a) continuously assessing clients’ capabilities to participate in decision-making and use appropriate decision-makers when necessary. Environmental supports involve elements that are generally a joint responsibility of the CNS and administration. 2. The master's-level EBP competencies can be transposed on a crosswalk of the ACE Star Model and the 5 CNS practice domains to form a matrix representing the influence that CNSs can have over the EBP process. The award application process is open to CNLs, faculty, and practice … Identifies human, material and organizational system needs. 5. 3. USA.gov. The CNS’s leadership subrole may take place in a number of different ways in different systems. 12. While the other APNs function primarily as providers, the CNS role encompasses a multitude of healthcare practices. Maintains membership in provincial, federal and/or international professional associations. 11. New York: McGraw Hill. The CNS: May develop collaborative research proposals in his/her clinical nursing specialty, as a primary investigator or co-investigator. The CNS: Supports clients in decision-making regarding health care by: Glossary 2008 Jul-Sep;15(3):91-3. doi: 10.1097/01.JTN.0000337148.21926.71. Ottawa: Canadian Nurses Association. Chaska, The Nursing Profession: A Time to Speak. 2. Promotes an intra-and inter-disciplinary collaborative approach in clinical decision-making by: 5. Critically analyzes socio/political issues and contributes to the political process to influence health outcomes. The clinical nurse specialist (CNS) is an advanced practice nurse (APN) who serves as a clinical expert within a specialty population. Check out one of our sample CNS practice tests, absolutely free. The Commission on Nurse Certification (CNC) is now accepting applications for the 2021 CNL Innovative Project Award. -National Council of State Board of Nursing, Inc. (1986). Applies relevant research and a broad-range of theories to clinical practice using critical thinking and analysis. Clients experience care which is client-centered, innovative, and satisfying. Timely access to relevant clinical and system information. Melnyk BM, Fineout-Overholt E, Feinstein NF, Sadler LS, Green-Hernandez C. J Prof Nurs. 8. Epub 2013 Feb 20. 2007 Oct-Dec;30(4):165-82. doi: 10.1080/01460860701738336. The Clinical Practice Pillar can be further developed to reflect particular requirements of speciality groups. Fundamental to these competencies is that the CNS maintains clinical Assumptions It has an identity defined by a shared domain of interest. The Clinical Nurse Specialist role was introduced to the Canadian health care system in the early 1970’s. Care is provided to clients with varying levels of acuity in highly variable work settings. Hold a current license as a registered nurse (RN). tributions of CNS practice to the health and welfare of the public. The practice setting promotes ongoing learning of nurses. The employing agency/system supports the identification and referral of clients with complex needs. Secondary care include (1) the treatment of temporary dysfunctions that requires hospitalization but not highly skilled services and high risk interventions. 3. 2. Purpose: Acts as a role model demonstrating advanced nursing practice. • Assumptions The CNS provides linkages between systems and transcends traditional boundaries. Position Paper on the Clinical Nurse Specialist. The purpose of this document is to articulate Standards of Practice of the Clinical Nurse Specialist (CNS) within an evolving health care system. Get the latest research from NIH: https://www.nih.gov/coronavirus. 2. The domains of practice include advanced practice, consultation, education, research and leadership. -Quadertiary Care – a highly complex health care available only in a few centres. Each role had distinct expression of the NONPF practice domains, particularly in two areas: management of client health-illness states and the professional role. Expectation of collaborative relationships with nurse leaders and others. In RCH we plan to shine a light on CNS within teams and organisationally. Participates in learning needs assessment related to the professional development of nurses and others. Outcome  |  4. Implications: There was widespread variability in the level of practice both within and between the CNC grades as well as significant differences in job content. b) Facilitating the process of clients’ decision-making about health choices. Each role had distinct expression of the NONPF practice domains, particularly in two areas: management of client health-illness states and the professional role. Progressive change is evident within the CNS’s domain of responsibility. relationship development, problem solving, critical thinking, clinical skills, etc).   -Secondary Care – involves preventing complications of disease conditions. c) Referring the care of the client to appropriate health care professional when the client’s health situations outside the CNS’s scope of practice or clinical competence. Practice within the CNS’s domain of responsibility is positively influenced by research findings. May participate in research projects. Clarifies different perceptions of stakeholders. CNSs first emerged in the 1970s as client care grew more complex. 1. Society of Trauma Nurses position statement on the role of the clinical nurse specialist in trauma. CNS Vital Signs tests and auto-scored results provide the clinician with a broader spectrum of clinical domains and the sensitivity to assessing neurocognitive function is such that they often reveal abnormality in the absence of positive findings in CT and MRI scans e.g. Domain of Research 7. -Canadian Nurses Association (1986). -Advanced Practitioner - one who exhibits in-depth expert competency and in-depth knowledge of nursing and related sciences to provide quality nursing care to individuals, families, groups and community. Specialization in CNS practice includes application of a broad range of theories and research to particular client situations that are within the domain of nursing. Domain of Consultation These two roles evolved from different roots. Nursing knowledge is constantly evolving and increasing in complexity. -Client – an individual, group, family, or community who receives the services of another who is qualified to provide this service. 8. -Smith, R.H., Forchuk, C., & Martin, M-L. (1985). 9. The CNS helps nurses in meeting the current and future needs of individuals, families, communities, populations and the profession by sharing current knowledge. • Introduction Environmental Support for Consultation -Primary Care – the first level of contact and maintenance within the health care system. 1. Standards were developed through consultation from across Canada. Employing systems facilitate research activities including material and non-material support. 6. d) Demonstrating skills and ability to practice when following clients across settings. -Tertiary Care – complex health care available only in specialized health care agencies. There was widespread variability in the level of practice both within and between the CNC grades as well as significant differences in job content. Agreements: CNS is to have a collaborative practice agreement with one or more licensed physicians; this agreement designates the scope of practice/amount of autonomy specific to prescribing, monitoring, and managing drugs. 4. Patient/Client SphereWithin the patient/client sphere, the clinical nurse specialist engages in direct patient care in a variety of settings, including acute care, private practice, or community clinics. 11. The Clinical Nurse / Midwife Consultant provides expert clinical advice to patients, carers and other health care professionals within a defined specialty. Demonstrates the ability and knowledge to participate on research committees. Evidence-based practice: a primer for action. -Advanced Practice - the practice of nursing at a level which requires in depth theoretical knowledge at a graduate level in nursing. Original product version: Windows Server 2012 R2 Original KB number: 825036. For example, client services received from a family practice agency or public health service. 1. In addition, CNS core competencies communicate the expectations of CNS practice to healthcare organizations using CNSs. July 1, 2020. The Clinical Nurse / Midwife Consultant develops, facilitates implementation and evaluates care management plans for … 5. 5. 3. A system exists for the documentation and communication of CNS consultations. Placement in organization systems at level appropriate to impact across individual programs/units/sectors. Develops and evaluates innovative approaches and programs for complex practice issues. 1. Supports nurses in professional development and career planning in furthering their educational qualifications. The organizational placement and position description of the CNS facilitates formal and informal consultations. Developing an empirical base for clinical nurse specialist education. Environmental Support for Education 4. 1. The purpose of this article is to describe master's-level evidence-based practice (EBP) competencies as determined by a national consensus panel and present an EBP matrix that illustrates the influence that the clinical nurse specialist (CNS) practice can have on driving EBP change. Issues Compr Pediatr Nurs. The consultations may be informal or formal. Plans, recommends and collaborates with the consultee. Internal/external committees benefit from CNS representation. Clients demonstrate optimum health J Athl Train. The environmental supports required for optimal enactment of each domain of practice are listed below: • Domain of Advanced Practice 3. The CNS is an advanced practitioner who holds a Masters or Doctoral degree from a nursing program and has expertise in a clinical nursing specialty. 6. Environmental Supports 3. The competencies of the specialist include the ability to assess, conceptualize, and analyze complex problems related to health, and make appropriate recommendations and/or complement a plan of care (Adapted from National Council of State Board of Nursing, Inc., 1986). Evaluates the effects of educational experiences on nurses’ behaviour, and client and system outcomes. -Domains of Practice – (advanced practice, consultation, education, research, and leadership) are an organizing framework for the description of clinical nurse specialist performance. Their work modified Ben- ner's domains of expert nursing practice (1984). 4. 1. The future health care delivery system in the United States. This mean engaging in practice and/or planning care for complex situations or complex client needs. 8. Newbury Park, Califoria: Sage Publications. (You could belong to the same network as someone and never know it.) The CNS may work independently with other nurses or in collaboration with other disciplines or caregivers. 1. They work in partnership with individuals, families and communities and the multidisciplinary care team. The domain: A community of practice is not merely a club of friends or a network of connections between people. Nurses practice in diverse and complex environments and may require consultation with a CNS. • Reference List J Nurs Manag. Identifies and/or creates resources for learning. 1. 5. NLM 1. Policy planning and development demonstrates intersectorial representation. Performance Standards 3. Regardless of where the CNS works, it is always in context of work with others. -Performance Standards – authoritative statements with measurement criteria which describe a competent level of behaviour in the clinical nurse specialist role regardless of specialty or practice setting. The recommendations in this article are for the installation of Windows 2000 Server or Windows Server 2003 environments where there is no previously defined DNS infrastructure. The scope of advanced practice nursing is distinguished by autonomy to practice at the edges of the expanding boundaries of nursings’ scope of practice (ANA,1995). Performance Standards 9. Domain of Education 3. CNS Domains of Practice Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. The CNS's practice can be organized around 5 domains: expert practitioner, researcher, consultant, educator, and leader. -Advocate - an agent who acts on behalf of vulnerable people. 10. The leadership occurs at multiple systems levels. Opportunity for participating in key clinical and nursing decisions. 2. 1. -Criteria – a standard or principle by which a thing is judged. 5. Expands the scientific base of nursing practice by utilizing, facilitating, and conducting research in nursing and other disciplines. 13. For example, transplant units. a) Demonstrating interpersonal communication and leadership skills to promote collaborative care among various disciplines in hospital and/or community. Pediatric Nursing, 16(6), 603-618. These drafts were revised through national consultation. The CNS facilitates others understanding and application of research. The study of nursing science and related arts and sciences provides a basis for advanced practice. Performance Standards References The ACE Star Model conceptualizes the knowledge transformation that must occur in an EBP environment as 5 distinct points: discovery, summary, translation, integration, and evaluation. Implementation of Best Practices Based on Evidence; Quality Improvement; Learn more about the CNL . The domains of practice did not appear to have played a central role in the design of these CNC roles despite being defined in the industrial legislation and linked to a pay structure. This guide provides NUM and applicants with clear organisational expectations of the CNS role. Performance Standards 3. practice. 4. Disseminates recent innovations and research findings relevant to nursing practice and client outcomes. All other domains of practice draw upon advanced practice. Stimulates others to read and interpret research findings in health care literature. Clinical Nurse Specialist (CNS) as the pinnacle in point of care nursing practice. Position Paper on Advanced Clinical Nursing Practice. The core CNS competencies are comprehensive, entry-level competencies and behaviors expected of graduates of master’s and post-master’s programs that prepare CNSs. For example, a low risk birthing centre in a community hospital, or a short term psychiatric unit in a general hospital or community-based ambulatory care centre. -Kaplan, S.M. 4. Anticipates future changes (needs, technology, changing system, professional development) and recommends appropriate changes/implications. It is expected that a CNS is able to meet and exceed all of the requirements of a RN as identified in the professional standards of practice. Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. c) Expanding other caregivers’ understanding of the subjective experience of clients. The Certified Nutrition Specialist® credential (CNS®) is the most advanced certification for personalized nutrition practitioners. This will occur organisationally in Tuesday@2 ceremonies in April and October of each year. 2. A clinical nurse specialist is a registered nurse who holds at least a masters degree in nursing and has expertise in a clinical nursing specialty (Canadian Nurses Association, 1986). 2. • Glossary 4. Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. 4. The emphasis on each Pillar at a particular level of the framework will vary according to specific roles e.g. Nursing research is integral to the development of nursing theory and nursing practice. Leadership is required to advance nursing practice and to promote quality client care. -Role Model – The demonstration of the behaviour associated with a particular position or profession that serves as an example for others. Clients will benefit from the application of current theory and research based practice. 1. The CNS's practice can be organized around 5 domains: expert practitioner, researcher, consultant, educator, and leader. Demonstrates ability to function as an external reviewer for research proposals. J Trauma Nurs. Consultation with care providers allows the CNS to influence the plan of care for clients/families and provide learning to the consultee which can be applied to future situations. Evidence-based practice is a growing and necessary paradigm for nursing care. Demonstrates knowledge of qualitative and quantitative research methods. 2. • Domain of Consultation Get started today! News & Announcements. (3) the provision of counseling and therapy that can not be provided in a primary care centre (Aydelotte, 1983). 7. Please enable it to take advantage of the complete set of features! The CNS: -Canadian Nurses Association (1994). Participates and provides leadership on internal and external committees relating to care delivery, policy and procedure development, research, education and professional development. This article describes best practices for the configuration of Domain Name System (DNS) client settings. College of Nurses of Ontario. Facilitates the implementation of planned learning experiences. 2. Collaborates in the development of nursing roles within a changing health care system. 2. J Athl Train.   Nurse practitioner educators' perceived knowledge, beliefs, and teaching strategies regarding evidence-based practice: implications for accelerating the integration of evidence-based practice into graduate programs. The CNS contributes to the research process through application of research findings and may develop and implement research projects. COVID-19 is an emerging, rapidly evolving situation. The role of the CNS includes five inter-related domains: advanced practice, education, research, leadership, and consultation. Although there are variations in the implementation of the subroles, this implementation always includes the practitioner subrole. The consultee demonstrates an enhanced understanding of the issues. These Standards of Practice for CNS’s identify the additional minimum expectations for CNSs. 2008 May-Jun;22(3):143-8. doi: 10.1097/01.NUR.0000311694.69791.e9. A "hybrid" CNS/NP curriculum faces the danger of lacking both the depth …  |  Since the 1970’s, the Clinical Nurse Specialist role has become well established in hospital, community and independent practice. 2008 May;16(4):409-16. doi: 10.1111/j.1365-2834.2008.00860.x. Perceptions of approved clinical instructors: barriers in the implementation of evidence-based practice. Print or eBook. 2. 9. 7. HHS Human, material and organizational resources are positively influenced. Certification Program: An Information Booklet. International Nursing Review, 32 (6), 175-176, 180. Environmental Support for Research 4. CNSs are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills. (1990). Negotiates with consultee a process for follow up. Acts as a role model and clinical expert in the area of clinical specialty. CNS practice is within the domain authorized by state-regulated initial RN licensure (nursing's autonomous domain and responsibilities implicit in … Identifies learning issues and problems, and assists nurses in strategizing and solving problems related to learning. 4. The Regulation on Advanced Nursing Practice. (1990). The quality of nursing care and/or worklife is evaluated and improved by the CNS’s research activities. concussion. a) Providing clients with the information required to make health care choices regarding care, treatment, and participation in clinical research. A {"}hybrid{"} CNS/NP curriculum faces the danger of lacking both the depth and specificity of knowledge that has resulted in the roles' past successes. Like other APNs, (nurse practitioner, nurse midwife, and certified registered nurse anesthetist) the CNS is educationally prepared with either a master’s or doctoral degree. Flexibility in job description to capitalize on opportunities for leadership. The Clinical Nurse Specialist provides care or plans care for clients with highly complex needs in selected practice situations. Assists in the skill development of nurses (e.g. Nursing’s Social Policy Statement. In N.I. 6. The Clinical Nurse Specialist is a nurse with a Masters or Doctorate degree from a nursing program, with a clinical specialty area who functions in the sub-roles of practitioner, leader, consultant, educator, and researcher (Canadian Nurses Association, 1993). 7. Clinical Nurse Specialists work within complex systems. Negotiates the type and duration of involvement. Assures ethical and legal practices in the conduction of research. as per the Authorization and Proctoring’ system Experience Three (3) years of clinical experience after registration as RGN. 6. Demonstrates advanced knowledge and synthesis of advanced nursing practice within a clinical specialty. Clients may be individuals, groups, families, communities, or populations.   - American Nurses Association (1995). Advocates for client-focused decision-making within the health care deliver system by: The CNS may clarify, recommend and/or educate. Demonstrates advanced knowledge and synthesis of negotiation and conflict resolution. Due to the wide range of specialties in which CNSs practice, these competencies reflect CNS practice across all specialties, populations, and settings. Clin Nurse Spec. Outcome Identifies individuals and systems facilitators and barriers to professional education. Introduction Domain of Advanced Practice 5. -Clinical Nurse Specialist – an expert advanced practitioner who provides direct care to clients and services as a role model and consultant to practicing nurses and others. 5. Demonstrates knowledge and skills in managing organizations and environments. Certified Nutrition Specialists practice science-based personalized nutrition therapy to power people to health. Demonstrates advanced health assessment and clinical decision-making within a clinical specialty. 7. Presents rounds and/or workshops on areas of expertise at local, regional, provincial, national and/or international forums. (2) the evaluation of long-term illness that requires hospitalization to determine any needed change in treatment. Chicago: National Council of State Board of Nursing, Inc. -Powers, B.A., & Knapp, T.R. Develops a collaborative relationship with the consultee. Get the latest public health information from CDC: https://www.coronavirus.gov. 1. Collaborates in the development of strategic and program planning and evaluation to foster innovation. Documents analysis, findings, and recommendations. Clinical practice includes both direct client care and indirect ... the CNS and NP. New CNL Innovative Project Award. The practice of the clinical nurse specialist is based on in-depth knowledge of nursing and behavioural and biological sciences. The CNS can advocate for environmental supports but it is an administrative responsibility to provide them. -Theory – A theory is a set of statements that tentatively describe, explain, or predict relationships between concepts that have been systematically selected and organized as an abstract representation of some phenomenon. The employing system allows flexibility of work hours for both learners and educators to meet the learning needs of staff on varying work schedules. The consultee is able to generalize and apply the new knowledge to other situations. Over 1,000 questions covering every BCNS study domain. Communicates the importance of nursing research to clinical practice and theory development. CNS domains of practice are within nursing's scope of practice. Washington, D.C.: Author. The domains of practice did not appear to have played a central role in the design of these CNC roles despite being defined in the industrial legislation and linked to a pay structure. This license should either be issued by an official body in the United States or by a legally recognized licensing body elsewhere. Share knowledge of client’s perspectives during policy development and planning. Fenton (1984, 1985) studied CNSs, whereas Brykczyn- ski … The employing agency/system supports the advanced practice of the CNS by promoting flexible time arrangements and protected time for the provision of direct care. 9. The Clinical Nurse Specialist facilitates the empowerment of clients related to public policy issues. 3. 2. Demonstrates advanced knowledge and synthesis of therapeutic counselling modalities. What is the CNS credential? Study Design ORGANIZING FRAMEWORK Research regarding master's-level role domains and competencies by Fenton and Brykczynski (1993) led them to develop a model to guide CNS and NP CNS/NP PRACTICE DOMAIN COMPARISON 283 curriculum development. The nurse participates in research to improve the quality of nursing care and communicates and uses research findings. The master's-level EBP competencies can be transposed on a crosswalk of the ACE Star Model and the 5 CNS practice domains to form a matrix representing the influence that CNSs can have over the EBP process. The role of the CNS includes five inter-related domains: advanced practice, education, research, leadership, and consultation. Guaranteed to raise your score. The nurse as change agent. 2008 Jan-Feb;24(1):7-13. doi: 10.1016/j.profnurs.2007.06.023. 2013 May-Jun;48(3):382-93. doi: 10.4085/1062-6050-48.1.18. Systems exist for the CNS to receive formal and informal consultations. 7. The Dictionary of Nursing Theory and Research. 1. The standards enable the quality of advanced practice, consultation, education, research and leadership to be judged. View CNL FAQs . Demonstrates advanced knowledge and synthesis of teaching and learning theories for individuals and groups. 2. practice domain, and the enviro nment domain. 6. Mechanisms exist for communication and documentation of research activity. The CNS strives to optimize client(s) involvement to the extent possible within cognitive and developmental abilities. • Environmental Supports 4. Consultation may be requested by nurses, other health professionals, clients, families, or groups. is means that nurses hav e to seek out knowl-edge from all of these sectors to apply in clinical . 6. CNSs provide leadership for other nurses, clinical programs, research programs, and client care. The domain of advanced practice is the foundation of the Clinical Nurse Specialist role. 8. 14. 1. 2. The CNS: Advanced Practice Nursing Roles Clinical Nurse Specialist vs Nurse Practitioner …How to decide the right role for you… Clinical Nurse Specialist (CNS) Nurse Practitioner (NP) What is… A Clinical Nurse Specialist (CNS) is an expert clinician who works in a specialized area of nursing practice.  |  Several provincial Interest Groups drafted standards for the sub-roles. The focus of the consultation may be at the individual, group, program, or systems level. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Navigating the evidence-based practice maze. CNS: A CNS is registered nurse with advanced nursing knowledge and skills in making complex decisions who holds a master’s or doctoral degree in nursing with expertise in a clinical nursing specialty. Demonstrates advanced understanding and synthesis of the role of the CNS within the nursing profession and the health care system. 8. 8. Participates in employee recruitment, selection, career development and performance appraisal. The first position paper by Canadian Nurses Association (CNA) on the role of the CNS was accepted in 1973. The advanced practitioner may work in areas of primary, secondary, tertiary and quadertiary care, in health care agencies, or in an independent practice. 10. Clipboard, Search History, and several other advanced features are temporarily unavailable. Domain of Leadership • Domain of Research -Change Agent – an individual who facilitates in problem-solving, strategic planning, and change projects (Kaplan, 1990). Nurses and others will demonstrate the acquisition of knowledge and skills in their clinical practice. Ottawa: Canadian Nurses Association. May be appointed or cross-appointed to a university or college. Environmental Support for Leadership Nurses and others will identify and utilize the CNS as a resource in meeting learning needs. 4. CNS role descriptions include research activity. Prepare for the exam efficiently & effectively with our up-to-date questions & helpful explanations. NIH Primary What? Outcome • Domain of Education They practice in collaboration with other health care professionals to promote health, prevent disease and to diagnose, access and manage health needs. The CNS uses advanced knowledge and skills to assist in clarifying issues, exploring options, facilitating change, creating new possibilities.   The CNS is an agent of change who brings value to clients, practice settings and organizations to improve safety, promote positive health outcomes and reduce costs. Membership therefore implies a commitment to the domain, and therefore a shared competence that distinguishes members from other people. It implies the delivery of a complex set of services and the assumption of responsibility for obtaining special services as required by the patient, in a manner that is responsive to patients’ needs and cultural values (Smith, Forchuk, & martin, 1985). Evaluates outcomes of policy decisions and communicates findings. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Environmental Support for Advanced Practice b) Assessing, analyzing, identifying priorities evaluating and creating plans for highly complex situations with clients and other caregivers. Influences the quality of nursing practice. Demonstrates advanced knowledge and synthesis of theory related to consultation for individuals, groups and systems. Questions were written & improved by a team of real-life CNS exam takers who hold graduate degrees & practice in the field of nutrition. APN focuses on the clinical domain in a wide array of practice settings. 3. Prepare with our CNS Study Guide and Practice Questions. Demonstrates and promotes critical thinking which leads to the formulation of research questions and hypotheses. -College of Nurses of Ontario (1987). 6. Client care is evidenced and reflects current knowledge. Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators. Although there are variations in the implementation of the subroles, this implementation always includes the practitioner subrole. • Domain of Leadership The role of the clinical nurse specialist includes the following components: practitioner, leader, consultant, educator and researcher. 15. Performance Standards 1. 2011 Sep-Oct;46(5):514-22. doi: 10.4085/1062-6050-46.5.514. Using a set of criteria, the standards define the uniqueness of the Clinical Nurse Specialist by addressing five domains of practice. The Clinical Practice Pillar also contains common elements of practice which are applicable to all practitioners. 3. -Aydelotte, M.K. In the case of private/independent practice, the CNS may be responsible for both domains of practice and environmental support. -Specialty – a defined area of clinical or functional nursing practice requiring a narrowed focus and in-depth knowledge and skills to meet the full range of client needs in that area of nursing (College of Nurses of Ontario, 1987). Nursing knowledge is validated or generated. Each competency falls well within the practice domains of the CNS, making the CNS an ideal person to lead the EBP movement forward, providing tangible outcomes to further demonstrate the need for the CNS role. 3. There are three domains of CNS practice, known as the three spheres of influence (Mayo, et al,2017; NACNS 2004): Patient; Nursing personnel; System (healthcare system) The three spheres are overlapping and interrelated, but each sphere possesses a distinctive focus. The employing system supports the identification of nurses’ learning needs 3. (1983). Background: National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Clinical nurse specialists engage in three domains of practice, known as the three spheres of influence: 1. Resources are available and accessible to education which recognizes variability of learning styles. Master's-level EBP competencies based on these 5 steps were established by a national consensus panel. b) Involving clients in decisions related to their care. 7. The employing agency/system ensures that mechanisms are in place for documentation and communication. The CNS … This mean engaging in practice and/or planning care for complex situations or complex client needs. CNS’ may demonstrate leadership …   5. Administrative structure facilitates consultation to the CNS by nursing staff, other health professionals, clients, families, and communities. 10. The role of the Clinical Nurse Specialist as an advanced practitioner is based on autonomy of practice, in-depth theoretical nursing knowledge, clinical experience, and research application. 6. The employing agency/system shares accountability for inter- and intra-professional communication and planning for optimal health care.