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Clinical Nurse Specialists Central to Improving Care and Efficiency


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By Megan Murdock Krischke, contributor

December 18, 2013 - Nurses play a pivotal role in the efforts to reduce costs and improve quality in today’s health care environment, and clinical nurse specialists (CNSs) may be able to show a particularly significant impact.

A new white paper released by the National Association of Clinical Nurse Specialists (NACNS) highlights evidence regarding CNSs, stating, “Research and demonstration projects have shown that the CNS role is uniquely suited to lead implementation of evidence-based quality improvement actions that also reduce cost throughout the health care system.”

The paper provides examples in a variety of settings including prenatal care, preventive care and wellness, behavioral health and chronic condition care; cases also reflect how clinical nurse specialists have helped reduce the rate of hospital-acquired infections, cut patients’ length of stay and prevent hospital readmissions.

A CNS is an advanced practice nurse who can provide patient care within his or her specialty and who, in most states, has prescriptive authority. A CNS is also uniquely equipped to evaluate and improve systems and processes such as workflow management and patient safety. 

Carol Manchester, MSN, ACNS, BC-ADM, CDE, NACNS 2013 president, explained the role of CNSs in more detail: “In addition to the direct care role, clinical nurse specialists are leaders of change in health organizations, developers of evidence-based programs to prevent avoidable complications, coaches of those with chronic diseases to prevent hospital readmissions, facilitators of teams in acute care and other facilities to improve the quality and safety of care, including preventing hospital-acquired infections and reducing length of stays. The clinical nurse specialist utilizes this system-level knowledge to facilitate improved patient care and outcomes.”

“There now is definite research and evidence that supports what we recognize as cost-saving and improved quality in patient care and clinical outcomes with care provided by a CNS,” she continued. “As the body of knowledge grows and the research continues, we expect it to support that the CNS is an important advanced practice role within the new health care model, which includes, of course, the accountable care organizations and the medical homes.”

Some cases in the NACNS paper highlighting the importance of clinical nurse specialists:

  • Prenatal home care offered by a CNS dramatically decreased the length of hospital stays for mothers at high-risk of delivering low birth-weight infants, and their children.
  • An organization that hired a team of CNSs to provide wellness and preventive care to their employees saw a major decrease in their annual health insurance premium hikes.
  • CNSs have a strong track record in reducing hospital-acquired conditions (HACs); one study demonstrated that CNSs reduced HACs by nearly half.

Among the many changes happening in health care today, the effects of the affordable care act (ACA) are some of the most significant. In the midst of these changes, CNSs are not only delivering care, but improving the quality of that care.

Lisa Byrd: Clinical nurse specialists (CNSs) are integral to the healthcare team.
Lisa Byrd, president of the Gerontological Advanced Practice Nurses Association, says CNSs are an integral part of the health care team serving a growing patient population.

“The ACA will open doors to patients who need health care practitioners who are educated and have the know-how to effectively and proactively promote health, to diagnostically manage health, and to reactively manage diseases and quality of life for the individuals,” commented Lisa Byrd, PhD, FNP-BC, GNP-BC, president of the Gerontological Advanced Practice Nurses Association (GAPNA). 

“The role of the CNS, especially in the geriatric field, will increase in its importance and function as part of the health care team since there are a large number of graying baby boomers,” Byrd continued. “Clinical analysis, disease identification and management, and education of the patient and the family--as well as the community--are key roles for the CNS.”

“The ACA has provided many opportunities for the CNS role to become more visible within the health care system,” added Manchester. “CNSs have unique and advanced level competencies that can meet the increased needs of improving quality and reducing costs within the system.  The CNS is involved in transition of care issues for the patients and can work to decrease readmissions of patients through their assessment of patient needs.”

“In addition, the CNS is seeing a growing role in the medical home, providing both population-based wellness care as well as managing chronically ill patients with their primary care needs,” she continued. “As health care reimbursement becomes more focused on evidence-based practice, the CNS will have a pronounced role in assuring that evidence-based guidelines are appropriately applied to patient populations within a health care system.”

A CNS can work in many different settings such as hospitals, clinics, long-term care, community or public health, and even in private practice, noted Byrd.

“An advanced degree in nursing, such as a CNS, places a nurse in the elite role of health care decision-maker and allows the nurse to play a major role in influencing the direction of health care,” she offered.

“The CNS is an exciting professional option and allows the expert CNS to be creative within their clinical specialty to meet the needs of the population they focus on,” asserted Manchester. “For me, the role provides autonomy and the opportunity to continually grow and learn in my specialty. I truly believe we all need to be lifelong learners, and the CNS is a role for those who highly value new information.”

“In my work, as I provide direct patient care to diabetic patients and their families,” she continued, “I am motivated and inspired by these individuals who work hard to adapt to their disease and move past it to achieve their life goals. I am often able to advocate for them in ways that other individuals in the healthcare system are not.”



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