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Establishing the Clinical Nurse Specialist Identity by Transforming Structures, Processes, and Outcomes

Sanchez, Kimberly, MSN, RN, CCRN-K, ACCNS-AG; Winnie, Kathrine, DNP, RN, CCRN-K, AGCNS-BC; de Haas-Rowland, Natalie, MSN, RN, CCNS-CCRN-CSC-CMC

doi: 10.1097/NUR.0000000000000438
Feature Article

Purpose: The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes.

Description of Project: The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected.

Outcome: Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities.

Conclusion: The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.

Author Affiliations: Clinical Nurse Specialists, Keck Hospital of USC, Los Angeles, California.

Correspondence: Kimberly Sanchez, MSN, RN, CCRN-K, ACCNS-AG, 630 N Coronado St, Los Angeles, CA 90026 (

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