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Widening Our Lens for a More Global Perspective

Fulton, Janet, S., PhD, RN, ACNS-BC, ANEF, FAAN

doi: 10.1097/NUR.0000000000000379

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

The editor reports no conflicts of interest.

Correspondence: Janet S. Fulton, PhD, RN, ACNS-BC, ANEF, FAAN, School of Nursing, Indiana University, 600 Barnhill Dr, Indianapolis, IN 46033 (

Increasingly, the journal is receiving manuscripts from across the world. Last year, in addition to the United States, manuscripts were submitted from Australia, Brazil, Canada, China, Egypt, Finland, India, Iran, Iraq, Italy, Japan, Jordan, Korea, Lithuania, Poland, Saudi Arabia, Turkey, and the United Kingdom. Diverse in topics and cultures, these manuscripts lend both depth and breadth to our understanding of advanced practice nursing in general, and the clinical nurse specialist (CNS) role in particular. The journal appreciates the extra effort required to prepare and submit a manuscript when English is a second language. Here are a few tips to help authors, especially international authors, increase chances for successful publication in this journal.

Make sure the manuscript addresses the purpose and objectives of the journal. These are printed in the journal and can be found on the journal’s Web site at Briefly, the journal’s purpose is to disseminate outcomes of CNS practice, to foster continued development of the CNS role, and to highlight CNS contributions to advancing nursing practice and health policy globally. Successful manuscripts advance nursing practice by offering topics such as research-based new knowledge and understanding, innovative approaches to care delivery, groundbreaking educational strategies, application of evidence for improved outcomes, and policy initiatives for practice regulation and population health. These topics either are about CNS practice or inform CNS practice. In other words, the manuscripts provide readers, who are CNSs in practice and CNS educators, with timely information relative to the CNS role. A common reason for rejection of a manuscript is failure to address specialty nursing practiced at an advanced level, which is the hallmark of the CNS role.

Authors can help readers understand the context of the CNS role in the home country by briefly describing the role, educational preparation, and scope of practice. Some countries recognize an advanced specialty practice role but may not regulate the use of the title CNS. Advanced educational requirements differ based on the educational system and standards in individual countries. Such are challenges in writing for a global audience. To assist authors in determining manuscript preparation, the journal has developed a definition of the CNS for use in determining the appropriateness of the manuscript for the journal.

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What Is a CNS?

The CNS scope of practice extends beyond the generalist nurse in terms of expertise, role functions, mastery, and accountability and reflects a core body of nursing and health knowledge. Clinical nurse specialists evaluate disease patterns, technological advances, environmental conditions, and political influences and interpret for nurses and others our professional responsibility to serve the public’s need for nursing services (nursing’s social mandate). Clinical nurse specialists function as expert clinicians, leading the advancement of nursing practice through teaching, mentoring, consulting, and ensuring nursing practice is evidence based.

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What Are CNS Practice Characteristics and Competencies?

The following characteristics and competencies, in varying combination, delineate the CNS role and practice.

  • Clinical nurse specialists are professional nurses with a graduate level preparation (master’s or doctoral degree).
  • CNSs are expert clinicians providing direct clinical care in a specialized area of nursing practice. Specialty practice may be defined by population (e.g. pediatrics, geriatrics, women’s health); clinical setting (e.g. critical care, emergency); a disease/medical subspecialty (e.g. oncology, diabetes); type of care (psychiatric, rehabilitation); or type of problem (e.g. pain, wound, incontinence).
  • Clinical practice for a specialty population includes health promotion, risk reduction, and management of symptoms, and functional problems related to disease and illness.
  • Clinical nurse specialists provide direct care to patients and families, which may include diagnosis and treatment of disease.
  • Clinical nurse specialists practice patient-/family-centered care that emphasizes wellness and strengths over disease and deficits.
  • Clinical nurse specialists influence nursing practice outcomes by leading and supporting nurses to provide scientifically grounded, evidence-based care.
  • Clinical nurse specialists implement improvements in the healthcare delivery system and translate high-quality research evidence into clinical practice to improve clinical and fiscal outcomes.
  • Clinical nurse specialists design, implement, and evaluate programs of care and programs of research that address common problems for specialty populations.
  • Clinical nurse specialists practice in a wide variety of healthcare settings, such as hospitals, community clinics, schools, mental health facilities, and occupational health clinics, to name a few.

This information will be posted on the journal’s Web site for future reference (

At its core, the CNS role is about advancing nursing practice. Regardless of how nursing is practiced, whatever the setting, population, or politics, the CNS role is the advanced role in the nursing profession that leads nursing practice for all nurses to follow and all patients to benefit. For this reason, the CNS role can be easily interpreted into different countries and cultures. Regardless of country, nurses need clinical leadership and support, and nursing practice needs continual innovation and evidence-based improvement. It is the CNS who can advance nursing care in the context of country, culture, and customs. The journal welcomes manuscripts from many places as we strive for a more global perspective about advanced nursing practice and the CNS role.

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