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The Implications of the New Essentials on the CNS Profession—Let's Respond!

Saunders, Mitzi M. PhD, APRN, CNS-C

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doi: 10.1097/NUR.0000000000000668
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The new Essentials of Nursing Education1 is a competency-based framework to guide nursing curriculum for undergraduate (level 1) and graduate (level 2) nursing education. The primary goals of the new Essentials1 are to decrease the variability in the educational preparation of nurses and better equip all nurses to lead change across healthcare settings.

In level 2, or graduate nursing education, there are 244 competencies. These competencies are doctor of nursing practice (DNP) level, but colleges and universities will ultimately decide on the granting of a master's or DNP degree.1 The intent, however, is that all level 2 nurses will become DNPs. In 2015, the National Association of Clinical Nurse Specialists endorsed the DNP as entry into clinical nurse specialist (CNS) practice.2 Thus, CNS faculty should fully integrate the new Essentials1 into CNS curriculum to achieve either the terminal degree of DNP-CNS or the doctor of philosophy in nursing (PhD-CNS). We need paths to both degrees.

Beyond a terminal degree for all future CNSs, the new Essentials1 have additional and positive implications on the CNS profession. First, the new Essentials1 support an advanced, nursing leadership role that aligns well with the CNS role competencies3 in the nurse/nursing practice and organization/system spheres of CNS impact. I am optimistic that a fully integrated competency-based curriculum will support an even stronger, practice-ready CNS graduate.

Second, the new Essentials1 help to articulate how the advanced practice registered nurse (APRN) is different from non-APRN roles. For example, the new Essentials1 exclude the competency of “prescribing,” a unique characteristic of the APRN role. In addition, it is the CNS direct care role competencies related to complex care/complex situations, patient/family coaching, mentoring and education, and the advanced clinical decision-making of diagnosing and prescribing3 that are unique to the CNS and the APRN role. For this reason, the CNS profession must continue to emphasize full scope of practice until every CNS is recognized as an APRN or advanced practice provider (APP) by their respective healthcare system. There is one way of doing this—all eligible CNSs need to be credentialed and privileged (C&P).

Finally, regardless of the new Essentials1 support for more nurse leadership in healthcare systems, the outcome of this education remains a degree, not a role. The DNP is a degree. There is a role, though, the CNS, who leads and sustains system-level change.3 The nurse practitioner graduate will assume the primary “role competencies” of delivering primary care. The nurse anesthetist graduate will administer anesthesia. The nurse midwife graduate will provide women's health/neonatal primary care. The CNS graduate will respond eagerly to the call of the new Essentials1 and lead across 3 spheres of impact (patient direct care, nurse/nursing practice, organizations/systems). It is the role of the CNS.

If I learned anything from the new Essentials,1 it is that we (CNSs) are in demand and greatly needed. The new Essentials1 (level 2) align well with the CNS role competencies,3 and the new Essentials1 are what healthcare leaders are seeking. Thus, we must keep our faith in the CNS role and grow the numbers of CNSs until we sufficiently meet this goal: “All patients/families, nurses, and healthcare organizations have CNSs who are recognized as APRNs or APPs and practicing at full scope of practice.” We need to incessantly deliver our elevator speeches and never shy away from opportunities to articulate the CNS role. Let's make our proclamations public—there is power in public accountability.

Over the next year, let's produce some extraordinary work together by achieving 3 goals: (1) articulate the CNS role like never before; (2) get all eligible CNSs C&P; and (3) support every CNS toward publishing on CNS outcomes. By articulating the CNS role, we will increase the numbers of persons who recognize the CNS, recruit more nurses to the CNS profession, and get more chief nurse officers on board to employ more CNSs. Create a scoreboard and keep a tally of your weekly work on those 3 goals. Know you are winning when you hear others outside the profession talking about the CNS role, when you get a nurse to apply for a CNS program, and when your chief nurse officer decides to hire more CNSs.

We need more CNSs who are C&P. I cannot think of a better way to demonstrate the visibility of the role than through the tangible acts of prescribing care and billing for services—like other APRNs or APPs. These are features missing in CNS practice today. Five years ago, a CNS in Pennsylvania who manages a heart failure program voiced how it took 2 or more healthcare professionals and unintended, expensive redundancy to address a patient's elevated heart rate—a problem the CNS would have quickly addressed if C&P.4 In my recent publication, “Informing and Supporting the New Clinical Nurse Specialist Prescriber,”5 I give current recommendations to move forward as a safe, competent CNS prescriber. What are we waiting for? The time is now.

Finally, publish, publish, and publish! Every CNS should publish one article in the next year that highlights CNS outcomes. We need publications on the advanced, direct care role competencies of the CNS—our uniqueness as APRNs and a major difference from non-APRNs like the clinical nurse leader role. Case reports on CNS prescribing for complex patients/situations are needed. The direct care CNS role competencies3 are distinct from the new Essentials1 competencies—let's boldly show how.

Together, let's grow our numbers and the visibility of the CNS role—the calling is strong. The new Essentials1 support how vital the CNS role is. Let's respond!


1. American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education. April 6, 2021. Accessed January 15, 2022.
2. National Association of Clinical Nurse Specialists. Position statement on doctor or nursing practice. July 2015. Accessed January 15, 2022.
3. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. 3rd ed. Reston, VA: NACNS; 2019.
4. Robert Wood Johnson Foundation. How practice barriers differ by APRN role. In: Charting Nursing's Future. Princeton, NJ. Vol. 30. 2017:4–6.
5. Saunders MM. Informing and supporting the new CNS prescriber. AACN Adv Crit Care. 2021;32(4):404–412.
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