Substantive Areas of Clinical Nurse Specialist Practice

ArticleinClinical nurse specialist CNS 23(2):73-90; quiz 91-2 · March 2009with109 Reads
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.
    • "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. "
    [Show abstract] [Hide abstract] ABSTRACT: AimThis paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. Background There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. IntroductionInternational agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. MethodsA literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. ResultsThe review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. Conclusions Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. Implications for Nursing and Health PolicyThe results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes.
    Full-text · Article · Nov 2014
    • "Recently, the National Association of Clinical Nurse Specialists articulated even further the competencies and outcomes of the contemporary CNS practice by introducing a conceptual model of CNS practice, in which the three spheres of CNS influence are the patient/client sphere, the nurses and nursing practice sphere, and the organization sphere (Lewandowski & Adamle, 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.
    Article · Sep 2012
    • "Despite the global trend of adopting ANP in hospital and community settings to ensure accessibility to quality healthcare , the development has not been uneventful (Sheer & Wong 2008, Lewis et al. 2009, Pulcini et al. 2010). In particular, to match with the evolution of the healthcare environments and client care needs, the essential practice characteristics of AP nurses, including roles and responsibilities , have been constantly reshaping, leading to the need of AP nurses to continuously define and redefine the scope of their practice to administrators, healthcare professionals and clients to ensure clear understanding (Bonsall & Cheater 2008, Lewandowski & Adamle 2009). Corresponding education and legal issues surrounding the evolution of ANP have emerged, which require AP nurses to undertake higher levels of postgraduate nursing education and to work through the legislative systems to enact or amend regulations so as to enable the evolution of practice (Phillips 2009, Swider et al. 2009). "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Nov 2011
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