Career Outlook of a CNS

Siew Lee Grand-Clement, MSN, RN, CPHQ, CPPS, CLSSBB is a 2006 alumna of the Johns Hopkins School of Nursing Adult-Gerontological CNS

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Siew Lee Grand-Clement has had an impressive 20-year career in health care quality management, improvement, and patient safety—yet the path was not always crystal clear.

CNS tracks in the DNP Advanced Practice Program

After completing her BSN and working as an ICU nurse for a few years, Siew Lee considered many further education options. She ultimately became a clinical nurse specialist through the Critical Care CNS program at Johns Hopkins after learning that CNS’s are “The fabric of, and an expert to, the health care system they work in, and the position that understands systemic needs among patients and staff to advocate for them.” This description is from Sharon Olsen, the previous CNS program director; the current program director is Dr. Michelle Patch. In a talk with the Johns Hopkins School of Nursing community, Siew Lee reflected on her career. She uses her CNS education every day.

A particularly transformative experience was when she was exposed to health management improvement and Lean Six Sigma initiatives for infection reduction and improving effectiveness and efficiency. Six Sigma is a set of techniques and tools for process improvement.

”I became one of the first three staff of The Joint Commission International (TJC) to be certified in Lean Six Sigma Black Belt (a certification that means I can explain Six Sigma philosophies and principles, including supporting systems and tools) and faculty in that arena,” she said. “I led trainings and improvement initiatives for health care organizations around the world and we reduced the number of avoidable health care acquired conditions across the hospital system.”

One of Siew Lee’s first positions was not quite a traditional CNS role.

Now at the University of Pittsburgh Medical Center (UPMC) – China, Siew Lee is Vice President of Clinical Operations, Nursing, and Quality. “It’s my dream job,” she said. The position allows her to learn and apply her cumulative experience and skills in her daily work.

She is leading the effort to design and operationalize the first tertiary private academia medical center in China that will aim to achieve the highest quality recognition from China’s regulatory body as well as the international standards of Joint Commission International (JCI) accreditation. Her call to action as she builds the team? “If you’re an adventurous pioneer who wants to bring excellent health care overseas, join us!”

Looking back on her decision to become a CNS, Siew Lee has no regrets on this “beautiful, rewarding path, with never a dull moment.” And she offered a few words of wisdom for nurses considering a career as a clinical nurse specialist.

First, recognize the value of your clinical and system expertise in understanding opportunities to improve health care. It will be particularly valuable as a CNS, since the role helps ensure effective and efficient care through direct patient interaction, nursing practice, and systems/organizations. “Balancing the intersection of those three spheres can be both challenging and inspiring,” she said.

Second, consider the customer in the issue at hand and advocate for their voice. Look at the micro and macro process and system, and make a business case to reach the end goal. The CNS role offers a lot of autonomy to be creative, research evidence-based practice, and find solutions. By understanding what quality measures look like, a CNS can propose a proper investment of budget, staff, rooms, and resources to ensure that care is done right. “It is critically important to measure work and successful outcomes during the uncertainty presented by COVID-19,” she said.

And last, she reminded the Johns Hopkins community of Dean Davidson’s message that we must not be afraid to try and must never stop asking why. There are so many paths within nursing that the choices can be overwhelming, but Siew Lee said, ”Don’t worry too much, just stay open to opportunities and possibilities.”

And don’t forget the networking! “Ask questions to understand what people do and get advice on how to get there, and volunteer in professional organizations,” she said.  “One meeting led to my entire career! I have loved each job, with each building on the next. So just enjoy the journey and have fun!”

Read more:

• Career Services at the Johns Hopkins School of Nursing
• Advice to Nurses Considering a Career in Oncology
• 9 Tips to Ace a Nursing Career Fair

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