The United States Army Clinical Nurse Specialist (CNS) role presents a unique opportunity to lead teams in successfully implementing sustainable, evidence-based practice (EBP) change that drives measurable and lasting outcomes in mil- itary healthcare. An Army CNS is an Advanced Practice Registered Nurse (APRN) who holds an Additional Skill Identifier (ASI) “7T”. The 7T ASI is awarded to APRNs who successfully complete a master’s, doctoral, or post-graduate certificate program, and obtain National Board Certification as a CNS. Army CNSs play a pivotal role in advancing military healthcare by integrating clinical excellence with strategic leadership

Mapping the advanced practice nursing in emergency and intensive care units: A scoping review.

Clinical Nurse Specialists in Adult Congenital Heart Disease: A Prospective Evaluation of Service in a Large Specialist Centre.

To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability. A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation. Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August-December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs. Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of "success by design" was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies. Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap. Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce. We have adhered to COREQ reporting guidelines (See supplemental file). This study did not include patient or public involvement in its design, conduct, or reporting.

Pediatric healthcare faces critical workforce challenges, budget constraints, and complex patient needs. Pediatric Clinical Nurse Specialists, as Advanced Practice Nurses, possess unique leadership, clinical expertise, and system-level influence to address these challenges. This paper collates evidence of pediatric Clinical Nurse Specialist impact on quality, safety, and financial outcomes while offering strategic recommendations for healthcare organizations to integrate these roles, simultaneously advancing excellence in pediatric care delivery and organizational performance.

Attitude and adherence to evidence-based pressure injury prevention practices of neonatal intensive care nurses in China: a cross-sectional study.

97 Bridging the Gap: Enhancing Continuity of Care Through Cross-Site Working by the Mesothelioma UK Clinical Nurse Specialist

The coronavirus disease 2019 pandemic highlighted vulnerabilities in the nursing workforce needing attention before future crises. Clinical nurse specialists (CNSs) led teams, provided clinical expertise for policies and patient care, and adapted rapidly; however, the pandemic experiences of CNSs are not understood. We aimed to explore the lived experiences of Michigan's CNSs throughout the pandemic. Using a descriptive phenomenological design, semi-structured, one-on-one interviews were conducted between January and April 2021. Interviews were audio-recorded and transcribed to allow for rigorous analysis. Nine CNSs participated. Three themes emerged from the data. Within each of those 3 broad themes were 3 to 4 subthemes. Theme 1: nurses adapting to a crisis mindset consists of constant stress and work, rapid and unpredictable change, adapting with the science, and feelings toward the public. Theme 2: CNSs adapting to the crisis in unique ways is comprised of bearing extra emotional weight, losing a sense of control, role representation and clarity, and pride and responsibility. Theme 3: CNSs as holistic beings consists of coping mechanisms, support systems, and persistent life demands. The stress experienced by CNSs was distinct from the stress felt by other health care professionals as they were expected to lead teams through 3 spheres of impact. The magnitude and uniqueness of their stress identifies a priority for adequate preparation of CNSs and highlights an opportunity for specific areas of improvement prior to any future crises.

ESD enables stroke patients to leave hospital earlier and continue receiving nursing and therapy at home over a 6-8-week period. The CNS role within ESD is relatively new, and its involvement in stroke secondary prevention is not well defined. To describe the current role, knowledge, and practice of Stroke Clinical Nurse Specialists (CNSs) and Advanced Nurse Practitioners (ANPs) in secondary prevention and their contribution to early supported discharge (ESD) for stroke patients. Cross-sectional survey. An online survey was distributed to Stroke CNSs and ANPs working in inpatient stroke services or ESD teams. It explored three domains: (i) secondary prevention at initial hospital contact, (ii) secondary prevention at discharge, (iii) secondary prevention during ESD. The respondents described the pivotal role of stroke clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) in delivering secondary prevention from hospital admission through to discharge. Persistent challenges in patient information retention during acute care were highlighted. Participants identified structured national resources-particularly printed materials over apps-as essential tools for effective secondary prevention. Despite broad recognition of their value, integration of stroke CNSs into Early Supported Discharge (ESD) teams remains inconsistent, signalling a key area for service development in Ireland. There is a clear need to enhance continuity of nurse-led secondary prevention in community settings, particularly within ESD pathways.

The National Association of Clinical Nurse Specialists (NACNS) developed a comprehensive toolkit for implementing "Grow your Own" Clinical Nurse Specialist (CNS) programs. The toolkit addresses the critical shortage of CNSs by providing healthcare leaders with practical resources for internal talent development. Implementation examples demonstrate significant returns on investment through cost avoidance and quality improvements. The guide offers a sustainable solution for healthcare organizations facing CNS recruitment challenges while promoting professional advancement opportunities.

Discrimination and stigmatization in emergency departments continue to threaten equitable and safe patient care, particularly for individuals with psychiatric disorders and other marginalized groups. This could include people who are homeless or who are discriminated against because of their sexuality or gender or for other reasons. Traditional education focused solely on knowledge transfer has proven insufficient to address these issues. Person-centered practice, grounded in values, beliefs, and authentic relationships, offers a promising framework to foster equity, inclusion, and reflection among health care professionals. This project explored how person-centered, active learning strategies, facilitated by clinical nurse specialists, can promote awareness of bias and discrimination within emergency care teams. A practice development project titled "The Year of Education" was implemented in the emergency department of the University Hospital Basel in January 2024. Rooted in McCormack's person-centered practice framework, the initiative integrated active learning, reflection, and person-centered approaches across monthly educational themes. Two immersive learning interventions are described: (1) a self-experience simulation contrasting stigmatizing and inclusive handovers and (2) a reflective listening exercise using audio recordings of former psychiatric patients describing their experiences with coercive interventions. Each session was facilitated by clinical nurse specialists and followed by group discussions and qualitative evaluations using written reflections and team feedback. Participants showed increased self-awareness of stigmatizing behaviors. The learning interventions fostered empathy and critical reflection, prompting staff to reconsider routine practices such as the presence of too many people during psychiatric crises or giving handovers behind closed curtains. Staff expressed that these experiences deepened their understanding of patient perspectives and strengthened person-centered approaches in daily practice. The interventions demonstrated that person-centered, reflective education can meaningfully shift attitudes and communication patterns within emergency care. Although the project lacked a formal quantitative evaluation, its perceived impact led to its continuing as the emergency department's educational strategy. Embedding advanced practice nurse roles focused on health equity may be a further step toward less stigmatization and more equity in the emergency department.

An Exploration of Nursing Roles in Hereditary Colorectal Cancer- A Narrative Literature Review.

Abstract Background The role of the IBD nurse in Ireland has expanded significantly in recent years. The establishment of the National Clinical Programme in Gastroenterology and Hepatology in 2021 aimed to improve care for people with IBD through the establishment of additional advanced nursing posts and models of care that emphasise nurse-led triage, community support, and integrated services. This study provides updated national data on the role and level of practice of IBD nurses in Ireland following the introduction of this programme. Methods A cross-sectional online survey was conducted using an 88-item tool adapted from the UK National IBD Standards Survey (Mason et al., 2012) and informed by the Standards and Requirements for Clinical Nurse Specialists (NMBI, 2008). All members of the Inflammatory Bowel Disease Nurses Association of Ireland (n = 78) were invited to participate in April 2025. Results Twenty-seven nurses from 19 hospitals completed the survey (response rate 35%). Job titles included IBD Clinical Nurse Specialist (n = 8; 30%), IBD Advanced Nurse Practitioner (n = 7; 26%), Candidate ANP (n = 7; 26%), and Clinical Nurse Manager II (n = 5; 19%), reflecting a diversifying and increasingly advanced workforce. Although many were new to their current post, most had extensive IBD experience and an average of over 20 years of post-registration practice. Caseloads varied widely, from 180 to over 6,000 patients, with services staffed by between 1–10 gastroenterologists and 1–6 IBD nurses, highlighting major variation in service size and capacity. Ten respondents reported unfilled posts, largely attributed to the national recruitment embargo, and most nurses reported working 1–2 hours of unpaid overtime weekly. Participants were highly qualified: most held a master’s degree (n = 10), 15 were registered prescribers, and 17 had completed an IBD-specific postgraduate programme—supported by the introduction of the Certificate in IBD Care at Munster Technological University in 2021. All respondents reported involvement in service improvement initiatives, and most were conducting audits within their IBD service. Conclusion IBD nursing in Ireland is expanding and becoming increasingly specialised, despite significant variation in service size and ongoing recruitment challenges. The workforce is highly educated, experienced, and actively engaged in service development. These findings offer important national benchmarking data to inform workforce planning, equitable access to specialist IBD care, and future education and career pathway development. Conflict of interest: Keogh, Aine M.: No conflict of interest Farrell, Dawn: No conflict of interest

Advanced Practice Registered Nurses are increasingly recognized for their role and impact in hospice and palliative care. The Clinical Nurse Specialist (CNS) role is emerging as uniquely suitable for practice and leadership in this setting. The integration of a CNS into the practice of a large, multistate Hospice and Palliative Care program is discussed in this article. A timeline is provided with 4 phases of integration with priorities identified and specific strategies that were implemented to overcome challenges during the process. The value of CNS practice to the organization is highlighted in 3 practice exemplars, showing return on investment in terms of increased patient safety and implementation of evidence-based practice for home infusions, developing nurse confidence through complex case reviews, and reducing staff injuries through developing a Safe Patient Handling program.

To assess public awareness, perceptions, and educational intentions regarding Clinical Nurse Specialist (CNS) and Physician Associate (PA) roles in Israel, and to identify predictors of interest in these career pathways. Amid physician shortages, countries are promoting advanced roles such as CNSs and PAs to strengthen healthcare capacity. In Israel, both roles are relatively new and underrecognized. A cross-sectional survey of 200 adults in Israel used descriptive statistics to assess familiarity and interest in CNS and PA roles. Two multiple linear regression models identified predictors of interest in pursuing each role's educational pathway. Awareness of advanced roles was limited: 25.5% and 21% reported familiarity with CNSs and PAs, respectively. Despite this, 26.5% expressed interest in the CNS pathway and 17% in the PA pathway. Women were more likely to favor the CNS role; men showed greater interest in the PA role. Self-efficacy, career motivation, and gender predicted CNS interest (R2 = 0.332). PA interest was predicted by academic background and gender (R2 = 0.256), but not by self-efficacy or motivation. These findings highlight the need to clarify role definitions, address gendered perceptions, and implement targeted outreach. Differences in predictors suggest that CNS and PA roles appeal to distinct motivational and cognitive profiles. Despite low awareness, there is substantial public interest in CNS and PA roles. Tailored educational and communication strategies are needed to increase understanding and engagement. Nurses should use clinical encounters to explain CNS and PA roles and build trust. Policymakers should support awareness campaigns, training incentives, and curricular integration to promote role legitimacy and address global workforce challenges.

Abstract Aim The volume of patients referred on the Upper GI 28-day Faster Diagnosis Standard Pathway (28-day FDS) continues to increase. Following recruitment of an advanced clinical practitioner (ACP), 2 clinical nurse specialists (CNS) and a pathway navigator, a dedicated telephone and face-to-face triage clinic and virtual results review and dissemination session (‘switch off’) was introduced to address this. A retrospective audit was conducted to review the impact of this change on 28-day FDS compliance (75% patients receiving oesophagogastric cancer diagnosis or exclusion). Method Retrospective data was collected on all UGI 28-day FDS referrals over two 3-month periods from January to March 2024 (Group 1: prior to the introduction of the ACP and CNS Led triage clinic) and between January and March 2025 (Group 2: following its implementation). Outcome data was collected on time to first clinical review, and 28-day FDS compliance. Results The mean number of monthly referrals was 145 in Group one versus 157 in Group 2. There was reduction in the meantime to first clinical review in Group 2 (5.0 vs 3.4 days), but mean monthly 28-day FDS compliance remained similar (78% vs 79%). However, monthly 28-day compliance was more consistently achieved in Group 2 (67% vs 100%) Conclusions Implementation of an ACP/CNS led triage service has led to both a reduction in the time to first clinical review and more consistent UGI 28-day FDS compliance. Further work is required to see if implementation of ACP/CNS ‘switch off sessions improve overall UGI 28-day compliance.

Abstract Background Current research indicates that patients aged over 65yrs have a 10% risk of frailty, with this number increasing up to 50% in patients over 85yrs age1. The management of acute pain within this group of patients is challenging owing to the increased risk of delirium if pain or medications to relieve the pain are poorly managed. Given the ageing Irish population and the prospective increased demands on the health care system, we aimed to evaluate if current practice is in keeping with national opioid prescribing recommendations and stewardship. Methods A snapshot audit approach using point prevalence was undertaken in 2024. All patients meeting the inclusion criteria, > 65yrs and able to self-report, were assessed by the Clinical Nurse Specialist in Pain Medicine, using The Pain Assessment Documentation Tool (PADT). Results Forty eight (54%) of inpatients met the inclusion criteria. There was a 35% incidence of severe pain. Furthermore, 23% felt their physical function had declined since admission due to pain and 12.5% reported pain interfered with their sleep. A total of 46% of the patients were prescribed opioids, in line with HSE guidance. However, of this cohort, 33% received no dose of prescribed short acting opioid, despite the high reported rate of severe pain. Thus, highlighting the need to provide further support for clinical staff to ensure the appropriate use of analgesia at ward level. Conclusion This audit identified crucial areas for immediate improvement. Notably, the need for a tailored algorithm for the management of acute pain in patients > 65yrs. This led to the formation of a working group, including Pain Medicine CNS, Pain Consultant and Clinical Pharmacist resulting in the development of two algorithms aimed at addressing both acute and neuropathic pain informed by best practice and an extensive literature review.

Abstract Background In acute hospital wards across Ireland, older adults often face prolonged stays with limited stimulation. Nearly 50% have dementia and may exhibit symptoms such as agitation and anxiety. National guidelines advocate for non-pharmacological interventions, particularly meaningful activities, to manage these symptoms. Tailored engagement enhances well-being and provides a sense of purpose, yet remains underutilised due to resource constraints. Structured activity programs offer a compassionate, evidence-based approach to improving care and the hospital experience for this population. Methods A multidisciplinary working group—comprising a Dementia Clinical Nurse Specialist (CNS), Assistant Director of Nursing, CMN 3, Practice Facilitator, and Healthcare Assistant—collaborated with ward managers and staff nurses to introduce meaningful activity interventions. Funding was secured for resources, and the CNS adapted the 'Meaningful Activities Guide' for local use. Activity trolleys and the guide were implemented across five wards. A QR code poster, created with the Dementia Services and Information Development Centre (DSiDC), explained the resources to staff, patients, and visitors. A tiered education program was delivered, with trained HCA Champions leading the initiative. Over three months, daily staff training was conducted, and patient engagement data were collected. Results Twenty-four surveys were completed. Most participants engaged in multiple activities. Cognitive (e.g., crosswords, board games) and physical (e.g., balloon play, walking) activities were frequently used, often resulting in increased communication and smiling. No increase in agitation was reported. While causality cannot be established, descriptive trends suggest positive behavioural outcomes were more common when activities were implemented. Conclusion This successful pilot supports person-centred care through meaningful engagement, offering benefits for older inpatients and reducing the risk of inactivity. Funding has been secured to continue and expand the initiative.

Experiences and perceptions of oncology patients with the care provided by clinical nurse specialists in an outpatient nurse-led clinic.

Effectiveness of a blended learning program on chemotherapy nursing education led by oncology clinical nurse specialists: A single-group pretest-posttest study.