The purpose of this presentation is to describe CNS perceived barriers to practice and explain differences in perceived barriers as related to organizational and personal practice characteristics.
SAMPLE/ METHODS: The sample consisted of 547 practicing CNSs, certified by the California Board of Registered Nursing. Data were collected via the CNS Specialists Outcomes/Barrier Analysis (CNS-SOBA). Barrier subscales included Functional (i.e., lack of time, secretarial support), Interpersonal (i.e., staff nurse or MD resistance), Physical (i.e., inadequate space, poor layout of work areas), and Organizational (lack of administrative or peer support). Data analysis: descriptive and inferential statistics.
FINDINGS: The top three barriers to practice included multiple job expectations (M = 3.08, SD 1.069), lack of time (M = 2.94; SD 0.976), and lack of personnel (M = 2.74; SD 1.030). In general, these functional barriers (M = 60.99; SD 26.54) were perceived to have more effect on influencing outcomes than did physical (M = 44.76; SD 36.41), interpersonal (M = 32.81; SD 25.54), and organizational (M = 32.39, SD 24.77) barriers. Functional barriers were highest when CNSs reported to directors of education as compared to when CNSs reported others or were self-employed.
CONCLUSIONS: CNSs perceive they encounter a number of barriers to practice. Perceived barriers are primarily functional, and therefore, are resource dependent. In addition, reporting structures (especially when CNSs report to directors of education) influence the barriers encountered by CNSs.
APPLICATION: The time has come for organizations to evaluate CNS advanced practice in terms of outcomes. However, CNS outcomes should be evaluated in the context of barriers to practice. Expectations for patient/family care outcomes and system outcomes (i.e. research and evidence-based practice activities, unit-based quality projects) should be appraised in terms of CNS experience, organizational reporting structures, and functional barriers (i.e., multiple job expectations, lack of secretarial support and nursing personnel).
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