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A Tool to Guide Clinical Nurse Specialist Orientation, Professional Development, and Evaluation

McNeill, Margaret M., PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, CPAN, NE-BC, NHDP-BC, FAAN; Ahluwalia, Anushree R., MSN, RN, ACNS-BC; Young, Samantha, MS, RN, CCRN, ACNPC, CCNS; Randell, Tania Vucich, MSN, RN, ACCNS-AG; Moore, Denise Ann, PhD, RN-BC, APRN-CNS

doi: 10.1097/NUR.0000000000000424
Feature Article

Purpose/Objectives: Currently, orientation for clinical nurse specialists (CNSs) in the Baltimore region is based on past practices: facility-specific or position-specific. A Chesapeake Bay affiliate work group identified a need to develop a theory-driven, competency-based program and tool to guide orientation and ongoing professional development reflecting the scope of CNS practice.

Description of the Project/Program: The tool incorporates Benner’s concepts of novice-to-expert competence levels, guides progressive development of the CNS, and has relevant assessment metrics that highlight contributions to the patient, nurse, and system.

Outcome: The group developed a comprehensive orientation tool grounded in the spheres of influence and advanced practice competencies and specific, measurable behavioral statements related to competencies from the 2018 National Association of Clinical Nurse Specialists’ draft. This program is adaptable to guide the practice of a CNS in any facility, validate competence, and relate to those with varied experience in the role.

Conclusion: In a method similar to the process for developing nationally recognized educational standards used to develop the competencies, the program was revised based on an iterative, stepwise process. It was distributed to the membership for evaluation and feedback, which was incorporated into the final version.

Author Affiliations: Clinical Nurse Specialist/Nurse Scientist (Dr McNeill), Department of Professional and Clinical Development, Frederick Regional Health System; Masters of Nursing, Adult Health Clinical Nurse Specialist and Health Systems Management and Clinical Education Manager (Ms Ahluwalia), Union Hospital of Cecil County, Baltimore; Clinical Nurse Specialist/Acute Care NP (Ms Young), The Johns Hopkins Hospital, Ellicott City; Clinical Nurse Specialist, Progressive Cardiac Care Unit (Ms Randell), Johns Hopkins Hospital, Glen Burnie; and Professional Development Specialist/Consultant (Dr Moore), Independent Contractor, Carney, Maryland.

Correspondence: Margaret M. McNeill, PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, CPAN, NE-BC, NHDP-BC, FAAN, Department of Professional and Clinical Development, Frederick Regional Health System, 8215 Glendale Dr, Frederick, MD 21702 (

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