should focus on strengthening interprofessional support to improve system feasibility in practice. Also, an appropriately funded and supported CNS certification system should be established. Finally, CNS contents must be incorporated into graduate-level nursing education to ensure the quality of CNS practice. 建構台灣臨床護理專家制度—混合研究法. 因應人口老化與疾病複雜化，臨床護理專家（clinical nurse specialists, CNS）的專業照護需求日益增加，然而台灣尚缺乏完整制度架構，亟需建構CNS制度以提升照護品質。. 建構臨床護理專家制度，以強化護理專業能量，進而提升醫療照護品質。. 採混合研究法，以國內外相關文獻探討、專家焦點團體訪談、修正式德菲法與全國產官學界共識論壇，初步建構具台灣本土特色的CNS制度。. 透過三回合專家焦點團體座談完成的結構式問卷，並由30位Delphi專家學者進行兩回合填答。六章19項條文之可行性與合適性收斂度分別為94%−94.3%與93.6%−95.8%，顯示專家意見高度一致。最終CNS制度架構包含：總則（3條）、任用（6條）、核心能力與工作職責（4條）、甄選（2條）、繼續教育（2條）及工作評核（2條）。. 本研究建構之CNS制度，有助於拓展護理專業角色並提升照護品質，對台灣護理發展具重要意義。未來推動應強化醫護團隊支持，以提升制度可行性，並建議政府推動法制化認證與資源配置。同時，落實碩士教育培育，以確保CNS實踐品質。.
Clinical nurse specialists (CNSs) are pivotal in advancing patient outcomes, guiding evidence-based practice, and leading system-level improvements. Recognition and awards programs play an important role in elevating CNS visibility, strengthening professional identity, and celebrating excellence in advanced practice nursing. This article explores how recognition initiatives contribute to professional growth, leadership, and engagement among CNSs. Drawing on the author's experience as Chair of the National Association of Clinical Nurse Specialists (NACNS) Awards Committee, published exemplars of recognition in nursing, and organizational trends, this article synthesizes effective approaches for celebrating excellence and sustaining participation within the CNS community. Recognition serves as a catalyst for engagement and innovation by highlighting CNS achievements that exemplify leadership, mentorship, and quality improvement. Trends from the NACNS Awards Program demonstrate increasing participation and diversification of award categories, reflecting the expanding scope and influence of CNS practice. Structured recognition validates the impact of CNSs, fosters professional pride, and inspires the next generation of clinical leaders. By maintaining rigor and integrity in award processes, professional organizations like NACNS ensure that recognition remains a meaningful lever for advancing the visibility, credibility, and sustained growth of the CNS role.
The purpose of this paper is to argue that clinical nurse specialist (CNS) education represents the most conceptually and professionally continuous advanced practice pathway for critical care transport nurses, and to highlight transport nursing as an underrecognized practice context that aligns closely with CNS competencies and warrants deliberate attention from CNS educators and programs. This paper presents a conceptual analysis of transport nursing through the CNS spheres of influence, emphasizing continuity with bedside nursing expertise while extending into quality improvement and systems leadership. This perspective examines how transport nurses routinely navigate high-acuity clinical cases and interfacility system constraints. These encounters frequently reveal latent system vulnerabilities rife for systems improvement. It positions transport nursing practice as inherently CNS-aligned, particularly in its integration of clinical expertise with systems-level awareness. CNS preparation would uniquely support the advancement of transport nurses' practice by preserving a nursing-centered clinical identity while providing the analytic and leadership skills necessary to translate bedside insights into durable system improvements. Concurrently, it argues that transport nurses are particularly well-prepared candidates for CNS education. Recognizing the reciprocal alignment between transport nursing and CNS education strengthens this advanced practice pathway, expands the CNS pipeline, and reinforces nursing-driven care delivery.
Background/Objectives: Japan introduced a certification system for Advanced Practice Nursing Workforce (APNW) in 1996. The Japanese Nursing Association formally certified two types of the APNW: Certified Nurses (CNs) and Certified Nurse Specialists (CNSs). Little is known about the geographic distribution of CNs and CNSs. Methods: We conducted an ecological panel analysis using prefecture-level data from 1996 to 2022. To assess the degree of inequality of CN and CNS among prefectures, we calculated the Gini overall coefficients, as well as those by categories of CN and CNS, number of hospitals, number of hospital doctors, and hospital nurses. Using data available from 2000 to 2017, we examined factors associated with CN and CNS density through fixed-effects panel data analyses of log-transformed overall and category-specific densities. Results: During the study period, the number of CNs and CNSs consistently increased, and geographic disparities in their distribution decreased until around 2010. After 2010, however, geographic disparities in prefectures with persistently low CN and CNS densities persisted without significant change. For overall CN and CNS density, significant associations were observed with population aging, per capita income, hospital density, hospital doctor density, hospital nurse density, and study year, whereas hospital nurse wages showed a positive but not statistically significant association. When stratified by clinical category, the directions of associations for several regional factors varied; however, hospital nurse density and hospital nurse wages tended to be positively associated with CN and CNS density in most categories. Conclusions: This study highlighted the need for targeted strategies to increase CN and CNS numbers specifically in prefectures with persistently low densities, tailored to each clinical category.
To assess public awareness, perceptions, and educational intentions regarding Clinical Nurse Specialist (CNS) and Physician Associate (PA) roles in Israel, and to identify predictors of interest in these career pathways. Amid physician shortages, countries are promoting advanced roles such as CNSs and PAs to strengthen healthcare capacity. In Israel, both roles are relatively new and underrecognized. A cross-sectional survey of 200 adults in Israel used descriptive statistics to assess familiarity and interest in CNS and PA roles. Two multiple linear regression models identified predictors of interest in pursuing each role's educational pathway. Awareness of advanced roles was limited: 25.5% and 21% reported familiarity with CNSs and PAs, respectively. Despite this, 26.5% expressed interest in the CNS pathway and 17% in the PA pathway. Women were more likely to favor the CNS role; men showed greater interest in the PA role. Self-efficacy, career motivation, and gender predicted CNS interest (R2 = 0.332). PA interest was predicted by academic background and gender (R2 = 0.256), but not by self-efficacy or motivation. These findings highlight the need to clarify role definitions, address gendered perceptions, and implement targeted outreach. Differences in predictors suggest that CNS and PA roles appeal to distinct motivational and cognitive profiles. Despite low awareness, there is substantial public interest in CNS and PA roles. Tailored educational and communication strategies are needed to increase understanding and engagement. Nurses should use clinical encounters to explain CNS and PA roles and build trust. Policymakers should support awareness campaigns, training incentives, and curricular integration to promote role legitimacy and address global workforce challenges.
The Clinical Nurse Specialist (CNS) represents a critical advanced practice nursing role, yet educational institutions face significant challenges in providing effective clinical experiences for CNS students. Unlike other advanced practice nursing roles, CNS precepting involves unique complexities related to specialty requirements, geographic limitations, and evolving financial pressures. To address the gap in CNS-specific precepting guidance by synthesizing existing evidence and providing practical recommendations for effective preceptor-student partnerships in CNS education. Drawing from available literature on advanced practice nursing precepting, adult learning theory, and clinical education best practices, this discussion paper presents a collaborative framework specifically tailored for CNS student precepting. Effective CNS precepting requires clearly defined roles for both preceptors and students, institutional support systems, and structured partnership strategies that acknowledge the unique transition from expert RN to novice APRN. Educational institutions, preceptors, and students must work collaboratively to create sustainable, high-quality clinical learning experiences that prepare the next generation of CNS providers while addressing current challenges in clinical education.
Preventable adverse events remain a significant challenge in US health care systems despite decades of patient safety initiatives. Hospital-acquired conditions such as falls, infections, and pressure injuries contribute to patient morbidity, mortality, and the cost of care. Clinical Nurse Specialists (CNSs) play a critical role in translating evidence into practice and implementing system-level strategies that reduce preventable harm. The purpose of this paper is to highlight how CNSs identify risks for preventable adverse events and lead evidence-based prevention strategies at both the clinical practice and systems levels to improve patient safety, enhance care quality, reduce costs, and align with organizational priorities. This paper synthesizes current evidence on preventable adverse events and examines CNS-led prevention strategies using 3 illustrative examples: falls reduction initiatives, standardized oral care protocols to prevent non-ventilator hospital-acquired pneumonia (NVHAP), and the use of in-bed mobility systems to reduce hospital-acquired pressure injuries (HAPIs). The discussion highlights the CNS role in identifying practice gaps, evaluating evidence, selecting appropriate technologies and clinical products, implementing standardized protocols, educating staff, and monitoring outcomes. Evidence demonstrates that structured, evidence-based nursing interventions can significantly reduce preventable adverse events. A CNS-led protocol on falls prevention reduced patient falls and generated an estimated $353,808 to $859,950 in cost avoidance. Standardized oral care protocols have been associated with reductions in NVHAP incidence. Similarly, implementation of in-bed mobility systems has been associated with reductions in HAPI rates, improved compliance with repositioning protocols, and reduced staff musculoskeletal injuries. CNS-led initiatives support consistent implementation of these interventions through education, competency validation, data monitoring, and interprofessional collaboration. CNSs serve as essential clinical and systems leaders in advancing patient safety through evidence-based prevention strategies. By supporting fundamental care practices and integrating evidence-based technologies into care processes, CNSs help reduce preventable adverse events while improving patient outcomes and supporting cost-effective health care delivery. Investing in prevention and CNS-led safety initiatives can shift health care systems from reactive management of complications to proactive, sustainable models of patient safety.
Adenocarcinoma of the pancreas (PANC) is an aggressive and often incurable cancer, associated with disease-related symptoms and poor outcomes. A comprehensive approach to care, including a focus on symptom management and quality of life, is essential. Introducing a palliative care approach early in the cancer journey improves survival and quality of life and decreases healthcare costs. However, barriers exist to providing early palliative care. This study is aimed at assessing the acceptability and impact of a novel clinical nurse specialist (CNS)-led early palliative care initiative on quality of care for patients with PANC. Patients with PANC in the pre- and post-CNS eras were identified using the Manitoba Cancer Registry and CNS clinical database. Acceptability of the CNS initiative was measured by capturing those who agreed to CNS consultation. Quality measures included the proportion enrolled in a community-based palliative care program early (within 8 weeks of diagnosis) and late (within 2 weeks of death). Descriptive statistics were used. Chi-square tests were used to test for significance between the two eras. The CNS model was acceptable, with 93.3% of patients accepting consultation. There were fewer late referrals to community palliative care programs with the involvement of a CNS (p = 0.02) and a trend towards more early referrals (p = 0.07), suggesting an improvement in quality of care. After CNS consultation, 33% of patients declined either a diagnostic biopsy, medical oncology consultation, or both, facilitating decisions in line with patient goals of care. The CNS-led model for PANC was acceptable to patients and associated with timely referral to community-based palliative care. This model provides an opportunity to address patient goals of care early and decrease unwanted procedures and consultations.
This article describes the work of the 2023 National Association of Clinical Nurse Specialists (NACNS) Pain Management Task Force in reviewing and updating the work of the 2018 Pain Management Task Force on pain management practices in clinical nurse specialist (CNS) practice. Convened in 2023, the Pain Management Task Force members collaborated to review and update the prior work to reflect current evidence and standards across the settings and populations served by CNS practice. The 2023 Task Force updated and revised the 3 prior NACNS position statements about pain practices through updated evidence review and with member feedback into 2 consolidated Position Statements. Updated recommendations and discussion around incorporating evidence-based pain management strategies across the CNS spheres of impact are described. Improving pain management is achieved through patient, nurse, and organizational level interventions to offer comprehensive and patient-centered care targeted at mitigating disparities. The CNS is uniquely qualified to develop, implement, and monitor the efficacy of pain management programs and improve care of pain across all populations and settings.
The National Association of Clinical Nurse Specialists (NACNS) developed a comprehensive toolkit for implementing "Grow your Own" Clinical Nurse Specialist (CNS) programs. The toolkit addresses the critical shortage of CNSs by providing healthcare leaders with practical resources for internal talent development. Implementation examples demonstrate significant returns on investment through cost avoidance and quality improvements. The guide offers a sustainable solution for healthcare organizations facing CNS recruitment challenges while promoting professional advancement opportunities.
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability. A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation. Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August-December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs. Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of "success by design" was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies. Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap. Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce. We have adhered to COREQ reporting guidelines (See supplemental file). This study did not include patient or public involvement in its design, conduct, or reporting.
The purpose of this paper is to show how a critical care clinical nurse specialist (CNS) with prescriptive authority can address immediate patient needs, drive quality improvement, and improve population health outcomes. A review of the current legislative landscape suggests that CNS practice could be enhanced by adding prescriptive authority for the purposes of improving patient, nurse, and system outcomes. Though 41 states support CNS prescribing, many factors may hinder its implementation. By examining the values of a CNS authorized to prescribe in their healthcare organization with real-time reflections (scenarios), the ability to enhance direct patient care, reduce delays, and foster nurse engagement is revealed. CNSs who elect to obtain prescriptive privileges may have opportunities to improve patient services and outcomes.
In 2022, updated strategies to reduce ventilator-associated pneumonia (VAP) were published that no longer recommend the routine use of chlorhexidine oral care in mechanically ventilated adult patients. The lack of evidence to support positive impact on patient outcomes prompted Clinical Nurse Specialists to lead a de-implementation initiative to align standard practice with the latest evidence-based literature. The CNSs led a multidisciplinary team including pharmacy, infection prevention, supply chain, physicians, and nursing informatics to revise VAP protocols, update critical care order sets, and implement a new oral care kit without chlorhexidine. The initiative was guided by the PDSA framework and de-implementation strategies. Outcome metrics were collected over the next 15 months to include infection rates and financial impact. Ventilator adverse events (VAE) decreased by 27.8%, with infection rates steadily declining by 6.45% per quarter. The standard infection rate also decreased by 19.7% after de-implementation. Financial spending and usage data over the last 15 months indicated a direct cost avoidance of $125,000 if? chlorhexidine oral care kits continued to be used. The de-implementation successfully eliminated a low-value, non-evidence-based nursing task, while reducing infection rates and generating cost savings for the organization. This highlights the pivotal role of the CNS in evaluating nursing practices to ensure they are grounded in current evidence rather than historic precedent.
Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge for stroke, is not well described although it is well established in other models of after-hospital and outreach specialist care in the community. In this scoping review we explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions in a community setting. The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions in a community setting. Scoping review of the available literature and narrative synthesis. A narrative scoping literature review was conducted in accordance with the five-stage process of Arksey and O'Malley (2005) and the PRISMA-ScR guidelines. The following databases were searched: Cochrane Central Register of Controlled Trials and systematic literature searches, MEDLINE, EMBASE, CINAHL, Google Scholar, and grey literature. Search terms included stroke, stroke rehabilitation, community nursing, early supported discharge. A total of 2531 references were identified. Following the removal of duplicates (838), and checking each article for suitability, 2507 articles were excluded, and 24 articles were included in this scoping review. Six key themes emerged from the data collection: (1) Absence of Nursing Role following Hospital Discharge; (2) Stroke Nursing in Secondary Prevention and Management of Risk Factors (Modifiable and Non-Modifiable); (3) Role of the Stroke Nurse in Secondary Prevention- Blood Pressure Management; (4) Role of the Stroke Nursing following Discharge Home; (5) Telephone Specific Interventions; (6) Blended Model- Telephone Calls and Home Visits. A narrative synthesis of these themes was conducted. Nurses working in stroke care are key health educators in stroke programme prevention implementation. Stroke nurses specialising in the unique challenges and needs of stroke patients play an essential role in educating this population in the community. Stroke nurses as part of early supported discharge have expert knowledge and the opportunity to educate patients in the community to reduce their overall risk of having further strokes and improve their overall health. This scoping review protocol was registered in Open Science Framework on 5th April 2023. https://doi.org/10.17605/OSF.IO/UCZ6R and published in HRB Open on 8th January 2024 https://doi.org/10.12688/hrbopenres.13818.1.
This study aimed to evaluate the differences in elective total joint replacement (TJR) orthopedic patients receiving discharge instructions from a Virtual Nurse Visit (VNV) compared to a bedside nurse. A descriptive, cross-sectional, and quasi-experimental design with a nonequivalent control group was utilized, using a convenience sample of elective TJR patients. A total of 111 participants were included in the study, with 40% (n=44) receiving discharge instructions from virtual nurses and 60% (n=67) receiving instructions from bedside nurses. The average age of participants was 65 years old, with those receiving discharge instructions from virtual nurses averaging 63 years and receiving instructions from bedside nurses averaging 66 years. Mean satisfaction score for virtual nurses was slightly higher (M = 4.88, SD = 0.41) compared to bedside nurses (M = 4.55, SD = 0.81), with a moderate effect size (Cohen's d = 0.39). No statistically significant differences were found in overall patient satisfaction between virtual nurses and bedside nurses providing discharge instructions (t (49) = 1.28, p = .205) indicating that both modes of instructions provided to patients were sufficient. Less than 1% of patients experienced a post-discharge 30-day ED visit, with no significant differences between groups receiving discharge instructions from virtual nurses or bedside nurses. Virtual nurses are a valuable addition to the healthcare team, enhancing patient satisfaction and optimizing nursing workflows during critical transitions of care. The consistency in satisfaction across demographic groups indicates that virtual nursing may offer an equitable approach to discharge education delivery.
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