Clinical Nurse Specialist

The Clinical Nurse Specialist (CNS) educational track at the University Of South Alabama College Of Nursing (USA CON) is offered completely online. The USA CON CNS program prepares one to seek certification as a CNS within three specialties: Adult/Gerontological, Women’s Health, and Pediatrics. Students take didactic courses in the comfort of their own home and arrange clinicals in their local communities or geographical regions. The preceptors will have to meet specific criteria (see criteria in the preceptor selection section below). You will need to have a master’s prepared or doctoral prepared CNS (serving in the role of a CNS) for at least 460 of the 540 clinical hours required for the program.

If you interested in the CNS track, there are two things you need to investigate and consider:

1) The availability of CNS preceptors and CNS jobs within your community (see statement regarding clinical above). You are responsible for identifying, along with faculty, appropriate CNS preceptors.
2) The role of the CNS in the state that you plan to work. Each state has different regulations and you should be familiar with them prior to starting the CNS program.

The Three CNS Specialties Available at USA* are:
1) Adult/Gerontological: Clinical hours would be in the medical surgical and gerontological clinical settings.
2) Women’s Health: Clinical hours would be in variety of clinical settings that focus on women’s health.
3) Pediatrics: Clinical hours would be with patients 30 days of age to 21 years of age. This does not include the neonatal settings.
            * Other specialties may be available in other institutions. USA CON only offers these specialties.

• General Facts
• Clinical Nurse Specialist Core Competencies
• Certification
• Clinical Hours
• Selecting Your Preceptor
• References
• Clinical Nurse Specialist Curriculum
• For Additional Information

General Facts about the CNS Role:  

Clinical Nurse Specialists (CNS) are licensed registered nurses who have master’s preparation in nursing.
*Clinical Nurse Specialists are expert clinicians in a specialized area of nursing practice. The specialty may be identified in terms of a:
• Population (e.g. pediatrics, adult-geriatrics, women’s health)
• Setting (e.g. critical care, emergency room)
• Disease or Medical Subspecialty (e.g. diabetes, oncology)
• Type of care (e.g. psychiatric, rehabilitation)
• Type of problem (e.g. pain, wounds, stress)

Clinical Nurse Specialists may practice in a variety of health care settings (primary, secondary, and tertiary).
Clinical Nurse Specialists may provide direct patient care, however they exert a significant influence on care outcomes by consulting with nursing staffs and by implementing improvements in health care delivery systems.

CNS practice is conceptualized across three spheres in which the CNS exerts influence:
• Patients/clients
• Nursing standards and nursing personnel
• Systems

One of the hallmarks of CNS practice is advanced specialization within nursing. Further, the advanced specialization is a narrowing and deepening of focus of the autonomous practice of nursing as defined and protected by RN licensure in each state. A critical attribute of all CNSs, regardless of specialty, is that they possess advanced knowledge of both the basic science and the nursing science underpinning the specialty. The CNS applies that knowledge to the assessment and diagnosis of illness, defined as the subjective experience of discomfort (ANA, 2004, p. 48).

Additionally, the following are examples of how CNS applies that knowledge in advanced practice competencies:
• Deliver, design, and test nursing interventions to prevent, lessen, or alleviate illness experiences
• Assure patient safety.
• Improve the quality of nursing care.
• Perform systems analyses.
• Conduct cost-benefit analyses.
• Advance evidence-based nursing practice.

Traditionally, professional assessment of CNS core and/or specialty knowledge and skills has been conducted through the use of national examinations with evidence of sound psychometric properties. However, alternative mechanisms exist to create additional strategies for professional validation with equivalent psychometric soundness. National Association of Clinical Nurse Specialist (NACNS) states that verification of CNS knowledge and competencies requires three (3) multilevel indicators:

1) Education: The CNS must graduate from nationally accredited masters or doctoral program that provides entry-level knowledge and competencies in a specialty area of CNS practice. All CNS education programs must provide a broad based foundation of advanced knowledge, as well as specialty knowledge.
2) Validation of core CNS knowledge and competencies: Core CNS knowledge and competencies are validated with a psychometrically sound and legally defensible assessment method. This may be accomplished through examination or other psychometrically sound and legally defensible assessment methods.
3) Validation of CNS specialty practice knowledge and competencies: Validation of the additional knowledge and competencies in the specialty practice is needed. This may be accomplished through specialty examination or other psychometrically sound and legally defensible assessment methods, such as a portfolio process administered by a testing service, like ANCC, and reported to State Boards of Nursing, like current exam scores are reported (ANA/Black, 2004).

Our curriculum is based on the American Nurses’ Credentialing Center’s (ANCC) requirements for CNS certification. Please be aware that other organizations have different requirements for certification that this program may not meet. Please visit the ANCC web site to investigate your opportunities with regard to certification.

Clinical Nurse Specialist Core Competencies  (Back to Top)

NACNS has published a Statement on Clinical Nurses Specialist Practice and Education (2nd E) (2004) in which core CNS competencies are listed. The core competencies are summarized/paraphrased below and can be found on pages 25-26 of the publication.

1) Use knowledge of illness and treatments in order to prevent or alleviate illness.
2) Design, implement, and evaluate innovative programs of care to achieve desired quality, cost-effective nurse-sensitive outcomes.
3) Serve as a leader, consultant, or mentor in advancing nursing practice to achieve outcomes among nursing personnel and within an organization.
4) Use evidence based practice to direct care and improve outcomes.
5) Lead multidisciplinary teams to collaborate and attain outcomes across continuum of care.
6) Manage resources and provide leadership in a system to support the delivery of nursing care.
7) Generate nursing knowledge to maintain expert clinical competencies for desired outcomes.
8) Demonstrate fiscal responsibility in a healthcare system by focusing on health policy, resource management, and cost effective outcomes of nursing care.
(Statement on Clinical Nurse Specialist Practice and Education, pages 25-26).

Certification  (Back to Top)

The ANCC offers CNS certification exams for certain specialties. For some specialties, for example Women’s Health, no exam currently exists. For a complete list, please see the ANCC web site under CNS certification.

The USA CON CNS program prepares one to seek certification as a CNS within three specialties: Adult/Gerontological, Women’s Health, and Pediatrics. We do not offer sub specialty preparation sufficient for seeking certification, i. e. critical care, pulmonary, etc. We also do not offer specific preparation for CNS certification exams available through other agencies such as the American Association of Critical Care Nurses.

If you wish specific information on the requirements for ANCC certification as a CNS, please contact that agency directly or visit their web site. The faculty and administration at the College can provide validation in support of an application for certification such as clinical hours, preceptor qualifications, etc, when requested by the certifying body, but we cannot provide detailed information on certification requirements.

Clinical Hours  (Back to Top)

There are 540 clinical hours within the curriculum. You will work with Clinical Nurse Specialist (CNS) preceptors to experience the five roles of the CNS and three spheres of influence. The roles of your clinical preceptor will reflect the objective of the clinical experience.

The five roles that you will be expected to focus clinical experiences around include:

• Clinical Expertise/Practice
• Education
• Research
• Collaboration/Leadership
• Consultation

Below is a table which delineates the distribution of your clinical areas and roles you will focus on in the clinical setting.

Selecting Your Preceptor:  (Back to Top)

When selecting a preceptor for the clinical courses, you will need to consider the role the preceptor is currently performing, the educational preparation of the preceptor, and the objectives of the clinical course. You will need to get approval of the preceptor for each course from the track coordinator prior to starting the paperwork with the organization. The track coordinator will need a copy of the potential preceptor’s CV (no more than 5 pages) and a copy of the position description. (The position description is what the preceptor signed when they accepted the job.) If you are unable to locate a preceptor in your home area, some travel may be required. The track coordinator may be able to assist you in locating an appropriate preceptor. Please contact the track coordinator for any questions regarding preceptor selection.

After Approval of Preceptor:
If the agency has a standing contract with the College (see approved clinical agencies on main College web page listed under current students), please get a Letter of Notification and Appreciation signed by your preceptor and submit it along with proof of student’s health insurance and the prerequisite sheet with copies of requirements attached. The required forms are found on the CON web site under Current Students heading: http://www.southalabama.edu/nursing/cmnforms.html.

If the agency does not have a standing contract with us, you will need to get a 2-page agreement signed. The agreement is on the CNS web site at http://www.southalabama.edu/nursing/cmnforms.html. Please print and obtain signatures from your preceptor, you, the faculty and the office manager/appropriate agency official (the person who can give permission for you to be in the facility). If you must get a two page agreement signed, you must submit all other clinical requirements (see above) as well as a copy of the front page of the agency’s malpractice policy with the amounts of coverage listed. Individual malpractice policies are not acceptable; we must have one that covers the agency. There is a letter from the Dean on the website that describes what you need in case you need to provide justification to the agency. In addition, there is a letter from our Risk Management officer detailing the malpractice coverage the College provides for you. If you experience difficulty obtaining the necessary malpractice documentation, please contact your track coordinator.

We must have original signatures on all contracts, so if the agency needs an original as well, you will have to have two originals signed; submit both for faculty signatures and one will be returned to you. The clinical agency representatives must sign the contract prior to requesting the track coordinator’s signature.

All clinical information, contracts, licenses, etc must be submitted each semester that you are enrolled in clinical courses. We do not maintain the information in this office, it is sent to several different locations so in order to be in compliance with the terms of the contract, we must obtain the information each semester. The contracts need to be sent to:

Dr. Anita Smith
College of Nursing
Springhill Campus
University of South Alabama
Mobile, AL 36688

References  (Back to Top)

American Board of Nursing Specialties (2005). Accreditation Standards. Accessed from http://www.nursingcertification.org/standards.htm on July 5, 2005.
American Board of Nursing Specialties (2005). A position statement on the value of specialty nursing certification. Approved by the ABNS March 5, 2005. Accessed from www.nursingcertification.org on June 25, 2005.
American Nurses Association (2003). Nursing’s Social Policy Statement. 2nd Edition, Washington , D.C. : Author.
American Nurses Association (2004). Nursing: Scope & Standards of Practice. Washington , D.C. : Author.
American Nurses Association. Black, R. M. (2004). Genetics Nursing Portfolios: A New Model for Credentialing, Black, Rita Monson, Editor, Washington, D.C.:Author.
Mick, D. J. and Ackermn, M. H. (2002). Deconstructing the myth of the advanced practice blended role: Support for role divergence. Heart and Lung, 31(6), 393- 398.
National Association of Clinical Nurse Specialist. (2004). Statement on Clinical Nurse Specialist Practice and Education (2nd Ed.). Harrisburg, PA.

For information and help with setting up your graduate degree program contact the CON Office of Graduate studies: congrad@usouthal.edu

Clinical Nurse Specialist Curriculum  (Back to Top)

• Clinical Nurse Specialist Post BSN Track (MSN)
      •Full-time 5 semester schedule of study - Fall Admission
      •Full-time 4 semester schedule of study - Spring Admission
      •Part-time 7 semester schedule of study - Spring Admission
      •Full-time 3 semester schedule of study - Summer Admission
      •Part-time 6 semester schedule of study - Summer Admission
• Clinical Nurse Specialist for RN to MSN for Associate/diploma RN’s
• Clinical Nurse Specialist RN to MSN for associate/diploma RN’s with a BS/BA degree in a non-nursing discipline
• Clinical Nurse Specialist Post Master’s Certificate

For Additional Information  (Back to Top)

For additional information and transcript evaluation write to:

Office of Student Services
USA College of Nursing - HAHN 3082
307 University Blvd N
Mobile AL 36688-0002
(251) 445-9400
Email: congrad@usouthal.edu
FAX: (251) 445-9416

For information regarding admission to the University contact:

Office of Admissions
University of South Alabama
Mobile, Alabama 36688-0002
(251) 460-6141
1 (800) 872-5247
Email: admiss@usouthal.edu

The college is approved by the Alabama Board of Nursing
and accredited by the Commission on Collegiate Nursing Education
One Dupont Circle, NW, Suite 520
Washington, D.C. 20036-1120
Telephone 202-887-6791