Advances in technology enable medical researchers to generate valuable findings for those working in health care. A CNS may find it difficult, however, to implement this information into clinical practice and at the bedside of her patients. Low staff levels, which place more demands on a CNS, also hamper changes, as does lack of preparation on how to implement new scientific findings.
Clinical nursing specialists fall under the wide category of advanced practice registered nurses, along with nursing practitioners, certified nurse midwives and certified registered nurse anesthetists. As an advanced practice nurse, the role of the CNS overlaps with the roles of other practitioners in education, consultation, research and administrative responsibilities. The ambiguity in the CNS's role can confuse the nurse and further make his integration into a health care organization difficult.
According to the Balanced Budget Act of 1997, a CNS should be reimbursed through Medicare program when undertaking a physician's work. Most states have a coding and billing system to ensure that a CNS receives her reimbursements, but some have been denied reimbursement even after performing physician services. For example, if a physician sees a patient who's already been seen by the CNS on the same day, then the CNS won't be reimbursed. The process of claiming and collecting Medicare reimbursements is often lengthy and complicated.
Title protection regulates the practice of nurses so that only fully qualified nurses can practice. Many states don't have title protection for clinical nurse specialists, who then face the challenge of not being recognized as advanced nurses. As of April 2010, 29 states legally protect the title of "nurse," but only Arkansas, Delaware and Florida specifically protect the title of clinical nurse specialist, according to the American Nurses Association.