Prepare CNSs to lead care, demonstrate value, and improve outcomes across complex healthcare systems

Essential for students, new CNSs, and practicing clinical nurse specialists, this updated text delivers practical guidance for CNS role development, evidence-informed decision-making, quality improvement, care delivery, and systems leadership. With actionable tools, updated competencies, and career-focused strategies, the Fourth Edition supports CNSs as they lead change, strengthen clinical influence, and advance outcomes across care, organizations, and professional practice.

For the new CNS, chapters address credentialing, navigating a first job, managing expectations in an unstructured role, and obtaining third-party reimbursement. For CNSs expanding beyond traditional practice roles, the text includes entrepreneurship, business planning, and marketing clinical innovations, along with system-level content on high-reliability organizations, big data, quality improvement, and program evaluation.Purchase includes online access via most mobile devices or computers.

What’s New:

Expanded history of the CNS role emphasizes historical knowledge as a foundation for shaping future practice

Clinical Nurse Specialist Practice Value Model links CNS practice to outcomes and supports documentation of clinical and economic value

Updated healthcare initiatives include transitions of care, telehealth, social determinants of health, patient safety, Magnet recognition, community engagement, and scholarly dissemination

Updated chapters offer new insights into teaching, mentoring, precepting, conducting research, and leading nursing and interprofessional teams

Expanded global and international perspectives support CNS practice across diverse healthcare settings

Key Features:

Comprehensive coverage of CNS roles, client care, systems leadership, quality, and global practice

Practical guidance for strengthening clinical influence, improving outcomes, leading change, and applying best practices

Career-focused content on credentialing, role development, reimbursement, entrepreneurship, and innovation

Case-based content and practical applications that reinforce applied CNS skills

Renowned expert editors with national leadership, research expertise, and decades of CNS education and practice experience

Contents

Unit 1: The Nature of CNS Practice

Chapter 1. Evolution of the Clinical Nurse Specialist Role and Practice in the United States

Chapter 2. Clinical Nurse Specialist Role and Practice: Conceptual Models

Chapter 3. Clinical Nurse Specialist Comportment: Professional Attributes, Ethical Conduct, and Citizenship

Chapter 4. Nursing Science and the Clinical Nurse Specialist Role

Chapter 5. Nurse-Sensitive Outcomes

Unit 2: Delivering Care to Clients

Chapter 6. Individual as Client

Chapter 7. Family as Client

Chapter 8. Managing Care Transitions

Chapter 9. Population-Based Data Analysis

Chapter 10. Social Determinants of Health: Implications for Clinical Care and Population Health

Chapter 11. Patient-Centered Teaching and Coaching

Chapter 12. Telehealth for Clinical Care

Chapter 13. Consultation in Clinical Nurse Specialist Practice

Chapter 14. Emerging Ethical Issues in Clinical Care

Unit 3: Designing and Evaluating Nursing Interventions

Chapter 15. Emerging Ethical Issues in Clinical Care

Chapter 16. Implementing and Sustaining Evidence-Based Practice

Chapter 17. A Roadmap for Innovation: From Concept to Market

Chapter 18. Evaluating Interventions in Clinical Nurse Specialist Practice

Chapter 19. Conducting Research in the Practice Setting

Chapter 20. Leadership for Advancing Clinical Practice

Unit 4: Creating a Culture of Quality

Chapter 21. Patient Safety

Chapter 22. Application of High Reliability Tenets to Clinical Nurse Specialist Practice

Chapter 23. Use of Data to Support the Role of the Clinical Nurse Specialist

Chapter 24. Improving Efficiency: New Approaches to Quality Improvement

Chapter 25. Clinical Nurse Specialist Practice Supporting Magnet Designation

Unit 5: Professional Engagement

Chapter 26. Preparing the Next Generation of Clinical Nurse Specialists: Establishing and Sustaining a Pre-Graduate Fellowship Program

Chapter 27. Engaging Staff in Learning

Chapter 28. Mentoring

Chapter 29. Student Clinical Experiences: Responsibilities of Student, Preceptor, and Faculty

Chapter 30. Clinical Nurse Specialist Engagement in Professional Activities

Chapter 31. Healthcare Financing and Business Case Development for Clinical Nurse Specialists

Chapter 32. The Practice of Health Policy and Health Policy Advocacy

Chapter 33. Disseminating Scholarly Works

Unit 6: The System-Level Business of CNS Practice

Chapter 34. Economic and Financial Considerations for Clinical Nurse Specialists

Chapter 35. Project Management: An Essential Competency for Clinical Nurse Specialists

Chapter 36. Program Evaluation and CNS Practice

Chapter 37. Technology Management in Complex Healthcare Settings

Chapter 38. Advanced Nursing Practice: Pathway to Entrepreneurship

Unit 7: Entry into CNS Practice

Chapter 39. Practitioner Credentialing for the Clinical Nurse Specialist

Chapter 40. Negotiating Your First Clinical Nurse Specialist Position

Chapter 41. Challenges for the Clinical Nurse Specialist: Structuring an Unstructured Job

Chapter 42. Billing and Reimbursement for Direct Care Services

Unit 8: Global Perspectives of Clinical Nurse Specialist Role and Practice

Chapter 43. Clinical Nurse Specialist Practice: An International Perspective

Chapter 44. Collaborating Across Borders: Memorandum of Understanding between National Association of Clinical Nurse Specialists (NACNS) and Clinical Nurse Specialists of Canada (CNS-C)

Chapter 45. The International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network

Authors

Janet S. Fulton, PhD, RN, ACNS-BC, ANEF, FCNS, FAAN, is the Centennial Endowed Professor in Innovation in Nursing Education Emerita at Indiana University School of Nursing and editor-in-chief for Clinical Nurse Specialist: The Journal of Advanced Nursing Practice. She served nationally as president of the National Association of Clinical Nurse Specialists (NACNS) and coordinator of the Oncology Nursing Society’s CNS Special Interest Group. She designed an innovative distance accessible CNS program, Learn Where You Live; received teaching awards from Indiana University, The Ohio State University Alumni Association, and NACNS; and received leadership awards from NACNS and Sigma Theta Tau, Alpha Chapter. She is also a recipient of the prestigious NACNS President’s Award and was recognized as a Top 100 graduate by The Ohio State University on occasion of the School of Nursing’s 100th Anniversary. She is an American Nurses Credentialing Center (ANCC)-certified Adult Clinical Nurse Specialist and holds fellowships in the National League for Nursing’s Academy of Nurse Educators, the Clinical Nurse Specialist Institute, and the American Academy of Nursing. Dr. Fulton has written in multiple publications including articles, books, chapters and editorials. 

Kelly A. Goudreau, PhD, RN, ACNS-BC, FCNS, FAAN, is a faculty member at North Island College and the University of Victoria in British Columbia. She is an associate editor for the Canadian Journal of Nursing Research and a past president of the National Association of Clinical Nurse Specialists (NACNS). She is licensed as a Clinical Nurse Specialist (CNS) in Oregon and is certified by the American Nurses Credentialing Center (ANCC) as a CNS in adult health. Dr. Goudreau is a recipient of the Brenda Lyon Leadership Award and the President’s Award from NACNS and is a Fellow of the Clinical Nurse Specialist Institute and the American Academy of Nursing. She has published more than 30 journal articles and is the coeditor of two books. Dr. Goudreau holds a Baccalaureate in Nursing from the University of British Columbia in Canada, a master’s in nursing from Washington State University, and a PhD in Nursing from the University of Alabama at Birmingham.

Kristen L. Swartzell, PhD, RN, ACNS-BC, CNE is a clinical assistant professor at Purdue University School of Nursing, West Lafayette, Indiana. Kristen has substantial clinical experience in orthopedics, surgical trauma, and wound and ostomy care, as well as hospital leadership. Her research and publications address health policy and caregiving.  She is certified by the American Nurses Credentialing Center (ANCC) as an adult health CNS and by the National League for Nursing (NLN) as a nurse educator.    

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