Substantive Areas of Clinical Nurse Specialist Practice

Kent State University, College of Nursing, Ohio, USA.
Clinical nurse specialist CNS (Impact Factor: 0.99). 03/2009; 23(2):73-90; quiz 91-2. DOI: 10.1097/NUR.0b013e31819971d0
Source: PubMed


A comprehensive review of the literature was performed to describe the substantive clinical areas of clinical nurse specialist (CNS) practice.
There is lack of understanding about the role of CNSs. Debates over blending CNS and nurse practitioner roles are common, as are questions and uncertainties about new models of advanced practice nursing endorsed by the American Association of Colleges of Nursing. To better understand the role of the CNSs and plan for new models of advanced practice nursing, it is important to know what CNSs say about the nature of their work and examine research related to CNS practice.
The following databases were searched using the terms clinical nurse specialist or advanced nursing practice: Cumulative Index to Nursing and Allied Health Literature, Medline, PsychInfo, Academic Search Premier, ProQuest Dissertations and Theses, PapersFirst, and ProceedingsFirst. Criteria for inclusion in the sample were determined a priori. Data were extracted from each article and abstract using thematic content analysis.
The final sample included anecdotal articles (n = 753), research articles (n = 277), dissertation/thesis abstracts (n = 62), and abstracts from presentations (n = 181). Three substantive areas of CNS clinical practice emerged: manage the care of complex and vulnerable populations, educate and support interdisciplinary staff, and facilitate change and innovation within healthcare systems.
There is a clear conceptual basis for CNS practice, which is substantiated in the literature. Clinical nurse specialists must continue to define this scope of practice to organizations, administrators, healthcare professionals, and consumers.

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    • "Acute care nurse practitioner roles Col; Ldr; Men Synergy model (Edwards 1999) Critical care nursing roles Col; Ldr; Men; Adv University Health Network (UHN) framework for APN (Micevski et al. 2004) Canadian advanced practice roles Col; Ldr; Cha Hamric (Hamric 2005) Clinical nurse specialist role Col; Ldr; Res; Men; Con; Eth Instrument Conceptual framework for advanced practice (Manley 1997) Advanced practitioner and consultant nurse roles Edu; Exp; Res; Ldr; Con; Col; Car Substantive areas of clinical nurse specialist practice (Lewandowski & Adamle 2009) Clinical nurse specialist role Car; Col; Edu; Con; Cha Criterion-based performance assessment for advanced practice nurses (Scarpa 2011) APN roles Ldr; Col; Con; Edu; Res APN clinical competencies (Nieminen et al. 2011) Scandinavian APN roles Exp; Aut; Con; Coa; Col; Evi Competency domains: Adv, advocacy; Aut, professional autonomy; Car, care management; Cha, change agent; Col, collaboration; Com, communication; Con, consulting; Evi, evidence-based practice; Edu, education; Eth, ethical and legal practice; Exp, expert clinical judgement; Ldr, clinical and professional leadership ; Men, mentoring and coaching; Res, research; Tea, teaching. "
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