Clinical Nurse Specialist (CNS)

It was not until 1963 that the federal Professional Nurse Traineeship Program was expanded to include education for clinical nurse specialists (Holmes, 1998). With advancing technology and the demanded for increasingly specialized health care, the role of the CNS has become increasingly important, together with the roles of NP, nurse midwife and nurse anesthetist.

The roles of CNS and NP have diverged so that the CNS is found chiefly in an acute care institution, while an NP is more likely to be found in a community setting and involved in health promotion and physical assessment in an outpatient setting (Page and Mackowiak, 1997). In her work setting, the CNS has broad experience with the acutely ill hospitalized patient. She has more knowledge, expertise and experience in specialized areas of nursing than can be learned in a basic nursing diploma course.

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e CNS is also expected to serve as a leader, educator and consultant, and to effect changes which will result in quality, but cost-effective, care. She should have expertise in ôsystems theory, program evaluation, outcome management, evidence-based practice, leadership and group processes, and continuous quality improvement.ö The NP role developed along somewhat different lines, and to fill a different need than that of the CNS. While the CNS works in a hospital setting, the NP works primarily in an outpatient setting. The role evolved to fill the need for community health care. The advanced training of an NP provides a nurse with the knowledge and skills to become the most effective provider of preventive medicine and screening services in an outpatient setting (Thomas, 2001). In 1997, the Balanced Budget Act expanded significantly the Medicare coverage for preventive and screening services, and also allowed NPS to be reimbursed for Medicare Part B services at 85 percent of physician reimbursements. This opened many new avenues for NPS to follow, and also helped cut costs for Medicare as many patients sought these services from an NP rather than a physician (physicians are known to order a greater number of, and more expe
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Approximate Word count = 1234
Approximate Pages = 5 (250 words per page)

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