Outcomes assessment applied to CLS curriculum revision evaluation.

OBJECTIVE: To describe the application of outcomes measurement and assessment to curriculum revision. SETTING: A baccalaureate level clinical laboratory science (CLS) program in an academic health center. PRACTICE DESCRIPTION: Professional portion of CLS educational program. PRACTICE INNOVATION: Curriculum revision. MAIN OUTCOME MEASUREMENTS: Student retention, remediation and performance data; student, employer and faculty feedback. RESULTS: Outcome measures indicated which innovations were successful and which were less successful. CONCLUSION: Outcome measures can provide valuable information and guidance for curriculum evaluation, renewal, improvement and redesign.     

An entry-level MS degree in clinical laboratory science: is it time?

OBJECTIVE: The study was undertaken to address the following questions: 1) Does the scope of practice of the clinical laboratory scientist require an entry-level master's (MS) degree? 2) How would a change to an entry-level MS degree in clinical laboratory science (CLS) affect educational programs, the practice field, and students? and 3) Based on this study, what recommendations can be made to CLS educators? DESIGN: Surveys were developed to assess the opinions of educators, managers, and practitioners on the need for an entry-level MS degree in CLS. Surveys were also sent to students to assess their interest in an entry-level MS degree and their perceptions of the advantages and disadvantages of this type of program. Surveys sent to educators included questions addressing the effect of a change to an entry-level MS degree in CLS on enrollment and program viability. Managers were asked questions concerning job expectations and compensation for graduates with an entry-level MS degree and practitioners were asked about their interest in this type of program. PARTICIPANTS: The sample for the survey included 280 directors of National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) educational programs, 600 managers randomly selected from the Clinical Laboratory Management Association (CLMA) mailing list, 600 practitioners randomly selected from the American Society for Clinical Laboratory Science (ASCLS) mailing list, and 1400 CLS students selected by program directors. MAIN OUTCOME MEASURES: Educators, managers, and practitioners were asked to read 12 statements related to educational preparation for entry into CLS and indicate their level of agreement on a five point scale. Mean responses to these questions were compared for educators, managers, and practitioners, for educators in hospital-based and university-based programs, and for managers with BS and advanced degrees. Responses to demographic and other forced-choice type questions related to entry-level MS programs were counted and reported. RESULTS: Response rates of 58% (educators), 28% (practitioners), 39% (managers), and 40% (students) were obtained. Educators, managers, and practitioners all agreed that the scope of practice of CLS does not require an entry-level MS degree and that the MS degree is appropriate for those practitioners who wish to further their education. There were no major differences in educators', managers', and practitioners' responses to questions on the need for an MS in CLS. Students indicated that they would be interested in an entry-level MS program if the additional education would give them higher salaries and more job opportunities. Students who entered their CLS program with a baccalaureate (BS) degree were more interested in the entry-level MS option than students who entered with an associate degree or high school diploma. Managers indicated that they would not pay a graduate with an entry-level MS degree more than a graduate with a baccalaureate degree. CONCLUSION: There is currently no support for an overall change from the BS degree to the MS degree as the entry-level requirement for CLS practitioners. Entry-level MS programs in CLS may be attractive to students who already have BS degrees.     

CLS advanced degrees and career enhancement. Part 2--A comparison of perceptions.

OBJECTIVE: To determine whether recipients of clinical laboratory science (CLS) advanced degrees (MS) perceive greater career enhancement value related to earning an advanced degree than is perceived by their baccalaureate level (BS) colleagues. DESIGN: Two questionnaires were used-one for certified or licensed CLS professionals who had earned MS CLS degrees; the other for matched BS CLS colleagues. SETTING: Five academic programs that conduct both National Accrediting Agency for Clinical Laboratory Sciences accredited CLS education and CLS MS degree programs participated. PARTICIPANTS: The number of survey respondents was 220 (117-MS; 103-BS level controls). The groups were matched for gender, residence region, and years of experience. MAIN OUTCOME MEASURES: The primary outcome measurements were the perceived benefits of having a CLS MS degree, the reasons for and against obtaining a CLS MS degree, and the overall evaluation of CLS degree programs at both levels. RESULTS: The highest perceived benefit of having a CLS MS degree was the same in both groups, "enhanced self esteem and confidence". The highest priority motivation of MS degree recipients for obtaining a CLS advanced degree was "personal satisfaction". The highest priority reason of the BS group for not obtaining a CLS advanced degree was "family obligation". In both levels of degree programs the subject most commonly cited as needing modification was laboratory management. CONCLUSION: The results indicate that CLS professionals who have CLS MS degrees perceive a greater career enhancement value of advanced CLS degrees than their BS level colleagues.     

Introducing clinical laboratory science: CLS students help shape the future.

OBJECTIVES: The profession of clinical laboratory science (CLS) is in dire need of increased exposure to young people. By introducing the clinical laboratory sciences to students at a critical point in their science education and by making it relevant to their lives, more choices are made available to them when considering future career options. With this in mind, the CLS faculty at Texas Tech University Health Sciences Center (TTUHSC) redesigned a recruitment program and developed it into one making use of CLS student knowledge, enthusiasm, and professionalism. CLS students were given the assignment of designing an entire curriculum for a ten day presentation of clinical laboratory science topics to middle and secondary school students. Following the presentations, participants in the program were asked to provide feedback regarding CLS student performance and overall opinion of their interest in clinical laboratory science. The objectives of this study were twofold: 1) to determine if educational methodologies could be appropriately applied by CLS students to present CLS disciplines to middle and high school students; and 2) to determine if the student presentation was successful in initiating interest in the CLS profession based on outcome measures. DESIGN: As a component of the CLS laboratory management course, CLS students were instructed in education methodologies including objective writing, teaching-unit preparation, and evaluation tool design. In the following semester, these students were divided into groups and assigned a specific CLS discipline that would then be presented to middle and secondary school students in a two week, 30 hour educational program. This program was offered by the TTUHSC CLS program in cooperation with the Institute for the Development and Enrichment of Advanced Learners (IDEAL) at Texas Tech University. The curriculum prepared by the CLS students (with faculty supervision) provided the framework for the present study. SETTING: Didactic instruction of the CLS students regarding objective writing, curriculum design, and preparation of evaluations was included as a component of a CLS laboratory management course. The educational program presented by IDEAL in conjunction with the TTUHSC CLS program within the School of Allied Health Sciences occurred in the CLS student laboratories located in Lubbock, Texas. PARTICIPANTS: TTUHSC senior CLS students in a 2 + 2 baccalaureate level CLS program acted as instructors in the educational program which was presented to middle and secondary school students from around the region. CLS program faculty served as supervisors of this program. MAIN OUTCOME MEASURES: Questionnaires with Likert-scaled responses were used to evaluate outcomes. These questionnaires regarded 1) faculty assessment of CLS student performance relative to instruction in education methods; 2) participant feedback on the effectiveness and competence of the CLS student instructors and overall appeal of the presented subject material; and 3) peer evaluations of attitude, contribution, and effort of the group members. RESULTS: CLS faculty strongly agreed that the CLS students demonstrated a high level of competence when writing objectives, planning age-appropriate curriculum and activities, and demonstrating a positive image of the profession. Regarding satisfaction of the IDEAL student participant, questionnaire responses demonstrated a high rate (84% or greater for middle school participants and 85% for high school students). The program design has been so successful that it has been implemented for several other programs offered by TTU and IDEAL. CONCLUSION: The education methods used in presenting the IDEAL program mirror those found in clinical and academic settings and is an effective technique to introduce CLS students to the varied aspects of educational methodology. The presentation by the CLS students also demonstrated that introduction of clinical laboratory science disciplines early in the education of middle and secondary school students leads to an interest in the CLS profession and to the desire to learn more about it.     

CLS advanced degrees and career enhancement. Part 1--Comparison of career data.

OBJECTIVE: Determine whether recipients of clinical laboratory science (CLS) advanced degrees (MS) experience greater career achievements than their baccalaureate level (BS) colleagues. DESIGN: Two similar questionnaires were used-one for certified or licensed CLS professionals who had earned advanced CLS degrees (MS); the other for matched BS CLS colleagues. SETTING: Five academic programs that conduct both National Accrediting Agency for Clinical Laboratory Sciences accredited CLS education and CLS MS degree programs participated. PARTICIPANTS: The number of survey respondents was 220, 117 with advanced CLS degrees and 103 BS level controls. There were 99 matched pairs, i.e., 198 individuals were matched for gender, residence region, and years of experience. MAIN OUTCOME MEASURES: Careers of BS vs. MS respondents were statistically compared, e.g., fractions with managerial level jobs, relative earnings increases per year, numbers of publications and reports, and other professional contributions. RESULTS: Compared to their BS degree controls, MS degree respondents had more managerial level jobs (62% MS; 36% BS), a higher frequency of job change (once per 4.3 years MS; once per 5.9 years BS), and a higher increase per year of earnings (9.1% MS; 8.1% BS). A greater percentage of the MS degree graduates (77%) than the BS level controls (33%) had authored external publications; the responses related to authorship of institutional reports and procedures were less different-84% MS and 64% BS. Professional contributions to their institutions or profession were cited slightly more frequently by the MS graduates (65%) than by the BS level controls (55%). CONCLUSION: Compared to their matched BS level CLS colleagues, CLS MS degree recipients had greater job mobility, greater management authority, higher salary, and more numerous professional contributions.     

Tracing our roots: a new era in clinical laboratory science education.

OBJECTIVE: To describe the emergence of laboratory personnel at the technician and assistant levels and discuss educational issues that arose between 1962 and 1977. DESIGN: A survey of literature on the history of clinical laboratory science (CLS) was conducted. References consulted include various books and professional journals. CONCLUSION: Advances in scientific and medical knowledge and the development of new technologies created new roles and responsibilities for medical technologists (MTs) in the areas of education, research, and laboratory management. At the same time, the certified laboratory assistant (CLA) category was established as a means of providing competent personnel to work in physician office laboratories and small community hospitals in lieu of a certified MT. The growth in popularity of two-year colleges and the availability of federal funding for the development of allied health programs led to the establishment of yet another category of laboratory personnel: the medical laboratory technician (MLT). These developments prompted educators to modify their CLS curricula, develop educational programs at the CLA and MLT levels, and provide opportunities to CLAs, and MLTs for upward mobility. Furthermore, once the Board of Registry (BOR) established the baccalaureate degree as the prerequisite for MT certification, educators also began to restructure and more closely integrate the academic and clinical components of MT programs.     

CLS competencies expected at entry-level and beyond.

OBJECTIVE: The study was undertaken to assess educators', practitioners', and managers' perceptions of the future job expectations of clinical laboratory scientists (CLSs) and their opinions on the skills that are expected of CLSs at entry-level and with experience. DESIGN: Survey participants were given a list of 44 competencies related to clinical laboratory science (CLS) practice and were asked whether they would expect a graduate of a respected CLS program to perform each competency in one of three educational categories: the first year of practice, with three to five years of experience but no additional education, or with three to five years of experience plus additional education. The competencies were subclassified into one of four major management functions: laboratory operations, human resource management, financial operations, or communications/consultation. Surveys also included eight Lickert-type questions designed to assess the respondents' opinions on the future job expectations of CLS practitioners. PARTICIPANTS: The sample for the survey included 280 directors of CLS educational programs, 600 managers randomly selected from the Clinical Laboratory Management Association (CLMA) membership, and 600 practitioners randomly selected from the American Society for Clinical Laboratory Science (ASCLS) membership. MAIN OUTCOME MEASURES: The percent of respondents selecting each educational category was tabulated and each competency was assigned to one educational category based onthe highest percent of respondents selecting that category. The means of the responses to the Lickert-type questions were calculated for all respondents and for each group of respondents (educators, managers, and practitioners). RESULTS: Response rates of 58% (educators), 28% (practitioners), and 39% (managers) were obtained. Of the 44 competencies in the survey, four were expected at career-entry, 17 were expected of CLS graduates with work experience but no additional education, and 23 were expected of CLS graduates with experience plus additional education. Competencies expected in the first year of practice were primarily scientific and technical. With three to five years of practice and no additional education, the expectations for practitioners were primarily in laboratory operations and communications/consultation areas. The majority of the human resource management and financial operations competencies were expected with three to five years of practice and additional education. All participants agreed that CLS staff-level practitioners need more management and administrative skills and that, in the future, CLS practitioners will spend less time performing laboratory tests and more time solving problems. CLS managers were more positive than CLS educators in response to statements asserting that CLT practitioners and non-certified personnel will have an increased role in the laboratory in the future. CONCLUSION: This study suggests that extensive laboratory operations and communication skills are expected of CLS graduates without any additional education beyond their CLS programs. CLS educators should adequately address those areas in the curriculum. Competence in other non-technical skills may not be expected without the benefit of post-baccalaureate education and in these areas, CLS programs can provide a foundation for future learning.     

CLT and CLS job responsibilities: current distinctions and updates.

OBJECTIVE: This study was undertaken to address the following questions: 1. What tasks distinguish the job of a clinical laboratory scientist (CLS) from that of a clinical laboratory technician (CLT)? 2. What changes in role distinctions, have occurred for entry-level CLS and CLT practitioners over the five-year period 1993-98? 3. What tasks have been deleted from the CLT and CLS content outlines because they were not frequently performed or not considered entry-level? 4. What changes in practice are reflected in the current job analyses? DESIGN: A national job analysis of tasks constituting the job of clinical laboratory scientists (CLSs) and clinical laboratory technicians (CLTs) was conducted in 1998-99 as part of a standard setting process for the certifying examinations of the National Credentialing Agency for Laboratory Personnel (NCA). The job analyses relied upon mail surveys to 1200 individuals for each job level asking respondents to identify tasks significant to effective practice at job entry. The task lists resulting from statistical analysis of those surveys were examined to answer the study questions. PARTICIPANTS: The sample for each survey included 1200 practitioners, educators and laboratory managers selected at random from membership in professional organizations or from NCA certificant lists. Sampling was stratified to insure adequate practitioner representation. MAIN OUTCOME MEASURES: The mean rating on a four point scale for each item on the surveys was evaluated for overall significance as well as significance across geographic regions. The tasks meeting specified criteria were retained in the final task lists. Tasks were counted and their content evaluated to compare CLS and CLT job tasks. RESULTS: The response rates to the surveys were 33% for CLT and 21% for CLS. Reliability was judged based on average intraclass correlation coefficients of .86 and .82 for the CLT and CLS surveys, respectively. There were 952 tasks retained on the CLS content outline and 725 retained on the CLT content outline of the 1151 tasks on the original survey. Seven hundred and twenty two tasks were found on content outlines of both job levels, representing a 76% overlap. Tasks found only on the CLS outline included advanced technical tasks, a few management tasks, and more communication tasks. CONCLUSIONS: The jobs of CLS and CLT practitioners are distinct at job entry level with CLSs performing a broader array of technical and communication tasks as well as some management tasks. Though CLS staff uses few management skills at job entry, those tasks are performed by CLS staff in the laboratory and curricula must help prepare graduates for these tasks expected of experienced staff. CLTs perform tasks requiring problem solving and high level reasoning. CLT curricula must address the need for CLTs to perform these tasks.     

Advanced nursing practice: policy, education and role development

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people‐centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.     

Updating the immunology curriculum in clinical laboratory science.

OBJECTIVE: To determine essential content areas of immunology/serology courses at the clinical laboratory technician (CLT) and clinical laboratory scientist (CLS) levels. DESIGN: A questionnaire was designed which listed all major topics in immunology and serology. Participants were asked to place a check beside each topic covered. For an additional list of serological and immunological laboratory testing, participants were asked to indicate if each test was performed in either the didactic or clinical setting, or not performed at all. SETTING: A national survey of 593 NAACLS approved CLT and CLS programs was conducted by mail under the auspices of ASCLS. PARTICIPANTS: Responses were obtained from 158 programs. Respondents from all across the United States included 60 CLT programs, 48 hospital-based CLS programs, 45 university-based CLS programs, and 5 university-based combined CLT and CLS programs. MAIN OUTCOME MEASURES: The survey was designed to enumerate major topics included in immunology and serology courses by a majority of participants at two distinct educational levels, CLT and CLS. Laboratory testing routinely performed in student laboratories as well as in the clinical setting was also determined for these two levels of practitioners. RESULTS: Certain key topics were common to most immunology and serology courses. There were some notable differences in the depth of courses at the CLT and CLS levels. Laboratory testing associated with these courses also differed at the two levels. Testing requiring more detailed interpretation, such as antinuclear antibody patterns (ANAs), was mainly performed by CLS students only. CONCLUSION: There are certain key topics as well as specific laboratory tests that should be included in immunology/serology courses at each of the two different educational levels to best prepare students for the workplace. Educators can use this information as a guide to plan a curriculum for such courses.     

Assessing the educational preparation of clinical laboratory scientists.

OBJECTIVE: To assess the educational preparation of clinical laboratory science (CLS) graduates using an approach that addresses the general education and professional components of the curriculum and includes multiple programs. DESIGN: Survey of a convenience sample. SETTING: Four CLS programs in North Carolina. PARTICIPANTS: CLS graduates with one, three, and five years of experience. MAIN OUTCOME MEASURE: Results of 48 competency statements rated by graduates for level of preparation and importance in current jobs. RESULTS: Graduates indicated that they were well prepared in most conceptual and technical competencies with the exception of computers and management. Preparation in career marketability skills (interviewing, writing résumés, and career planning), contextual competence (understanding socioeconomic and governmental issues), and scholarly concern for professional improvement (research skills) was rated relatively low. Graduates considered the conceptual and technical competencies related to their current specialty as very important for their jobs. They also rated professional ethics, communication skills, and integrative competencies as very important for practice. Graduates in supervisory positions rated communication competencies significantly higher in importance than did graduates in other positions. Graduates rated as relatively unimportant competencies in conceptual and technical skills unrelated to their current specialties and scholarly concern for professional improvement. CONCLUSION: In the professional component of the curriculum, educators should review the amount of conceptual and technical content required and the level of preparation in career marketability skills. In the general education component of the curriculum, CLS students' preparation in contextual competencies and communication skills should be reviewed and strengthened.     

Obtaining a clinical laboratory science degree via distance technology.

OBJECTIVE: To identify institutions and program officials associated with clinical laboratory science (CLS) academic programs available via distance technology; to collect and summarize data from these programs with regard to on-line instructional methodologies; to determine the level of success of educational strategies and methodologies utilized in on-line CLS programs; to determine the feasibility of developing an on-line program at Seward County Community College (SCCC), Liberal, Kansas. DESIGN: An on-line CLS program survey tool was sent to eight higher education institutions which had previously indicated that they offer a CLS academic program at the associate, bachelor, or master level via distance technology. Program officials were asked to answer questions pertaining to areas such as program format, on-line admission requirements, program costs, student costs, faculty workload, and on-campus versus on-line student performance. SETTING AND PARTICIPANTS: The survey was sent to eight program officials who identified their institutions as having a CLS program available through distance technology. MAIN OUTCOME MEASURES: Responses from current distance technology CLS program officials were collected and tallied. Responses were recorded as 'yes' or 'no' in categories such as program format, program and student costs, and comparison of on-campus versus on-line student performance. The two groups of students were compared in areas of success rate, retention rate, graduation rate, external certification pass rate, employment placement rate, and employer satisfaction level. RESULTS: The response rate for the survey was 87.5% (7/8). Program officials indicated that various educational methodologies were incorporated in providing CLS education via distance technology. All of the respondents utilize some type of Web-enhanced, Internet based access to deliver course material. Clinical laboratory procedures are taught via instruction within a cooperative laboratory, program clinical affiliate laboratory, or during on-campus student laboratories. Program officials indicated that student enrollment has increased due to the availability of the distance technology. Students enrolled via distance technology perform as well or better than the on-campus students on certification exams and in the clinical setting. Data from these institutions indicate that it is feasible to develop an on-line program at SCCC in an effort to increase student enrollment. CONCLUSION: The results indicate that CLS programs which offer the curriculum via distance technology have experienced increased student enrollment thus graduating more students to fill the employment needs. These current distance technology programs are leading the future trends in CLS education of the 21st century.     

Determining clinical laboratory science curriculum for the 21st century.

OBJECTIVE: To conduct a study to show possible differences in clinical laboratory science (CLS) education in relation to knowledge and skill levels deemed most important to job performance success of entry bench level CLS practitioners as determined by laboratory supervisors. Information gained from the study may indicate areas of program curriculum needing revision, or the incorporation of subject areas not presently offered. DESIGN: Survey. PARTICIPANTS: CLS educators from 100 different hospital-based and university-based CLS programs, and medical laboratory departmental supervisors from 209 different hospital laboratories. OUTCOME MEASURES: An analysis of the data from the survey consisted of individual item percentages generated by both surveys and a comparison of tasks deemed highly important by supervisors with class time estimates devoted to those tasks. RESULTS: The study indicated differences between what supervisors viewed as important knowledge and skills of entry bench level CLSs and the amount of class time devoted to those subjects by CLS educators. CONCLUSIONS: To ensure continuing professional credibility, additional study will be needed regarding the education and practice of CLSs as automation, emerging technologies, and laboratory restructuring will continue to change the laboratory environment.     

An Evaluation of Consistency in Baccalaureate Public Health Nursing Education

A national study was conducted to determine the public health nursing content and clinical experiences faculty include in the baccalaureate preparation of nurses and the degree of consistency that exists among these programs. The concept of professionalism provided a framework for determining standardization in educational preparation. Data were collected using a mailed questionnaire distributed to all National League for Nursing-accredited baccalaureate programs and completed by the person responsible for the public health nursing curriculum. The questionnaire obtained information related to theory and practice objectives. A response rate of 82 percent (n= 275) was obtained after follow-up mailings and telephone calls. Content analyses of responses allowed us to identify curricular components most and least emphasized in baccalaureate public health nursing education as well as a core curriculum in public health nursing. Overall, the nursing educators were more consistent in the emphasis placed on areas of clinical competence than on public health nursing concepts. Public health nursing educators are encouraged to consider what constitutes the theoretical base for public health nursing practice.     

Selected options supporting use of the group embedded figures test in modeling achievement in clinical laboratory science programs.

OBJECTIVE: To identify, in light of predicted future shortages of allied-health personnel, student and curricular characteristics of clinical laboratory science (CLS) programs relevant to recruitment and retention at the baccalaureate level. SETTING: Not applicable. PRACTICE DESCRIPTION: Not applicable. PRACTICE INNOVATION: Options for modeling achievement in CLS programs are developed, and designs and procedures for clarifying procedural questions are considered in a context of delivery of instruction for specialized curricula and skill development. Considerable attention is given to the potential for using the Group Embedded Figures Test (GEFT) in modeling, advising, designing curricula, and monitoring quality improvement of programs and graduates. MAIN OUTCOME MEASUREMENT: Not applicable. RESULTS: Supporting evidence is supplied from the literature for options in developing an appropriate model for examining those salient variables known to have linkages to achievement. CONCLUSION: An argument is presented for better understanding of antecedent variables affecting achievement and retention of CLS students. In addition, a case is made for development of an appropriate model examining variables identified in the literature as being linked to achievement. Dynamic models based on these considerations should be developed chronologically from entry through graduation with emphasis on growth at year-end milestones.     

Development of nurse specialists/advanced practitioners in Ireland

An Bord Altranais (Irish Nursing Board) published "Report of the Commission on Nursing: A Blueprint for the Future" in 1998. This report was the result of collaborative work among those involved in nursing in Ireland. It recommended the establishment of clinical career pathways, which would allow a nurse with extensive experience and advanced expertise, as well as an appropriate course, to be recognized as a clinical nurse specialist. Further advancement along this pathway could possibly enable the nurse to progress to an advanced practitioner grade. The report acknowledged that there are "various and differing interpretations" of the title "practitioner". This article explores the growth and development of the roles of the clinical nurse specialist and advanced nurse practitioners in Ireland over the past number of years. The literature reflects elements of confusion that exist in some areas about the role of a clinical nurse specialist and an advanced nurse practitioner. The "Review of the Scope of Nursing and Midwifery Practice" (An Board Altranais, 2000) recognized a lack of clear differentiation between the role of the clinical nurse specialist and the advanced nurse practitioner. Overall, some clear roles are identified for the nurse who advances or wishes to advance along clinical career pathways in nursing. However, there still appears to be a certain degree of confusion about the use of titles such as "nurse specialist" and/or "nurse practitioner". The guidelines about the level of practice and education/training required for the nurse moving along the pathways of clinical nurse specialism and/or advanced nursing practice is somewhat obscure and is interpreted in different ways in the literature.     

From student laboratory to clinical environment.

OBJECTIVE: To describe a clinical laboratory practice simulation experience for clinical laboratory science (CLS) students which was intended to improve the transition from the student laboratory to the clinical environment. SETTING: University of Kentucky Center for Rural Health, a rural health professions education center for a state-assisted institution. PRACTICE DESCRIPTION: Baccalaureate-level CLS program. PRACTICE INNOVATION: Clinical laboratory practice simulation experience allows students to become familiar with the clinical environment. It also allows faculty to assess student performance and to provide students with feedback in a controlled setting. MAIN OUTCOME MEASUREMENT: Perception of benefit from the simulation experience by CLS graduates. RESULTS: CLS graduates report the simulation experience helped to prepare them for practice in the clinical environment. CONCLUSION: Clinical laboratory simulation can improve the transition to actual clinical laboratory practice and is a valuable tool to evaluate pre-clinical deficiencies.     

Assessment of the graduate studies background of CLS faculty in university-based programs.

OBJECTIVE: To identify the degrees held and the graduate majors or fields of study for faculty teaching full-time and part-time in university-based, baccalaureate-degree clinical laboratory science/medical technology (CLS/MT) programs. DESIGN AND PARTICIPANTS: A survey and letter of project explanation was sent electronically to the 110 program directors of NAACLS-accredited university-based CLS/MT programs in the United States in May, 2003. Program directors were requested to provide for each full-time and part-time faculty member the following information: titles for all degrees held, major/field of study for each degree held, all specialist certifications held, all other formal degrees or certificates held, and all courses/areas taught in the CLS curriculum. RESULTS: Information was provided on 288 faculty in 52 CLS/MT programs, for a response rate of 47%. The majority of faculty (75%) described were full-time. A doctorate was held by 43% of the reported faculty, while 46% held a master's degree as their highest degree, and 11 % only a BS in CLS or in biology plus a certificate from a hospital-based CLS/MT program. Graduate degrees in a science major or field represented 52% of the degrees held by the reported faculty, while 48% of the graduate degrees were in education, public health, or administration. Only 13% of the reported faculty held master's degrees specifically in CLS. Detailed results are provided for degrees held, majors/fields of study, and specialist certifications by specific courses/areas of the curriculum taught. CONCLUSIONS: The results of this survey indicate that many faculty teaching in university-based CLS/MT programs are extending their preparation as scientists to the graduate level. This should prepare these faculty for their responsibilities in not only teaching but also research. A case cannot be made that a doctorate, as opposed to a master's degree, is viewed as the 'terminal degree' as less than half of the reported faculty in this study as well as others, held a doctorate. The results reported provide a national perspective on the graduate backgrounds of CLS faculty for comparison to an individual program's faculty during programmatic or institutional accreditation reviews.