Category: Ask Mitzi Anything

Ask Mitzi Anything: Professional Development, Trends, and Advocacy for the Clinical Nurse Specialist 

In this quarter’s edition, explore how NACNS aids in professional development, tackles challenges in the clinical nurse specialist role, and discover resources for staying updated on healthcare advancements and advocacy efforts at the state and national levels.

1. How does NACNS support the professional development of clinical nurse specialists?

We make this a priority at NACNS by using a variety of strategies. Our many committees are constantly working on toolkits to aid in such development. For example, our Professional Development Committee is currently working on coding and billing toolkits. Our Research, EBP and Scholarship Committee is working to update the CNS Outcomes White Paper, and our Leg/Reg Committee just completed an Executive Summary on CNS Title Protection that CNSs can use in their worksites and HR departments.

We also host many learning activities throughout the year, such as our Annual Conference. We put in countless hours to host an extraordinary event for CNSs and always at a reduced discount for our members to attend and receive plenty of professional development opportunities.

We also feature webinars and courses currently hosted on our website. We will continue to explore new ways to meet our members’ professional needs and hope to bring back a consistent webinar series, much like we had in the pre-COVID years.

Our level of opportunities for volunteerism and leadership positions in NACNS is also noteworthy. Being involved as a volunteer is one of the most important ways to grow professionally. 

2. Can you share insights on the current trends and challenges in the field of clinical nurse specialist practice?

A current trend in the CNS practice is a movement towards more CNSs gaining prescriptive privileges and/or authority. CNSs need to function at the full scope of practice and be writing orders as needed at the point of care to make the biggest impact and show CNS value in direct care.

One challenge CNSs are facing is the barriers to the full scope of practice imposed by healthcare systems, i.e., professional inequity towards CNSs. Other challenges are when CNSs focus too little on the direct care role, moving them further and further away from patient care and having more difficulty showing value as APRNs.

3. What resources or initiatives does NACNS provide to help CNS professionals stay updated on the latest advancements in healthcare?

I think attending our conference in person or virtually is one of the best ways to stay updated. I think the networking opportunities among members are another excellent and underutilized resource. Here at NACNS, we have a wealth of expertise, and I know CNSs are willing to share their expertise with others. I think being on committees as a volunteer or a taskforce to meet others is also an invaluable opportunity for networking and creating new partnerships among CNSs.

4. How does NACNS advocate for the role of clinical nurse specialists at both the state and national levels? 

There is a saying: “If you are not at the table, you are on the menu.” Your membership dollars help us to stay at the table. We are currently on major APRN groups and attending major conferences of importance to make sure the CNS role is visible. We just started that practice a year ago and want to continue it.

We are also focused on growing enrollments in CNS programs and public awareness of the role. We are now having booths at conferences we know can attract nurses to the role, like the National Student Nurses Association’s annual conference. We just launched a new user-friendly and updated CNS Program Directory to facilitate getting interested nurses in the role in front of program directors faster. We also started a new CNS Program Directors Council this year so NACNS can better support our CNS programs to grow the numbers of CNSs.

Position statements are also important. We work hard on them every year to help CNSs in practice advocacy efforts. We recently passed the Clinical Nurse Specialist (CNS) Full Practice Authority position statement and the Title Protection for CNSs PositionStatement will be available for public comment in early 2024.

These are just a few of the many, many activities NACNS does to support CNS practice nationwide. Make sure to subscribe to our newsletter to stay updated on all the exciting things we are up to!

Ask Mitzi Anything: Different Types of CNSs & More

Hello readers! In this edition continue reading to learn about the process for becoming a CNS, CNSs in the operating room, if there are primary care pediatric CNSs and more! 

Q: What is the process for becoming a CNS? What qualifications are required for a CNS?

A CNS is an advanced practice registered nurses who have graduate preparation (Master’s or Doctorate) in nursing. Like other advanced practice registered nurses, they are trained in advanced physiology, pharmacology and physical assessment in addition to their particular areas of specialty. They can diagnose, treat, prescribe and bill like other APRNs as allowed by their state regulations. For a comprehensive document with recommendations for becoming a CNS, please see our Entry for Practice Position Statement and our CNS Program Directory for a lists of schools that offer CNS education. 

Q: Is there such a thing as CNS for operating rooms/surgery?

Yes, a CNS can work in any setting or specialty population. The role goes anywhere there are complex patients and the surgery setting is always complex. 

Q: What is the pathway for an Oregon Nurse-Attorney (BSN/JD) to become a CNS solely for the purpose of providing advanced care planning and assisting clients with the completion of advance directives? No prescriptive authority is desired?

That is not the role of the CNS. You do not need a CNS to do that but if you feel you need the credentials to be able to advise at that level, then the CNS is a good one but you would be prepared well beyond that small piece of what a CNS can do. 

Q: Are there both primary care and acute care certifications for pediatric CNSs like there are for nurse practitioners?

No, just one and CNSs are not primary care providers. The only exam is the acute care exam through the American Association of Critical Care Nurses (AACN). You can download the test plan on their website. 

For more information, feel free to reach out to Mitzi at (734) 355-2792. 


Ask Mitzi Anything: How to Create a CNS Dashboard & More

Hello readers! This edition read on to hear Mitzi discuss how to create a CNS dashboard, career path advice, if a CNS is considered a nurse practitioner, and more! 

Q: Do you have any specific recommendations for how to create a CNS dashboard?

Yes, start with what you know as baseline data. Know your exact product of CNS intervention. Is it patient satisfaction, nurse satisfaction, reducing length of stay, reducing readmission rates in complex patients, prescribing medications to decrease inefficiencies in care, completion of major projects as project lead, etc.? What are your products? Get the data from the last 12 months (LTM). Put it in a table. Then, start recording data every month on the same day. Your interventions should be clearly listed out as well. That way, over the months, you will know which interventions work the best and which are not moving the dial to the better (pivot time). Dashboards are critical and every CNS regardless of role or title should be using them and updating them every month. 

Q: As a current LVN in California taking psychology online for my bachelor’s, what would recommend I do next? Whether I’m able to start now or after achieving my degree?

I assume LVN stands for Licensed Vocational Nurse. You would need your RN at minimum to enter a graduate nursing program. The minimum level is BSN but some programs allow an RN (non-BSN) to MSN bridge in that a gap analysis is undertaken to see if you have completed enough courses or work experience in research, leadership, and community based nursing. Those are key components that differentiate the bachelor’s and non-bachelor’s degree in nursing. You will need to first address the BSN component and qualifications. It can be done but will take some work on your part to meet with a CNS program director to figure it out. See our CNS program directory for assistance in locating an all online program or a face-to-face program near you. 

Q: Is a CNS still considered a nurse practitioner?

No, a CNS is not considered a nurse practitioner (NP) and an NP is not a CNS. The two are unique APRN roles and titles. However, the CNS can do the advanced direct care role much the same as the NP as training in CNS programs is similar in that way. 

Q: Are affiliates permitted to accept non-CNSs (i.e. other APRN roles) into their affiliate group meetings?

That all depends on the affiliate’s definition of membership in their Bylaws. I suggest you get a copy of the Bylaws and go from there. Next, talk to the President of the affiliate about any concerns you have. You mention “meetings” – that is a big “it depends” and up to the leadership to decide who attends meetings and again, based on the Bylaws. 

For more information, feel free to reach out to Mitzi at (734) 355-2792. 


Ask Mitzi Anything: How to Become a CNS & More

Hello readers! Our Ask Phee Phee blog series has now transitioned to the Ask Mitzi Anything series with the recent election of Mitzi Saunders, Ph.D., APRN, ACNS-BC, to president. This edition read on to hear Mitzi discuss CNS specialty roles, how to become a CNS and more. 

Q: Is there a CNS palliative care role that exists? What would that job description look like and how do I build the business case for it? 

Yes! There is a specialty CNS role for everything. You could build the case by having nursing experience in working with patients in symptom management and quality of life, and by having a passion and seeing the need for change that would improved patients’ lives. You could build the case by showing a gap in services that you could fill. You could make the case for prescription too by showing how you would fill gaps in patient care. It is all about access to care and improving patient and family outcomes.  

A job description would have you in the patient/family care role everyday consulting on patients through a palliative care consult system, ideally. Then, you would meet directly with patients and families meeting their needs. It would be best to have privileges to prescribe cares, so teaming up with a physician or two would be best. Then, you provide the other two spheres in your job description with nursing support to carry out the treatment plan and time for system level improvement too when you see inefficiencies in meeting the needs of patients with palliative care needs. The three spheres should be in your job description but the most important is the patient sphere and having a caseload of patients you see everyday. Be careful to record your outcomes for a quarterly report to the CNO. 

Q: I am a certified pediatric nurse practitioner by licence and certified pediatric hematology oncology nurse and have been working as a pediatric hematology/oncology CNS for the past 12 years. My institution is hoping to apply for magnet and is requesting that I have official CNS certification. Can you advise the best route for me to take? 

You will need a post-graduate certificate from a pediatric CNS program. You would likely transfer in two of the three Ps and maybe all 3 depending on the program (the three Ps are advanced physical assessment, advanced pathophysiology, and advanced pharmacology). Then, you would take the pediatric CNS courses and 500 clinical hours. I know that sounds tough as you are already in the role, but it would be over in three semesters at best (that is the case for my program but it is an adult-gero post grad certificate). Check out our CNS directory for a program. Lynn Mohr would also be an excellent resource; she has a pediatric program in Chicago and would be happy to help you.

Q: Does NACNS not recognize me as a CNS, since I do not have the three Ps? I graduated from an accredited CNS (MSN) program in 2009. I graduated with a DNP in 2017. 

Yes, you are a CNS. Having the three Ps will be necessary if you are seeking prescriptive authority or privileges to prescribe; but, yes, you are definitely a CNS. 

Q: I hold an MSN in Nursing Education and I am a board certified Advance Diabetes Manager. What are your recommendations for obtaining CNS licensure?

You will need to obtain a post-graduate certificate from one of our very fine programs for post-grad certificate CNSs. But, do check your state board of nursing rules on CNS licensure. Most states protect the title, but a few do not. 

For more information, feel free to reach out to Mitzi at (734) 355-2792.