Conceptual Models for Clinical Nurse Specialist Role and Practice

Abstract

A model or framework is central to achieving clinical nurse specialist (CNS) role consistency and sustainability and in supporting evolution of CNS as a distinct and legitimate healthcare expert in the healthcare delivery system. Models can describe CNS practice, CNS role structure, or regulatory authority to practice as a CNS. A model explaining CNS role structure describes the elements and characteristics of the role and the relationships between and among those elements. A model for CNS practice is a process model demonstrating interrelationships among elements constituting practice including domains of practice, practice competencies, and desired outcomes. Process models explain the relationship between practice competencies and clinical outcomes. A regulatory model explains the authority to practice, including legal requirements and the associated scope of practice. Existing models explaining CNS role and practice are limited; many current models are developed to explain advanced practice nursing and are not role specific. Existing models and frameworks are discussed for their usefulness in explaining CNS role and practice. Multiple models are needed to provide deeper understanding of the unique characteristics of the CNS role and core CNS practice competencies. No one model is best; the best model is the one that explains the phenomenon of interest.