The idea for the symposium in this issue of AACN Advanced Critical Care came to me at the National Teaching Institute in Denver, Colorado, May 2014. A colleague, Roberta Fruth, a senior consultant with JCR Consulting, and I were discussing the challenges of the current health care environment. In her role, Dr Fruth consults with health care institutions on how they can create high-reliability organizations and improve patient safety. Dr Fruth commented that the complexity of today’s patient populations, the financial pressures of organizations, and the demands of the regulatory environment present overwhelming challenges to frontline staff. Her comment to me was that organizations need the expertise of clinical nurse specialists (CNSs)—to provide leadership in clinical expertise, quality improvement efforts to optimize patient outcomes, and professional advancement of the nursing staff—but the contributions of CNSs are not well recognized. As a CNS myself, of course I totally agreed!

Why don’t all organizations use CNSs? Some senior leaders lack an awareness of the CNS role or the contributions CNSs provide in achieving organizational goals. I have heard some chief nursing officers comment that CNSs don’t generate revenue; therefore, they are seen as a costly investment to a nursing department. This statement is only partially true—CNSs functioning in the traditional role don’t typically bill or generate revenue, but neither do nurse managers, nursing directors, staff nurses, or educators. Yet all, like CNSs, play valuable roles in the delivery of optimal care to patients and the functioning of the health care institution. So how do we increase the visibility of the wonderful outcomes CNSs can and have achieved?

I continued to think about our conversation as I attended sessions at the National Teaching Institute and realized how many of the presenters were CNSs highlighting the good work they were doing in cost avoidance, decreasing lengths of stay, optimizing patient safety, improving patient outcomes, and mentoring staff nurses in evidence-based practice and professional presentation opportunities. All these contributions add value and are critical elements in improving health care delivery. It became clear that AACN Advanced Critical Care could highlight some of these success stories.

Therefore, this series provides examples of the work of CNSs. Lisa Soltis describes an interdisciplinary quality improvement project she led to improve the care of cardiovascular surgical patients in improving early extubation times after surgery. This project resulted in significant decreases in length of stay, decreased intensive care unit readmissions, and impressive cost savings. Stacy Jepsen describes a group effort in her institution to develop a CNS scorecard, clearly documenting to senior leaders the tangible outcomes of CNS-led quality improvement efforts. Dave Hanson highlights the valuable role CNSs play in the achievement of Magnet recognition. Finally, Paul Thurman describes one state’s efforts to ensure that CNSs are legally recognized as advanced practice nurses, protecting the use of the title and ensuring that CNSs are afforded the opportunity to practice to the full extent of their education and training, as recommended by the Institute of Medicine’s1 The Future of Nursing report.

Kenneth Davis, chief executive officer and president of Mount Sinai Health System in New York City, recently wrote in The Wall Street Journal:

The Affordable Care Act, as well as changes in how employers and insurance companies address health care, will try to change these disincentives and encourage health-care providers to manage populations…. However the population is defined, in the near future a hospital’s healthcare delivery network will be paid a certain amount to care for a given population.2 

Clinical nurse specialists are uniquely prepared to improve the care of patient populations—whether in acute and critical care settings, the ambulatory/clinic setting, or in the transitions of patients between settings. The articles in this series highlight some of the work CNSs do in improving that care. I hope these examples help you provide education to health care leaders, staff, and patients about the valuable contributions of CNSs.

Institute of Medicine
The Future of Nursing: Leading Change, Advancing Health
Washington, DC
The National Academies Press
Hospital mergers can lower costs and improve medical care
The Wall Street Journal
Accessed December 20, 2014


The author declares no conflicts of interest.