In 1999, the Institute of Medicine (IOM) concluded that at least 44,000 Americans die in hospitals annually as a result of preventable medical errors. They state that healthcare should be safe and patients should not be harmed by the very care that is intended to help them. Enter the Clinical Nurse Specialist (CNS) - a healthcare professional uniquely prepared to address patient safety issues through collaboration with the healthcare team to facilitate patient safety, quality improvement, and research.

Clinical Nurse Specialists comprise one category within advanced practice nursing. The four categories of advanced practice nursing include clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists. All four categories as well as the scope of practice for each are defined within the professional literature and statutory guidelines.

A CNS is a licensed registered nurse (RN) with either a graduate or doctorate degree from a program that prepares Clinical Nurse Specialists. The American Nurses Association (ANA) has recognized the CNS as a clinical expert in the nursing profession (ANA, 2004).

There has been much written regarding the culture of safety (IOM, 2004). Broader perspectives tend to present approaches to patient safety with a top-to-bottom course that starts with a conceptual view of evidence-based practice or a “safety culture” that launches a search for something to change. Yes, sometimes a cultural change is necessary (Hoff & Sutcliffe, 2006). Culture can be defined simply as “how things are done” in an organization based on norms, beliefs, and values (Stetler, 2003). Stetler summarizes the definition of organizational culture by connecting leadership to informal practices, routine behaviors, and common perceptions.

CNSs are the leaders in the nursing profession. They have influenced initiatives for safe nursing practice by increasing patient safety and quality of care. By observing front-line nursing staff, the CNS can observe clinical practice gaps and design practices to improve patient care. Consider taking your career to the next level by advancing your education or enrolling in leadership courses.

Biography:
Sandra Ann Evans is a clinical nurse specialist in acute care, patient care services at Detroit Medical Center, Detroit Receiving Hospital, Detroit, Michigan.

^{References:
American Nurses Association [ANA]. (2004). Nursing: Scope and Standards of Practice. Hoff, T. J., & Sutcliffe, K. M. (2006). Studying patient safety in health care organizations: Accentuate the qualitative. Journal on Quality and Patient Safety, 32(1), 5-12. Institute of Medicine, Committee on the Work Environment for Nurses and Patient Safety (2004). Keeping Patients Safe: Too Err is Human: Building a Safer Health System. Washington, D. C.: The National Academies Press. Stetler, C.B. (2003). Role of the organization in translating research into evidence-based practice. Outcomes Management, 7(3), 97-103.}