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Clinical Nurse Specialists National Survey

Section Editor(s): Fulton, Janet S. PhD, RN, ACNS-BC, FAAN

doi: 10.1097/

Author Affiliation: School of Nursing, Indiana University, Indianapolis.

The editor reports no conflicts of interest.

Correspondence: Janet S. Fulton, PhD, RN, ACNS-BC, FAAN, School of Nursing, Indiana University, 1111 Middle Dr, Indianapolis, IN 46202 (

Graduate degree–prepared clinical nurse specialists (CNSs) began appearing in the nursing workforce in the mid-1960s in response to a recognized need for clinical nursing expertise to drive nursing practice. Three foundational principles underpinned early CNS programs. One, the programs were clinically focused and distinctly different from programs preparing educators or administrators. Two, specialty content was embedded in graduate education, which included clinical experiences. Three, graduates were prepared to lead and advance nursing practice for specialty populations by serving as clinical experts, consultants, and researchers. You may be a graduate of one of the early CNS programs, or know a CNS who is.

Nursing schools responded to local demands for clinical nursing experts by creating programs for identified target needs. Community employment opportunities reflected CNS programs available at the university and vice versa. For example, communities with comprehensive cancer centers tended to have oncology CNS educational programs and large numbers of oncology CNSs practicing in the community. You may be a CNS prepared in a target specialty practice, or you may know a CNS who was.

Many CNSs were hired by hospitals, and the role became associated with inpatient care, although not exclusively. CNSs specializing in mental health and maternal-child care, for example, often were outpatient based or in community health centers. Some CNSs moved into different roles, such as academic educator, researcher, or administrator. You may be a CNS in a nontraditional setting or a different role, or you may know a CNS who is.

When first offered, professional certification as a CNS was a mark of excellence. Unlike current certification with a focus on entry-level competency, years of practice as a CNS were required for excellence-based certification eligibility. With few exceptions, certification was not required for employment or regulatory recognition. Certification options for specialty practice were (and remain) limited. As a result, uncertified CNSs have been providing excellent expert care for 50+ years. Perhaps you are not certified, or you know CNSs who are not certified.

Now, the Advanced Practice Registered Nurse Consensus Model ( is creating uniformity in the definition of a CNS. According to the model, there are only 6 permissible specialty foci, practice is being regulated by state boards, and these boards are requiring CNSs to have professional certifications. Some long practicing CNSs can be reluctant to identify as a CNS because they don’t fit the new model. Setting aside the new model, there is a large CNS workforce representing a body of expertise for leading nursing into the future. The National Association of Clinical Nurse Specialists (NACNS) is conducting a comprehensive CNS survey, and every CNS needs to participate. Any nurse graduating from a CNS program should complete the survey. Getting an accurate description of the CNS workforce is imperative. The survey is open to CNSs in any specialty, employment setting, current employment role, or certification status and with or without state-level recognition. This survey is the most comprehensive effort ever undertaken to identify the CNS population in the United States.

At a recent workshop, a retired nurse in the audience relayed a story about organizing a mobility safety program in a retirement setting, proving yet again how education shapes our view of the world. Once a nurse, always a nurse, and any nurse ever educated as a CNS still sees the world through the CNS practice frame. Even those who graduated in the 1960s! If you are a CNS, please complete the NACNS CNS survey and recruit CNS colleagues to do the same. All CNSs need to be represented in the database.

The survey link may be accessed directly at or from the NACNS Web site at The survey will remain open until December 31, 2014. Survey results will appear later in 2015 in this journal. Complete the survey if you are a CNS, and spread the word to everyone who is.

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