Sunday, November 2, 2003

This presentation is part of : Clinical Nurse Specialists' Practice Patterns: Activities, Outcomes and Barriers

CNS Patterns of Practice: Roles and Activities

Ann M. Mayo, RN, CNS, DNSc, Patient Care Services/Nursing Research, Patient Care Services/Nursing Research, Kaiser Permanente, San Diego, CA, USA

This presentation will describe CNS roles, patient and family health promoting activities, as well as, CNS organizational system activities (i.e., staff education) that promote the advancement of patient care, nursing practice and system efficiencies. Roles and activities will be elaborated on as they relate to both organizational and personal characteristics.

SAMPLE/METHODS: Sample size: 945 (62%) California (CA) BRN certified CNSs. Surveys: Demographic and Advanced Practice Survey (APS). APS measured ten activity categories (i.e., Consultation, Patient Education, Clinical Practice, Staff Development). Analysis: Descriptive/inferential statistics.

FINDINGS. Only 57.9% of respondents were practicing as CNSs. Average age: practicing CNSs was 49 years (range 27-75). Practicing CNSs spend varying amounts of time in the traditional five roles and ranked the importance of those roles similarly (expert clinical practice ranked most important). CNSs reporting to physicians or self-employed spent more time (53%, 68.9%) in expert clinical practice than CNSs reporting to nurse executives (31.3%) or directors of education (22%) (F=14.197, p=0.00). Top three categories of activities: Consultation, Leadership, and Patient Education. Critical care CNSs participated more in consultation activities than other CNSs (M=97 v 89, t=3.42, p=0.01). Novice CNSs (less than 2 years) reported fewer activities in Clinical Practice and Staff Development than CNSs with more years of practice.

CONCLUSIONS. A significant number of CNSs are not practicing as CNSs. CNSs value and report spending the majority of their time in expert clinical practice. Their ability to actualize that value appears to be impacted by their reporting structure. CNSs activities vary according to areas of clinical practice and years of experience.

CLINICAL APPLICATION: Novice CNSs may need more time, resources and/or mentoring in order to be successful. CNS job descriptions/evaluations should reflect these differences; CNS clinical ladders may be one approach. Reporting structures should be evaluated in terms of patient and family advanced practice activities.

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