The Clinical Nurse Specialist Role: A lack of clarity

In this article our Nurse Advisor Fiona, is taking a look at the lack of clarity surrounding the CNS role, and how it impacts on patient care.

Clinical Nurse Specialists (CNSs) have a vital role to play in delivering high quality and compassionate care. However, a lack of awareness and understanding of CNS roles among the healthcare team and the public has contributed to ambiguous role expectations. The most commonly used titles include CNS, Advanced Nurse Practitioner, Nurse Practitioner and Specialist Nurse. Title confusion and lack of role clarity pose substantial barriers to the full integration of CNSs in the healthcare system (Barton et al, 2012). Despite growing evidence that CNSs make a considerable difference to patient care, there is a distinct lack of clarity in the UK about the definition of these nurses (Leary et al 2017).

CNS ROLES

The focus of a CNS may be a specific disease area or a particular patient group, such as palliative care. The CNS role may also encompass leadership and education of other health professionals, such as junior doctors and nurses. The primary responsibilities of the CNS depend on the particular needs of the setting and include varying amounts of clinical practice, consultation, education, research and leadership activities. CNSs mentor nurses, contribute to the development of nursing knowledge and evidence-based practice, and address complex healthcare issues for patients, families and other disciplines. As individual CNSs undertake a wide variety of these roles and tasks it is difficult to develop accurate role definitions (Lowe 2012).

ROLE DEVELOPMENT

The CNS role is crucial to patient outcomes, but it is apparent that the CNS role is not being developed or utilized in a consistent way across the country (Barton et al 2012). A national competency framework is required to harness CNS skills to the full and to further develop them (Oliver et al 2012). When the role means different things to people and there is a lack of consensus about role expectations, role conflict and role overload can occur. The lack of clarity of the CNS role limits the ability to actualise the full scope of the role and in turn leads to issues with role sustainability.

IMPLICATIONS FOR NURSING

Numerous studies have demonstrated the effectiveness and high levels of patient satisfaction with CNSs, and they are recognised as key players in the drive for a more effective health care system (Oliver et al 2012). Despite its importance, the CNS role is at risk because the direct impact of this role on patient care and the organization is not readily visible to those who do not understand the role. Clarity around what each of the advanced nursing roles offer is paramount to taking advantage of this opportunity to improve healthcare delivery. It is difficult to provide evidence of efficiency and cost effectiveness without clarity and consistency of roles. This is only possible when definitions clearly articulate the advanced roles and functions, indicating how they make differences. Clear definition then leads to standardized measures that can provide verification of efficiency, cost effectiveness and the realisation of patient outcomes with respect to healthcare.

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