Category: Blog


Success Story: The CNS As Credentialed Provider

The University of Virginia Health (UVA Health), serving the Greater Charlottesville/Albemarle region of Virginia, took the important step this month to validate its 14 clinical nurse specialists (CNSs) as “credentialed providers.” This step formally recognizes CNSs as Advanced Practice Registered Nurses (APRN). UVA Health System includes a 631-bed hospital, level I trauma center, nationally recognized cancer and heart centers, and primary and specialty clinics throughout Central Virginia.

The entire credentialing approval process took four months and, today, CNSs at UVA Health can practice with full practice authority, ordering many services for patients based on their own professional assessment rather than relying exclusively on physician approval.

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN, lead clinical nurse specialist of UVA Health, coordinated the credentialing effort. According to Elgin, the other three APRN roles (nurse practitioners, nurse midwives, and nurse anesthetists) were already bundled underneath the credentialed provider structure and there was a growing need to recognize CNSs and align their level of responsibility and scope of practice with that of their APRN counterparts.

Beyond the interest in improving patients’ experiences, the ascension of CNSs to the status of credentialed providers means that UVA Health is in line with the CNS professional standards of practice. The change also will provide mechanisms for third-party billing of services provided by a CNS. At the same time, there is legislation in the Virginia General Assembly to elevate the scope of practice of the CNS to allow for prescriptive authority.

“There was a real need for credentialing CNSs,” said Elgin. “The fluidity of the CNS role is important, but it could lead to role confusion for colleagues. After centralizing the CNS team, I performed a systematic gap analysis, comparing our practice to the National Association of Clinical Nurse Specialists (NACNS) core competencies. Being able to validate our CNSs were ‘aligning with and meeting national standards’ is actionable language that is meaningful and powerful to an organization.”

NACNS core competencies can be found here. They include competencies in Direct Care, Consultation, Systems Leadership, Collaboration, Coaching, Research and Ethical Decision-Making, Moral Agency, and Advocacy.

The Benefits of Credentialing the CNS

As a credentialed provider, CNSs’ validation as an APRN by the UVA Health nursing body and interdisciplinary colleagues is helping to build the structures and processes that are necessary to facilitate reimbursement practices. Another significant improvement will be CNSs’ ability to formally consult other interdisciplinary clinicians without a physician co-signature. This efficient approach to patient care leverages the CNSs’ ability to generate revenue for the organization for the work they perform. Finally, and most importantly, validating a CNS as a credentialed provider creates an opportunity to rethink processes and structures around interprofessional practice and develop different and more efficient methods to work together in a healthcare setting.

A CNS-Credentialed Provider “How To”

The entire formal credentialing process at UVA Health took four months and involved the entire organization.

The process included working with stakeholders to obtain subcommittee approvals, a full vote by all of the organization’s clinical staff, and final approval by the UVA Health Board. Critical to the success of this effort was securing support from the chief nursing officer, director for advanced practice, as well as buy-in from the CNS team.

“Our CNSs had a vision for it, but we still put a lot of energy and effort into securing their buy-in,” said Elgin. “The change will create different workflows for our CNSs, so I needed them to be engaged in the credentialing process from the beginning if we were to be successful.”

The approval process started with the proposal being presented to the Advanced Practice Provider Subcommittee of the Organizational Credentialing Committee. Once approved, a recommendation was made to the Credentialing Committee to add CNSs as a provider type. Next, it was voted on and approved at the Credentialing Committee and the Credentialing Committee made their recommendation to the Clinical Staff Executive Committee. This executive committee also approved the proposal and sent it to the entire clinical staff for a vote. Finally, the last step was the UVA Health Board’s approval validating the CNS position as a credentialed provider.

Elgin credits her relatively smooth approval process to never underestimating the importance of engaging stakeholders both in formal and informal settings and really taking time to listen to them and hear their concerns.

About the author

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN is a Director at Large for NACNS, the only national organization representing the 89,000 CNSs in the US. CNSs are the most versatile advanced practice registered nurses and work in a variety of health care specialties to ensure the delivery of high-quality, evidence-based, patient-centered care. As leaders in the acute, post-acute, and ambulatory health care settings, CNSs impact direct patient care, nurses and nursing practice, and organizations and systems to optimize care and drive outstanding clinical outcomes.

RISE Up By Giving A Hand Up

Succession Planning To Advance The CNS Profession

Jan Powers, in her recent National Association of Clinical Nurse Specialists President’s Letter titled “We Rise By Lifting Others,” stated:

“As CNSs, we must look to the future and work to improve the pipeline of qualified CNSs to fill positions of vital need. We must have an intentional focus on succession planning and simultaneously encourage younger nurses to explore and step up to the role of CNS.”

Five generations of nurses are now working together with the oldest generation reaching retirement. As a matter of fact, nearly 20% of CNSs will reach retirement age over the next five years. Succession planning is an important way to fill this potential retirement gap in the ranks of the about 89,000 CNSs in North America.

Succession planning is defined as the systematic process of recognizing and creating future leaders who ready and able to accept the roles and responsibilities of those leaving the workforce via retirement, resignation, or promotion. Succession planning is a future-oriented process.

In short, it’s about giving younger nurses a “hand up” by introducing them to the role of the CNS and encouraging them to pursue the career. It is primarily through this effort that we advance the CNS role and ensure it thrives well into the future.

The Big Question

Ask yourself this question:

Who will replace you when you retire or leave the organization?

To truly RISE UP as a profession we must lead others forward. This is where succession planning is so critical because our current CNS positions must pave the way for the next CNS to take our place. Below are some tips and ideas to think about as you begin a succession plan.

CNS Succession Planning Tips

1. Establish accountability

  • Agree who has the responsibility to make the succession decision. Establishing clear responsibility of organizational succession early on is key to avoiding confusion later and is important to ensure a CNS has input into the process.

2. Focus on learning, not just performance

  • Provide potential successors opportunities to experience the future role and be educated on responsibilities before the succession itself is decided and implemented. This is where mentoring is important.

3. Turn succession short-term by breaking down tasks

  • Succession planning is a journey with many steps. People tend to think better in the short-term so breaking down the succession process into smaller projects rather than trying to make a switch all at once has a better chance of success.

4. Build transparency with the scientific method

  • Be upfront about succession planning and use CNS data skills to measure a potential successor’s performance and leadership ability. Establish standards to measure the success of a transition and share this information. This not only makes the succession process cleaner, but it builds trust among coworkers and the organization generally.

Is 90,000 Enough?

There are about 89,000 CNSs in North America and it is not nearly enough. The pandemic is swallowing resources while the online job boards scream for more CNSs. Our goal should be to retain and add more CNS to the workforce every year. We can do this with mentoring, succession planning, advising younger nurses, speaking at nursing programs among may other things. In sum, by giving a hand up to younger nurses to become CNSs we ensure the continuity of our profession and truly “RISE By Lifting Others.”


Lt Colonel David Bradley Armed Forces Affiliate Interview with NACNS

Lt. Colonel David Bradley Interview – Q&A

Q. What prompted the reinvigoration of the military affiliate within NACNS?

A few colleagues and I have been attending the National Association of Clinical Nurse Specialist (NACNS) Annual Conference for years and always found it exciting and informative. We decided there was a real
need for a military affiliate, and — in true military fashion — we just went ahead and completed all the paperwork and executed the mission. We plan to launch NACNS’s military affiliate in October with representation across three branches of the military — Navy, Air Force and Army. We’ve had a lot of interest already.

Q. What do you hope to accomplish with the creation of the Armed Services affiliate?

People are just unaware of the Clinical Nurse Specialist’s (CNS) role. They ask: “What are your skill sets and how can we better utilize you?” There is a great need for education and awareness around the CNS in the military. We want to make sure that the role of the CNS is understood and valued. The best ambassadors for this effort are the CNSs themselves, so we want to put our heads together and have an organization to build awareness and appreciation of our role.

Being an affiliate linked to a national organization can support and help with visibility and grow awareness. Our second goal is to share and collaborate on evidence-based practice and research. NACNS gives us the best forum for accomplishing these goals.

Q. Can you tell us more about the benefits of a NACNS military affiliate?

The primary benefit of the NACNS military affiliate is that it establishes a platform to better market the role of the CNS. An active affiliate will highlight the great things CNSs are doing across the nation as well as showing how CNSs are making an impact in military healthcare. We also plan to use the military affiliate to network and establish a robust mentoring program for newer CNSs. That’s an area of opportunity for the military affiliate, providing experienced mentors for recently graduated CNSs.

Q. Do you have anything else you would like to share about the role of the CNS?

I’m always looking for better ways to describe the role of a CNS. When the message gets through, people really do understand the unique value we bring to the table. I’ve found that analogies go a long way in this regard; they’re a simple way to explain what otherwise can sound like a complicated role. Here’s one of the best analogies about CNSs that I’ve heard:

A CNS is like a pitching coach in baseball. Now, can you play baseball without a pitching coach? Absolutely. So, why do they have pitching coaches and pay them so much money?

Teams invest in pitching coaches because pitching is the most important position on the field. For a team to be great, it has to have great pitching. So, even small improvements to a pitcher’s mechanics, to his pitch selection, or to something as simple as how he grips the ball can have significant impact on the team. The pitching coach can look at the spin of the ball, the velocity, or the way the ball leaves a pitcher’s hand and be able to offer insight that no one else on the field can see. The pitching coach will see things others miss. “You’re dropping your shoulder,” he’ll tell the pitcher who can’t find the strike zone. This advice and corrective action can and regularly does change the outcome for a pitcher and for the game.

A CNS plays a similar role to the pitching coach, providing expertise and guidance at key moments, relying on their deep expertise, to improve the quality of care and outcomes in hospitals and health systems across the country.


These are the most lucrative nursing careers right now

3 highest paying clinical nursing jobs today

Which nursing careers pay the highest annual salary or hourly rates? Nursing jobs vary by specialty, setting, location, degree, and certification requirements. Nurses can specialize in treating a population (geriatrics, pediatrics, etc.) or specialize in a therapeutic area (oncology, dermatology, etc.) Additionally, shifts low in supply and high in demand can cause pay rates to grow in certain types of jobs.

Below are the nursing careers that generally pay the highest salary across all locations, specialties, and clinical settings. Most of the highest-paid nursing careers are APRNs, or advanced practice registered nurses, which are registered nurses who obtain a master’s level degree and additional experience or specialization after completing their Bachelor of Science in Nursing degree and RN certification.

1. Nurse Anesthetist (CRNA) – Nurse anesthetists administer anesthesia to patients who are undergoing medical procedures in a hospital, outpatient surgery center, or medical office. With additional documented experience in ICU or surgery, plus completing an additional program and passing certification requirements, RNs can become CRNAs and earn an average of $181,040 annually, according to the Bureau of Labor Statistics. CRNAs can make up to $230,000 annually, while most CRNA salaries range between $171,130 and $205,506, according to Salary.com.

2. Nurse Practitioner (NP) – Nurse practitioners also complete additional training and education to get their NP degree which enables them to treat patients more autonomously than many other types of nurses. Some states allow NPs to practice independently and prescribe medications while other states require NPs to work with a licensed physician. As of February 2021, nurse practitioners earn an average of $109,025 annually, according to data from ZipRecruiter.com.

3. Clinical Nurse Specialist (CNS) – A clinical nurse specialist has obtained a minimum of a master’s degree, plus additional training in a specialized area of nursing practice, according to Nurse.org, which reports that the median salary for clinical nurse specialists as of May 2020 is $106,604. Clinical nurse specialists may specialize in a therapeutic area or population, and specialty certifications are available in gerontology, pediatrics, and neonatal care, according to the National Association of Clinical Nurse Specialists.

Honorable Mention – Registered Nurse (RN) – While not among the very top-paying jobs, RNs are well-paid. Additionally, becoming an RN is somewhat of the “gateway” milestone along the way to achieving higher-paying advanced practice nursing jobs. Completing an RN opens many doors and provides nurses with many more options for advanced degrees and more lucrative nursing roles. According to the Bureau of Labor Statistics, the average (mean) income for RNs nationally as of 2019 (the most recent BLS data available) is $37.24 per hour which translates to $77,460 annually, assuming a full-time schedule of about 40 hours per week.

Of the nearly three million RNs employed nationwide, the highest earners are those who work in outpatient care centers or hospital settings, with an average hourly income of $40.73 ($84,720 annually), and $38.20 per hour ($79,460 annually) respectively.

Where you work as an RN also impacts your hourly wage and annual income. California and Hawaii are the top-paying states for RNs, with hourly rates of $54.44 and 50.03, respectively, followed by Washington, D.C., Massachusetts, and Oregon as top-paying states, where the cost of living is also higher.

Other ways nurses may increase their annual income

In addition to high-paying clinical nursing careers, another way to grow your nursing career and annual income is to shift into leadership, administration, or teaching. Nurse administrators such as hospital CNOs, medical directors, etc. earn more than $100,000, and nurse instructors earn an average of $83,160 annually and up to $133,000 in the 90th percentile.

Changes in supply and demand can also factor into nursing salaries, causing pay fluctuations in either direction. For example, critical care nursing is in unusually high demand in 2020-2021 due to the coronavirus pandemic. This is causing pay rates in some areas to quadruple, as demand also grows by a reported 400-500%, multiple experts report. Switching practice areas may be a more feasible career change than obtaining a new advanced degree for some nurses.

If none of the above are an option, another way for nurses to potentially grow their annual income is to consider trying out a new part-time side-gig for a few extra hours a week. This may be a more realistic method to increase earnings for nurses who are unable to shift full-time into a new, higher-paying nursing career.