Integration and Standardization of Clinical Nurse Specialists in a Multihospital System: Exemplars in Practice

In 2013, our multihospital system began the process to integrate and standardize clinical nurse specialist (CNS) practice. The goal was to standardize work and to increase collaboration as part of one system.

An overall job description was established to provide a framework inclusive of the broad areas of practice. Clinical nurse specialists were positioned to support medical-surgical, critical care, or women and children's services offered at community-based hospitals. Main campus and community-based CNSs led significant system integration efforts such as the standardization of nursing policies and procedures across the health system. System CNSs were created to address the needs of specialties common to all hospitals. As an example, a system CNS collaborated with the main campus and community-based CNSs to improve the delirium screening process.

Clinical nurse specialists across the system have been integrated into a single team and report to 1 central director. Efforts to leverage expertise included the creation of a CNS-led practice council, increased communication via regular departmental meetings, and the sharing of resources using electronic platforms. There is now a CNS at hospitals that previously did not have one. The group values the structure and opportunities it provides as evidenced by favorable engagement surveys.

Our integration efforts improved collaboration and could be modified to benefit other care settings.