Statement on Clinical Nurse Specialist Practice and Education
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2nd Edition Statement on Clinical Nurse Specialist Practice and Education 2090 Linglestown Road, Suite 107 Harrisburg, PA 17110 www.nacns.org ACKNOWLEDGMENTS NACNS recognizes the authors of the first edition of the NACNS Statement on Clinical Nurse Specialist Practice and Education — Brenda L. Lyon, DNS, RN, FAAN and Sue B. Davidson, PhD, RN, CNS Co-Chairs of the Statement Development Task Force, and Task Force members Pauline C. Beecroft, PhD, RN, FAAN; Janet Bingle, MS, RN; Nancy Dayhoff, EdD, RN; and Kathleen Ellstrom, PhD, RN. Members of the 2004 Statement Revision Task Force: Angela P. Clark, PhD, RN, CNS, FAAN, FAHA, Co-Chair Sue Davidson, PhD, RN, CNS, Co-Chair Kathleen Baldwin, PhD, RN, CEN, CCRN, ANP, GNP Janet Bingle, MS, RN, CNS Karen Clark, MSN, RN, CCRN Nancy Dayhoff, EdD, RN, CNS Janet S. Fulton, PhD, RN, CNS Peggy Gerard, DNS, RN, CNS Barbara J. Hasbargen, MSN, RN, CNS, CNN Brenda L. Lyon, DNS, RN, CNS, FAAN Theresa Murray, MSN, RN, CCRN, CNS Jo Ellen Rust, MSN, RN, CNS Beverly B. Tidwell, DNS, RN, CNS Published by National Association of Clinical Nurse Specialists 2090 Linglestown Road, Suite 107 Harrisburg, PA 17110 ©1998, 2004 National Association of Clinical Nurse Specialists. All rights reserved TABLE OF CONTENTS Introduction...................................................................................................................................... 1 History of the Development of the Statement ...................................................................................... 2 Parameters of the Statement.......................................................................................................... 3 Goals of the Statement ................................................................................................................... 4 Section 1: Clinical Nurse Specialist Practice Introduction ................................................................................................................................... 5 Historical Foundations of CNS Practice....................................................................................... 6 Social and Professional Mandate for CNS Practice ..................................................................... 10 Definition of Clinical Nurse Specialists........................................................................................ 12 Relationship Between CNS Practice, Specialty Knowledge, and Practice Standards ................. 13 Essential Characteristics of the CNS .................................................................................... 13 Clinical Expertise in a Specialty............................................................................................ 14 Leadership Skills..................................................................................................................... 14 Collaboration Skills ............................................................................................................... 15 Consultation Skills................................................................................................................. 16 Professional Attributes........................................................................................................... 16 Ethical Conduct ..................................................................................................................... 16 Professional Citizenship for the Specialty and in the Profession of Nursing..................... 17 Conceptual Model of CNS Practice .............................................................................................. 17 CNS Practice: Patient/Client Sphere..................................................................................... 18 CNS Practice: Nurses and Nursing Practice Sphere ............................................................ 19 CNS Practice: Organization/System Sphere......................................................................... 19 Legislative Regulation of Clinical Nurse Specialist Practice........................................................ 20 Professional Validation of CNS Competencies ............................................................................ 22 Summary ........................................................................................................................................ 24 Section 2: Clinical Nurse Specialist Competencies and Outcomes Introduction ................................................................................................................................... 25 Overview of CNS Core Competencies.......................................................................................... 25 Assumptions Underlying the Core Competencies....................................................................... 26 CNS Competencies by Spheres of Influence ................................................................................ 27 Sphere of Influence: Patient/Client ............................................................................................... 28 Outcomes of CNS Practice.................................................................................................... 28 Competencies of CNS Practice ............................................................................................. 29 Assessment...................................................................................................................... 29 Diagnosis, Planning, and Identification of Outcomes................................................. 30 Intervention.................................................................................................................... 30 Evaluation....................................................................................................................... 31 Sphere of Influence: Nurses and Nursing Practice....................................................................... 31 Outcomes of CNS Practice.................................................................................................... 31 Competencies of CNS Practice ............................................................................................. 32 Assessment: Identifying and Defining Problems and Opportunities ......................... 32 Diagnosis, Outcome Identification, and Planning....................................................... 33 Intervention: Developing and Testing Solutions.......................................................... 33 Evaluation of the Effects................................................................................................ 34 Section 2 (cont.) Sphere of Influence: Organization/System ................................................................................... 34 Outcomes of CNS Practice.................................................................................................... 34 Competencies of CNS Practice ............................................................................................. 35 Assessment: Identifying and Defining Problems and Opportunities ......................... 35 Diagnosis, Outcome Identification, and Planning....................................................... 36 Intervention: Developing and Testing Solutions.......................................................... 36 Evaluation of the Effects................................................................................................ 37 Summary ........................................................................................................................................ 38 Section 3: Recommendations for Graduate Preparation of Clinical Nurse Specialists Introduction ................................................................................................................................... 39 History and Evolution of CNS Education.................................................................................... 39 Background to the Recommendations ......................................................................................... 41 Curricular Recommendations....................................................................................................... 42 Essential Core Content Areas for Developing CNS Competencies............................................. 43 Theoretical Foundations for CNS Practice .......................................................................... 44 Phenomena of Concern......................................................................................................... 44 Design and Development of Innovative Nursing Interventions......................................... 45 Clinical Inquiry/Critical Thinking Using Advanced Knowledge ........................................ 45 Technology, Products, and Devices....................................................................................... 46 Teaching and Coaching ......................................................................................................... 47 Influencing Change................................................................................................................ 47 Systems Thinking................................................................................................................... 48 Leadership for Multidisciplinary Collaboration .................................................................. 49 Consultation Theory ............................................................................................................