Perceptions of practicing CNSs about their future role.

The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

The imposter phenomenon describes individuals who at times feel as if they are imposters in their chosen profession. Individuals experiencing the phenomenon have a deep feeling that they are fooling everyone. The title of clinical nurse specialist (CNS) in itself may foster misinterpretations and false beliefs in oneself or others. The term "specialist" implies expertise in the five subroles of the CNS (educator, consultant, research, clinician and manager). Feelings of imposture within the CNS role can precipitate or exacerbate low self-esteem and lead to ineffective role implementation. The phenomenon must be recognized in the CNS and management strategies instituted. Management strategies include peer support, CNS mentoring and self-provided positive reinforcement. Further research is essential to document the existence of the phenomenon within the CNS role and the creation of effective management strategies to prevent or alleviate it.

Purpose and Background. The purpose of this article is to describe how clinical nurse specialists (CNSs) in one organization developed a structured interviewing process for CNS candidates. The process has evolved in relation to implementation of national CNS competencies, growth of the role in the organization, and changes to reporting structure. Outcomes. The CNS interview process includes panel interviews with various organizational leaders, CNSs, and team members. A behavioral-based tool relevant to the CNS role is used. Involving CNS peers in the interview ensures the successful hiring and retaining of suitable candidates. Clinical nurse specialists who were interviewed using the current peer interview procedure have reported satisfaction with the experience. Implications. Peer interviews for CNSs provide a forum for meaningful dialogue about the CNS role, competencies, and fit with the organization. This process can be used for other advanced practice disciplines.

In the present cost containment environment, hospitals often change their employment patterns. Nurses in advanced practice roles are particularly vulnerable to reassignment. In order to determine if the employment of Clinical Nurse Specialists (CNSs) in the Baltimore-Washington area had decreased and to determine what specialty areas employed the most CNSs, a survey of all area hospitals was conducted. The nursing departments of all 88 hospitals were contacted by phone with 40 of them (45%) agreeing to provide data. Seventeen institutions reported employing a total of 119 CNSs. Of these, only 12 required a Master's degree for nurses to hold that position. As expected, larger institutions employed more CNSs. This role appears to be stable, with only two institutions having eliminated CNS positions recently and five reporting plans to add such positions in the near future. Most CNSs reported either directly or indirectly to the Director of Nursing. Those in positions funded by another source reported to personnel in the funding department or agency. Almost all CNSs had clinical titles, and Psychiatric, Oncology, Medical and/or Surgical, Pediatrics or Critical Care were the most prevalent specialties mentioned. The CNS role is a viable role in the Baltimore-Washington area even in this time of cost containment. Most CNSs are identified with their area of clinical specialization.

The role of the clinical nurse specialist (CNS) remains an area of debate. To define this role, it is important to elicit the perspectives of stakeholders, such as the nurses working with the CNS and the patients. However, eliciting such views from those who are dependent on the CNS in some way ‐ either for care or in terms of supervision ‐ can be difficult. Therefore, this study applied a modified Delphi Technique to ascertain these views and define the role of the CNS in a haematology unit. The methodology can be applied to other specialist areas. The clinical nurse specialist role was introduced into the UK following the Briggs report in an effort to advance quality of care and to provide clinical leadership for nursing (Thomas and Ingham 1995). There is now a wide variation in the clinical nurse specialist’s (CNS) role and there has been a proliferation of nursing positions that are referred to collectively under the umbrella term of ‘advanced nursing practice,’ which has led to confusion and ambiguity (Dyson 1997).

Little progress has been made in economic evaluation of specialist cancer and palliative care nursing. A literature review of economic studies of clinical nurse specialists (CNSs) was undertaken to assess how the measurement of economic outcomes has been tackled in the literature to date. The initial search found 400 studies. Abstracts from all the studies were reviewed but only 17 studies met the basic criteria for inclusion, reporting primary cost and outcomes data, and clearly specifying the role of a CNS. All of the studies but one focused on direct patient care rather than other CNS roles and were undertaken alongside effectiveness studies. The economic evaluations considered only a narrow range of costs, but a wide range of outcomes. Specific nursing outcomes were only reported in a minority of studies. None of the studies reported cost-effectiveness ratios. However, CNS interventions were reported to be both less costly and more effective than alternative forms of care, negating the need for further cost-effectiveness analysis. Overall, the papers were not of good quality, reducing the validity of the findings. Robust economic evaluations of the CNS role need to be undertaken. These should involve nursing researchers and practitioners so that evaluations reflect the complex and multidimensional nature of CNS care and meet the required standard of evidence to influence practice.

As cancer care and outcomes improve, self-management becomes a critical aspect of care. Clinical Nurse Specialists roles empower, educate and support individuals with cancer to manage their health confidently. A systematic review following Joanna Briggs Institute guidance and reported in accordance with the PRISMA statement. This qualitative systematic review explored the impact of the Clinical Nurse Specialists role in supporting self-management, confidence and capability in people with cancer. Meta-aggregation was used to synthesise the heterogeneous findings. Five databases (Medline, CINAHL, PsycINFO, EmBase and EmCare) were searched for studies involving individuals with cancer in secondary care settings. Seven studies were included, generating 31 themes synthesised into four categories. All studies highlighted the positive impact of the Clinical Nurse Specialists role on individuals' knowledge, skills and abilities to self-manage. Clinical nurse specialists role in supporting self-management for individuals with cancer. Their holistic approach fosters confidence and empowers patients to effectively manage their health. Findings highlight the value of nurse-led follow-up services empowering patients with cancer to manage their condition, improving overall well-being. Cancer care is moving to a chronic care model.The review demonstrates CNS's positive impact on individuals care and how CNS are well placed to support patients in managing their care from a holistic perspective. This review highlights how qualitative research supports the value of the CNS role in an individual's experience and ability to self-manage their care. This systematic review did not have any public or patient contribution. Cancer care is moving to a chronic care, self-management model. Clinical nurse specialists are well placed to innovate interventions that assist people with cancer to self-manage. PROSPERO Registration Number: CRD42024494021.

The clinical nurse specialist (CNS) is 1 of the 4 advanced practice registered nurse roles and a vital component in palliative and hospice nursing care. The CNS is a specialty expert clinician capable of practicing in a variety of health care settings including acute care, primary care, and specialty ambulatory care. The CNS integrates palliative care standards across the 3 spheres of impact (patient, nurse, and system) to improve care patients receive at end of life, mentoring and coaching nurses in the unique aspects of palliative and hospice care (HPC), and serving as a clinical expert for the organization to ensure best practices and quality outcomes. Clinical nurse specialists are trained to diagnose, treat, and prescribe to provide holistic care to their patients. However, challenges exist for the CNS role due to variations in state regulations regarding title protection and scope of practice leading to inconsistency in and misperception of the CNS role. Clinical nurse specialists have a wealth of expertise that can lead to systematic improvement in patient outcomes, advances in hospice and palliative nursing practice, and management of HPC patients and their families. Clinical nurse specialists are a hidden treasure that should be integrated into HPC practice.

Moving Forward with Role Recognition for Clinical Nurse Specialists

Differences of nurse administrators and clinical nurse specialists regarding components of the clinical specialist role were investigated. To be effective in facilitating the maximum use of the abilities of the clinical specialist, it is essential that nurse educators establish a data base about the clinical nurse specialist role from the perspective of employers and the clinical nurse specialists themselves. Subjects were 54 nurse administrators and 35 clinical specialists from a large metropolitan area. The results indicated that, generally, both groups were in agreement except for the research component. Administrators placed a higher value on research than did the clinical specialists. Both groups valued the clinical practice component with the clinical specialists tending to see themselves more heavily committed to direct specialized patient care than did the administrators. The educational component was also valued with the consultant function receiving the highest rating of all the functions surveyed. The administration component was valued least highly of all the components. It is recommended that nurse educators evaluate their educational endeavors in preparation of clinical specialists especially for research functions, and, also, consultation and those functions supportive of nursing staff.

The purpose of this article is to describe the experiences of an entry-level clinical nurse specialist (CNS) leveraging practice from a structured orientation and mentorship program developed by advanced practice supervisors. An entry-level CNS may experience feelings of ambiguity, role confusion, social isolation, and inadequacy when transitioning into a CNS role. The author applied key components of a transition-to-practice program from a review of literature that includes a standardized competency-based orientation with mentorship, leadership support, and professional development opportunities. An annual portfolio outlined the completion of entry-level CNS outcomes in the 3 spheres of impact: patient care, nursing practice, and health system innovation. A structured CNS onboarding and mentoring program is crucial to support entry-level CNS on transition to practice. Entry-level CNSs are in a position to take action advocating for role clarity, establishing a working relationship with mentors and peers, and maintaining clinical competence through a structured orientation program with mentorship.

The purpose of Clinical Nurse Specialist™: The International Journal for Advanced Nursing Practice is to disseminate outcomes of clinical nurse specialist practice, to foster continued development o fthe clinical nurse specialist role, and to highlight clinical nurse specialist contributions to advancing nursing practice and health policy globally. Objectives of the journal are: 1. Disseminate knowledge about clinical nurse specialist competencies and the education and regulation of practice; 2. Communicate outcomes of clinical nurse specialist practice on quality, safety, and cost of nursing and health services across the continuum of care; 3. Promote evidence-based practice and innovation in the transformation of nursing and health policy for the betterment of the public welfare; 4. Foster intra-professional and interdisciplinary dialogue addressing nursing and health services for specialty populations in diverse care settings adn cultures. Clinical Nurse Specialist is the official journal of the National Association of Clinical Nurse Specialists.

Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments.

BackgroundThe specialist palliative care workforce is experiencing recruitment and retention challenges to Clinical Nurse Specialist (CNS) roles in all settings (Mills, Ven. Prog Palliat Care. 2019; 27(5):203–205; Sleeman, de Brito,...

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.