Linda D Urden, DNSc, RN, CNS, NE-BC, FAAN
Professor and Director
Master’s and International Nursing Programs
Hahn School of Nursing and Health Science
University of San Diego
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There are four types of advanced practice
nurses:
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Clinical Nurse Specialist (CNS)
Nurse Midwife
Nurse Practitioner
Nurse Anesthetist
CNSs are licensed registered nurses who have
graduate preparation at the master’s and
doctoral levels
CNSs have additional certifications or licenses
as a CNS
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CNSs are expert clinicians who work in a
variety of clinical practice settings
Population: pediatrics, geriatrics, women’s health
Setting: critical care, emergency room
Disease or medical subspecialty: diabetes, oncology
Type of Care: rehabilitation, home health, mental
health, palliative care
◦ Type of Problem: pain, stress, wounds
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CNSs are independent practitioners and may
form their own practice
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Patient
◦ May coordinate the care of a certain specialty
population, e.g., HF, transplant
◦ May manage clinics for specialty
◦ May be consulted to provide teaching, support for a
newly diagnosed condition
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Staff
◦ Mentor, role model for staff
◦ Teach, rounds, consultant for complex cases
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Organization
◦ Lead system wide initiatives, multidisciplinary teams
◦ Instrumental in managing change of practice (EBP)
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CNSs practice in a variety of health care
settings
◦ Per 2010 survey, 70% practice in some type of
inpatient care setting
◦ Remainder indicated home health care, long term
care, public health centers, ambulatory care,
correctional facilities, and private industry
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CNSs teach in schools of nursing….increasing
numbers with full time CNS practice while
teaching courses in the schools
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Leaders of teams in organizations to
improves quality and safety of care
Developers of programs to prevent avoidable
complications
Coaches of those with chronic diseases to
prevent hospital readmissions
Consumers of evidence-based practice to
ensure best care and services (MSN, DNP)
Researchers to create new knowledge to
improves outcomes of care (PhD).
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CNSs are uniquely positioned due to their
expertise and skills to be leaders as we move
forward with new models of care
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Improving the quality and safety of care
Eliminating unnecessary care
Improving the care for those with chronic illnesses
Reducing the costs of care
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Increase effectiveness of transitioning care
from hospital to home and prevent
readmissions (create a Medicare benefit that
would support providing transitional care)
Improve the quality and safety of care and
reduce health care costs (leading EB systemwide changes: med errors, HACs, etc.)
Educate, train, increase the nursing workforce
needed for improved health care system (EB
orientation programs, mentor new and
tenured staff)
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Increase access to community-based care
through the expansion of Nurse Managed
Health Care Centers (slow down progression
of chronic disease
Increase the availability of effective care for
those with chronic disease (promote self care
and manage symptoms)
Improve access to wellness and preventive
care (wellness company owned/managed by
CNSs reduce costs)
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Make rounds on high risk cases
Coordinate/attend multidisciplinary care
conference
Consult with staff on complex cases
(anywhere in the organization)
Discuss cases with MDs, other care team
members
Teach a specialty class
Meet with nurse residency program
participants
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Attend leadership meeting
Meet with pharmacist on join EBP project
Meet with Director regarding new orientees
Consult with another CNS
Conference call with professional
organization committee meeting
Intervene with new equipment that appeared
with a patient from the OR- that staff had
never seen before
Meet with staff who is presenting an inservice
for the first time
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Work on revising one of the many procedures
that need updated
Discuss with faculty the CNS student who you
will be precepting next semester
Prepare for the system-wide EBP team
meeting that you will lead tomorrow
Did anyone say lunch ?????
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Clinical experts in
diagnosis and
treatment of illness in
specialties across the
continuum of care
Provide evidencebased care in a variety
of settings
Direct providers of
Medicare services
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Prescribers of
medications (38 states)
Coordinators of care
across settings
Leaders and facilitators
of change among large
groups and organizations
Researchers in
identifying effective
interventions with proven
outcomes
Urden@sandiego.edu