In the United States, the 4 roles of Advanced Practice Registered Nurse (APRN) are: Nurse Practitioner (NP), Nurse Anesthetists (CRNA), Nurse Midwives (CNM), and Clinical Nurse Specialists (CNS) (APRN Consensus Workgroup, 2008; Centers for Medicare & Medicaid [CMS], 2024). In Florida (2022), there were approximately 46,000 total licensed APRNs, and each are qualified in one or more of the roles. The majority of Florida licensed APRNs are Nurse Practitioners (39,545, 86%), followed by CRNA (6,398, 14%), Clinical Nurse Specialists (230, 5%) and Nurse Midwives (90, 2%) (Florida Health MQA,2023). All 4 roles have title protection and scope of practice defined in the Florida Statute 464.012 (Regulations of Professions and Occupations, 2023).

Definition and Classification

Recently, the definition of the Clinical Nurse Specialist was revised (National Association of Clinical Nurse Specialists [NACNS], 2024). A Clinical Nurse Specialist (CNS) is an Advanced Practice Registered Nurse (APRN) prepared by a master’s or doctoral, or post-graduate certificate level CNS program. CNSs diagnose, prescribe, and treat patients and specialty populations across the continuum of care. The CNS improves outcomes by providing direct patient care, leading evidence-based practice, optimizing organizational systems, and advancing nursing practice. (NACNS, 2024)

Though the CNS is recognized as APRN by Medicare (CMS, 2024) and other professional organizations e.g. National Council of State Boards of Nursing (NCSBN, 2008), currently CNSs are categorized as Registered Nurses rather than APRNs in the Standard Occupational Classification System (SOC) or the U.S. Bureau of Labor Statistics’ (BLS) Occupational Employment and Wage Statistics (OEWS) Program (Bureau of Labor Statistics, 2024). This is a workforce database that classifies professions with codes specific to their profession. Of nearly 90,000 CNSs in the US, only 12,569 have a National Provider Identification (NPI) number. (Reed, 2022). To increase the visibility in the workforce database, CNSs can register for their National Provider Identification (NPI) number to demonstrate and classify the CNS as APRN (National Plan & Provider Enumeration System, 2024). Register: https://brnw.ch/21wIhZx

Expert Nursing Resource/Support

CNSs can be a significant influence on addressing growing nursing shortage crisis in Florida and nationally. The CNS is uniquely prepared and qualified to assess, implement, evaluate and support evidence-based nursing practice in all healthcare settings (NACNS, 2024). More than ever, there is a critical need for expert and experienced nurses to support, mentor, and retain novice and experienced nurses in clinical practice. The CNS plays a vital role as a clinical expert for specific populations in nursing, setting them apart from other advanced practice nurses. The CNS has a clinical focus of nursing practice and nursing sensitive interventions and outcomes for their specialty practice such as reducing hospital acquired infections and complications, length of stay, and unplanned hospital readmissions.

Here is a specific example of how the CNS adds value to aid in the development and implementation of critical clinical programs. At AdventHealth Orlando, the CNS team developed a health equity program focused on preventing readmissions in the African American Diabetic population. This program existed previously but relied on the primary RN to educate the patients and facilitate the connection to resources. Outcomes were variable, and key interventions often missed due to the workload of the bedside nurse. In late 2023, a CNS was hired to guide the program, assisting in program evaluation, development, and deployment. The CNS was able to bridge a significant clinical gap through the refinement of program processes, education of key stakeholders, direct patient consultation, and collaboration with post-acute resources. Since implementation, this population has demonstrated a 23% reduction in readmissions rates overall and an astounding 0% readmission rate for newly diagnosed diabetics in this same population.

To recognize and celebrate the value of the CNS, September 1-7 is national CNS week, an annual event that acknowledges the contributions of the nearly 90,000 Clinical Nurse Specialists (CNSs) in North America.

References

APRN Consensus Work Group, & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: licensure, accreditation, certification & education. https://www.ncsbn.org/3923.htm.

Bureau of Labor Statistics (2024). U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at https://www.bls.gov/ooh/healthcare/registered-nurses.htm

Centers for Medicare and Medicaid Services (2024). Advanced Practice Registered Nurses (APRNs). https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-practice-nonphysician-practitioners/advanced-practice-registered-nurses-aprns

Florida Health Medical Quality Assurance. (2023). Public Data Portal.
https://www.flhealthsource.gov/data-portal/

National Association of Clinical Nurse Specialists. (2024). What is a CNS.
https://www.nacns.org/about-us/what-is-a-cns/

National Plan & Provider Enumeration System. (2023). National Provider Identification Number.  https://www.nppes.cms.hhs.gov/#/

Reed, S. M., Arbet, J., & Staubli, L. (2021). Clinical nurse specialists in the United States registered with a national provider identifier. Clinical Nurse Specialist, 35(3), 119–128.

Regulation of Professions and Occupation, 2023 Fla.Statutes §464.012 (2023). https://www.flsenate.gov/Laws/Statutes/2023/464.012