The clinical nurse specialist: implementing the role in a hospital setting.

The introduction of a clinical nurse specialist into a functioning patient care setting represents a major institutional change, and implementation of the role should involve all affected staff members. The authors describe how one nurse unilaterally negotiated her role using an exchange theory approach. They make recommendations to help nursing service administrators aid in role negotiation.     

Clinical nurse leader and clinical nurse specialist role delineation in the acute care setting

More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors explore differences and similarities between the CNL and the clinical nurse specialist roles, describing the working strategies between a CNL and clinical nurse specialist, and role delineations that have resulted from their cooperation, collaboration, and planning.     

The role of the clinical nurse specialist

Despite the prevalence of clinical nurse specialists, research suggests that their role remains poorly understood (O'Hanlan and Gibbon 1996). In practice, they fulfil a number of important roles linked to developing practice. Here, the author critically examines the range of roles the clinical nurse specialist may undertake and how they influence patient care.     

The role of the clinical nurse specialist

In this article, the role of the clinical nurse specialist (CNS) at the University Hospital Insel in Bern, Switzerland, is described using four examples from daily practice. The first describes how the CNS may influence patient care by direct care, bedside teaching, or case reviews. Therefore, this form of co-operation with the nursing teams is a very important factor for improving nursing care. The second example is about wound care. Although the CNS work as generalists on the wards, they also have their specialist fields, where they have in-depth knowledge, skills and expertise. The third example describes how a CNS initiated an interprofessional working group with the aim of improving palliative care and palliative medicine throughout the hospital. Although such knowledge already existed in the hospital, it was not easily accessible to all the health care professionals. The fourth example is about project management. A CNS acted as a project leader of a multiprofessional group for pain assessment and management in babies, children and adolescents. This example also shows how a problem occurring in daily practice can be worked out and resolved.     

The role of the clinical nurse specialist in the development of a domestic violence program

In the demanding and ever-changing world of healthcare, CNSs are constantly challenged to define their practice and contributions to the organization. This article describes the multifaceted role of the CNS in the development of an innovative hospital-wide domestic violence program. The strategic use of the CNS, primarily as an organizational consultant, illustrates how nursing practice is improved when the organization is the primary focus.     

The development of the role of the clinical nurse specialist in the UK

The modern development of specialist nurses started in the early 1970s. This article provides a brief history of their evolution and in particular outlines some of the key factors in their emergence as a key care provider in health care today. There is a constant threat that their clinical nursing background and key nursing skills will be sacrificed or substituted by a more medical-oriented approach. The future, therefore, is one of striking the right balance between nursing and medicine sub-specialism and holistic patient care.     

The role of the clinical nurse specialist

AIM: To investigate the current work and role of the clinical nurse specialist. METHOD: Twenty semi-structured interviews were undertaken with clinical nurse specialists and analysed using the constant comparative approach of grounded theory. RESULTS: The clinical nurse specialists (CNSs) in this study identified the communicator-carer role as their key remit. This was perceived as being extremely effective and unique as well as providing the CNS with his or her main source of job satisfaction. Nonetheless, intrinsic desires and external demands create a considerable workload that therefore needs to be prioritised. In addition, the legitimacy of certain demands needs to be challenged to ensure appropriate demands are met and relevant opportunities realised. CONCLUSION: The pivotal role of the CNS might be under threat as it fails to fulfill its original extensive remit, specifically that of undertaking research.     

Product evaluation and the clinical nurse specialist: an opportunity for role development

Product evaluation activity is an area ripe for clinical nurse specialist (CNS) participation and has a high potential for administrative support in a cost-conscious environment. This article describes how product evaluation has evolved in the hospital setting and the levels and scopes of product evaluation activity. A section is included on the relationship between nursing and the materiel management department, its main collaborator in product evaluation. The product evaluation process is described for those CNSs who are unfamiliar with this activity and would like to try this clinically related area to demonstrate cost effectiveness or as the basis for a nursing research project.     

Evolution of robotics in surgery and implementing a perioperative robotics nurse specialist role

Use of robotics is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety). The evolution of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems. A new perioperative nursing role, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed.     

The clinical nurse specialist role in product research and development.

Think about the variety of products used each day in the critical care environment. They include everything from the most sophisticated monitors to the many disposable products. Most products function very well, but when they do not, do you wish you could talk to the person who designed that product? How can your input make medical products work better? The authors describe a career opportunity open to critical care nurses, that of a clinical nurse specialist for a medical products corporation, whose job it is to influence the design and quality of medical products.     

Challenges in the perinatal clinical nurse specialist role

Evolving changes in health care trends and national directives, including recommendations from the Institute of Medicine (1985), are shaping priorities in perinatal nursing care. This paper addresses considerations for expanding the scope of practice of perinatal clinical nurse specialists (PCNS). The role of the PCNS in the participation of healthy policy implementation is one area to activate. Legislative action involving perinatal nurses influences the scope of practice. Expansion of the clinical nurse specialist roles in consultation/education and practice/research is necessary to emphasize preventative health care, program development, and community liaison activities.