Substantive areas of clinical nurse specialist practice: a comprehensive review of the literature.
ABSTRACT 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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ABSTRACT: This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.Journal of Advanced Nursing 11/2011; 68(8):1780-92. DOI:10.1111/j.1365-2648.2011.05868.x · 1.69 Impact Factor
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ABSTRACT: Both novice and experienced clinical nurse specialists (CNSs) need a consistent orientation to ensure that all in the role have the same knowledge base from an agreed upon set of role expectations. The purpose of this article was to describe an orientation process using the 3 spheres of CNS practice as the framework for a CNS competency validation tool that can be used in all practice specialties and settings. Additionally, the roles of CNS preceptor and CNS mentor are delineated. The orientation tool based on the spheres of influence provides a thorough and consistent orientation for CNSs and may also be used as an educational tool for leadership and other staff regarding the CNS role.Clinical nurse specialist CNS 03/2011; 25(1):18-27. DOI:10.1097/NUR.0b013e3182011eda · 0.90 Impact Factor
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ABSTRACT: The purpose of this article was to describe the collaborative model established between the specialized nurse practitioner (SNP) and the clinical nurse specialist (CNS), within the cardiac surgery population. The literature has shown a trend that SNPs and CNSs work in parallel or even in competition. Little has been written about a collaborative model and the advantages to working together toward a mutual goal. It was felt that a collaborative model between advance practice nurses could demonstrate the advantages of using their unique perspectives to achieve improvement in the quality of care given to the patients. DESCRIPTION OF THE PROJECT/INNOVATION: The Structuration Model of Interprofessional Collaboration was used as a guide to our interventions and elaboration of our project. The team set out to establish, promote, and nurture a collaborative approach to care for the cardiac surgery population from admission to 3 months after discharge. A collaborative relationship was achieved between the SNP and the CNS, to the benefit of the patient population. Collaboration between these 2 advanced practice nurses is realistic and attainable. The advantages to this relationship outweigh the negative feelings harbored toward each professional title. By working in collaboration instead of in parallel, resources are pooled together to achieve greater services and care for the patients. A change in attitude between professionals has a positive impact on working relationships, partnerships, and communication. Ultimately, it is an advantage for the advanced practice nurse, the multidisciplinary team, and the patient.Clinical nurse specialist CNS 25(1):33-40. DOI:10.1097/NUR.0b013e318202104d · 0.90 Impact Factor