1. Patient/Client
2. Nurses and Nursing Practice; and/or
3. Organization/System (NACNS, Statement on Clinical Nurse Specialist Practice and Education, 2004).

The CNS role began some 50 years ago and has always required graduate education—masters or doctorate.  Typically a CNS provides expert care in a specialized area (ex cardiology)—the care might be given to individual patients (ex heart failure clinic) or might be provided as expertise across an organization or system of care (ex implement evidence-based practice across a hospital system to improve cardiology patient outcomes for patients with heart failure or open heart surgery). CNSs often practice in hospitals, physician offices/clinics (usually in specialty practice), or education settings. They are less likely to provide primary care but may provide care and management for patients with chronic illnesses/diseases. CNSs have a broad base of preparation in advanced knowledge as well as more specialized knowledge in a more focused area.

We subscribe to the definition given in the American Nurses Association (ANA) Scope and Standards of Practice (2004), p. 15:

Clinical Nurse Specialists are registered nurses, who have graduate level nursing preparation at the master’s or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients’ illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in advanced the practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings.