Role Of Clinical Nurse Specialist Research Articles

Student Simulation Professional Development: Adding Value to the Pediatric/Neonatal Clinical Nurse Specialist Role.

Student Simulation Professional Development: Adding Value to the Pediatric/Neonatal Clinical Nurse Specialist Role.

Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

National Association of Clinical Nurse Specialists Affiliate Support for Professional Growth of Clinical Nurse Specialist Students.

The purpose of this article was to describe how a National Association of Clinical Nurse Specialists affiliate partnered with a local university to engage clinical nurse specialist (CNS) students, enhance its mission and activities, and create succession planning opportunities, while providing mentorship and professional growth opportunities. Academic preparation of CNS students endeavors to instill professionalism. A 3-pronged partnership incorporating the inclusion of a student liaison on the board, presentation of student clinical work at the affiliate's annual conference, and development of a student scholarship was implemented. Membership in professional nursing organizations for a CNS student provides exposure and access to professional development resources, socialization to the role, rewarding networking opportunities with peers and colleagues, and leadership development. Anecdotal feedback demonstrated a better understanding of the CNS role, increased confidence, and enhanced knowledge on topics such as legislative advocacy as well as experiences of sharing clinical challenges with CNS colleagues. Partnership with the local university allowed the affiliate to maintain the influx of new CNSs, which sustains membership, nurtures the growth of new CNSs, and ensures the influx of new ideas. Furthermore, membership in professional nursing organizations is imperative to address the opportunities that exist in healthcare.

Mapping advanced practice nurses' scope of practice, satisfaction, and drivers of role performance.

Background: Advanced Practice Nurse (APN) roles in Switzerland include Clinical Nurse Specialist (CNS), Nurse Practitioner (NP) and blended roles. The variety contributes to unclear profiles and scope of practice. Aim: To describe a) the performance of APN tasks according to Hamric's competencies, b) job satisfaction, and c) barriers and facilitators to role performance. Methods: Nationwide cross-sectional survey among clinically working APNs. Inclusion criteria: academic degree, role with advanced nursing competency. Analysis of quantitative and qualitative data using inferential statistics and content analysis. Results: Of the 222 APNs, 49% (n = 108) described themselves as CNSs, 37% (n = 81) as working in a blended role, and 15% (n = 33) as NP. APNs provided the greatest proportion of their tasks in the competency direct clinical practice and the least in ethical decision-making. Group comparisons between roles revealed significant differences in the competencies: direct clinical practice, guidance and coaching, leadership, and evidence-based practice. Job satisfaction was high (76%, n = 165), most often described by the category work content/role (e.g., defined scope of practice). The most frequent barrier to role performance was the category scope of practice (e.g., unclear responsibilities); the most frequent facilitator was the category professional recognition (e.g., respect). Conclusion: The study highlights current APN scope of practice and can support the advancement of the role through clinical practice, educational institutions, and research.

A Compendium of Clinical Nurse Specialist Roles in a Canadian Health Authority.

Interior Health in British Columbia advocates for and supports advanced practice nurses, inclusive of regional clinical nurse specialists (CNSs). CNSs develop evidence-informed programs, education, policies and practice standards. The article uses an advanced practice nursing framework to anchor two case studies: (1) the operationalization and implementation of a regional CNS role in primary care and (2) the use of a knowledge translation strategy to build clinical capacity in serious illness conversations. These case studies embody the CNS role and provide a voice for CNSs to communicate the ways in which their advanced practice nursing role is pivotal in healthcare system transformation and for providing quality patient care.

The emerging role of a Stroke Clinical Nurse Specialist (CNS) in Early Supported Discharged: Developing a pathway for stroke nursing for secondary prevention in the community.  A scoping review protocol.

Background Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention. Objective The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting. Methods We will conduct a scoping review in accordance with the Arksey and O’Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

Evaluating the effectiveness of a clinical nurse specialist triage role in a specialist palliative care community service.

In 2017, a clinical nurse specialist (CNS) triaging role was created within a specialist palliative care community service (SPCCS) in Ireland to enhance the triage process. The aim of this study is to evaluate the effectiveness of the role regarding data collection and reporting. Structured feedback from healthcare professionals (HCPs) was obtained on the effects, challenges and sustainability of this role. This study used a mixed-methods approach. A quantitative analysis of referrals triaged by the SPCCS CNS over 2 years (2018-2019) was performed. Two focus groups with HCP's within the same service were completed in January 2020 and one-to-one interviews were conducted. The quantitative and qualitative results were merged using a triangulation protocol. In 2017, new health service executive (HSE) standards to categorise the urgency of patient assessment were introduced. Quantitatively, an improvement within the triage process was seen, with an increase in compliance with national access standards. In 2018, compliance was 89.1%. In 2019, this was 96.8%, an improvement of 7.7%. A data discrepancy of 9.5% of referrals was noted over the first 9 months of 2018. After this, data documentation and congruency were seen to improve for the final 3 months of 2018 to 100% and remained at 100%. Qualitative data highlighted the benefits and challenges of the Triage CNS role. Mixed-methods correlation revealed corroboration between both using a triangulation protocol. The triage CNS role was pivotal as an initial point of referral contact. Increased compliance with national access standards occurred resulting in improvements in case and case-load management, information gathering, documentation, data collection and analysis.

Capitalizing on the Value of the Clinical Nurse Specialist in Palliative Care.

The clinical nurse specialist (CNS) is 1 of the 4 advanced practice registered nurse roles and a vital component in palliative and hospice nursing care. The CNS is a specialty expert clinician capable of practicing in a variety of health care settings including acute care, primary care, and specialty ambulatory care. The CNS integrates palliative care standards across the 3 spheres of impact (patient, nurse, and system) to improve care patients receive at end of life, mentoring and coaching nurses in the unique aspects of palliative and hospice care (HPC), and serving as a clinical expert for the organization to ensure best practices and quality outcomes. Clinical nurse specialists are trained to diagnose, treat, and prescribe to provide holistic care to their patients. However, challenges exist for the CNS role due to variations in state regulations regarding title protection and scope of practice leading to inconsistency in and misperception of the CNS role. Clinical nurse specialists have a wealth of expertise that can lead to systematic improvement in patient outcomes, advances in hospice and palliative nursing practice, and management of HPC patients and their families. Clinical nurse specialists are a hidden treasure that should be integrated into HPC practice.

Implementation and assessment of an advanced practice nurse-led early palliative care initiative for patients with advanced pancreatic cancer.

262 Background: Early palliative care (EPC) referral reduces health care costs and improves quality of life and survival in some advanced cancers. Barriers to EPC exist. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the provincial centralized referral office are triaged by an oncologist and concurrently referred to the CNS. CNS consultation focuses on physical and psychological symptoms, medication review, patient and family coping, and goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system, and community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. This study reports on the impact of the CNS role and patient perceptions of this role on patient-centered care. Methods: We compared patients with PANC in the pre-implementation period (Jan 1, 2021, to December 31, 2021) to the post-implementation period (April 1, 2022, to March 31, 2023). Patients were identified using the Manitoba Cancer Registry and the CNS clinical database. Descriptive statistics were used to report quality measures. Results of patient reported perception of patient-centered care during the post-implementation period will also be reported. Results: In the pre-implementation period, 83 patients were referred to CCMB with PANC. In the post implementation period, 135 patients were referred. 125 (93%) accepted a consultation with the CNS, with a median time to meeting of 5 days (range, 0-18). After CNS consultation, 35% declined biopsy, oncology appointment or both. In the pre-implementation period, 29 (55%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 66 (77%) in the post-implementation period. The mean time to palliative care referral was 18.2 weeks pre-implementation vs 8.0 weeks post-implementation (p=0.0007). Data on number of diagnostic biopsies, medical oncology consultations, and receipt of chemotherapy are in the attached table. Conclusions: This novel approach of CNS assessment and education soon after diagnosis of PANC, at the time of referral to CCMB, is acceptable to patients. It results in increased early referral to community-based palliative care/hospice. Exploring patient goals early may also spare patients from treatments that are time-consuming and associated with adverse effects, allowing those with a life limiting illness to focus on quality of life.[Table: see text]

The role of the clinical nurse specialist in stoma care: a scoping review.

Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners.

The role of the clinical nurse specialist in stoma care: a scoping review

Aim: Rapidly evolving roles in nursing require exploration and description. This review aims to examine the role of the clinical nurse specialist (CNS) in stoma care from the UK perspective. Design: A scoping review was undertaken using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data were synthesised using content analysis to derive meaning units and themes. Data sources: Three electronic databases were used to conduct the search: Embase, AMED and Ovid Medline. Additional sources identified through the reference lists of included studies and guidelines were also included. Methods: Two reviewers undertook the search for articles that described the role of the stoma care CNS in the UK. Any disagreements were to be resolved through discussion. Results: Seven papers met the eligibility criteria. Analysis resulted in 184 unique meaning units. Meaning units were grouped into themes reflecting the four pillars of advanced practice: advanced clinical practice; leadership; facilitation of education and learning; and evidence, research and development. The fewest meaning units were attributed to the evidence theme (n=13) and the most related to advanced clinical practice (n=107) such as having specialist knowledge and skills to manage complications. Conclusion: The stoma care CNS role reflects the four pillars of advanced practice. These practitioners are valuable, carrying out a complex role that involves high-level, specialist decision-making skills. The results from this scoping review could be useful in service development; they will be used to inform the Association of Stoma Care Nurses UK modified Delphi consensus to examine the views of stoma care CNS practitioners.

The Oncology Clinical Nurse Specialist: A Rapid Review of Implementation Models and Barriers around the World.

The role of a clinical nurse specialist in oncology varies greatly between healthcare systems, and implementing this healthcare role with its multifaceted and co-existing responsibilities may prove challenging. While already integrated into healthcare systems and services in several European countries, Asia, Canada, and the United States, other countries are just beginning to develop clinical nursing specialties. The current study aims to provide healthcare policymakers with up-to-date evidence that focuses on the diverse modes of oncology clinical nurse specialist role implementation across several healthcare systems and pertinent implementation challenges as described in the literature. A rapid evidence assessment was carried out in order to provide policymakers with a rigorous review in a condensed timescale. Initially, only items in the English language were included, and "grey literature" was excluded. We searched PubMed between 1 January 2022 and 28 February 2022 and two independent scholars reviewed items. Based on 64 papers, both non-scientific and papers that met the initial criteria of the rapid review, we describe the modes of implementation of the oncology clinical nurse specialist in the United States, Canada, United Kingdom, Japan, Brazil and Australia. Barriers to implementation include conflicts around role boundaries, skepticism and lack of organizational support, as well as fears that oncology clinical nurse specialists will "encroach" on doctors' powers. In contrast, an oncology clinical nurse specialist is found to be universally more accessible to patients and their families and can help physicians deal with difficult workloads, among other advantages. Conclusions: This role offers a myriad of gains for cancer patients, oncology physicians, and the healthcare system. The literature demonstrates that it is a necessary role, albeit one that brings specific implementation challenges.

Nurses and Physicians’ Perceptions Regarding the Role of Oncology Clinical Nurse Specialists in an Exploratory Qualitative Study

The purpose of the study was to examine the attitudes of nursing and medical teams about the role of oncology clinical nurse specialists in the healthcare system in Israel, where, unlike many countries in the world, such a role has not yet been developed or professionally defined. We conducted 24 interviews with physicians and nurses between August and October 2021. The interviews were transcribed and analyzed using a thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. Five main themes emerged from the interviews: (1) contribution to the healthcare system, (2) contribution to the patient, (3) drawing professional boundaries, (4) additional responsibilities and authority for oncology clinical nurse specialists, and (5) the field’s readiness for a new position of oncology clinical nurse specialists. The findings provide evidence about the need to develop the role of clinical nurse specialists in the oncology field due to its potential benefits for nurses, physicians, patients, family members, and the healthcare system. At the same time, an in-depth exploration of the boundaries of the role and its implementation, in full cooperation with the oncologists and relevant professional unions, is needed to prevent unnecessary conflicts in the oncology field. Professional development training programs in nursing must create a platform for open dialogue between key stakeholders, nurses, and physicians, in order to help all involved parties, place the benefits to the patients above any personal or status considerations.

Why Senior Nurses are Required in Private Cardiology Practice Throughout New Zealand

• Traditionally, nurses in private cardiology practice have been task-orientated. • In the New Zealand public health sector, senior nursing roles have been identified to improve patient care, increase patient flow, and encourage holistic care focussing on better patient outcomes. • Most patients seen in private practice are in prevention mode. Clinical nurse specialist roles in interventional and clinical areas in cardiology include: • Nurse-led clinics • Patient focus information and resources • Website development • Patient follow-up, and • Triage assessment and patient follow-up. Future development: • Background for recognition and support from insurance companies • National rehabilitation standards provided by public hospitals to include private practice • Nurse-led clinics • Feedback from patients • Website traffic • Resources • Data collection provided to insurance companies in support of this cause. • Improved patient outcome standard of patient care is continuous across private and public sectors.

Implementation and assessment of a provincial early palliative care initiative for patients with pancreatic cancer.

e18742 Background: Early palliative care (EPC) referral reduces health care costs & improves quality of life and survival in some advanced cancers. One barrier to EPC is hesitancy of care providers to refer. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the centralized referral office are triaged by an oncologist & concurrently referred to the CNS. CNS consultation focuses on physical & psychological symptoms, medication review, patient/family coping, & goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system & community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. The primary aim of this study is to assess the impact of the CNS role on referral to multidisciplinary palliative care/hospice services within 8 weeks of diagnosis. Methods: We compared patients with PANC in the pre-implementation period (April 1, 2021 to December 31, 2021) to the post-implementation period (April 1, 2022 to December 31, 2022). Patients were identified using the Manitoba Cancer Registry & the CNS clinical database. Descriptive statistics were used to report quality measures. A one sample test of proportions was used to compare EPC referral in the pre- & post-implementation periods. Results: In the pre-implementation period, 64 patients were referred to CCMB with PANC. Fifty-nine (92%) were diagnosed via biopsy, 52 (81%) had consultation with a medical oncologist, 32 (50%) received chemotherapy. Forty-four (69%) were referred to a palliative care/hospice program. In the post implementation period, 88 patients were referred to CCMB. Eighty-five (97%) accepted a consultation with the CNS, with a median time to meeting of 6 days (range, 0-18), and 75% of patients seen within 10 days. After CNS consultation, 28 (32%) declined biopsy, oncology appointment or both. Overall, sixty-three (72%) patients in this cohort had a diagnostic biopsy, 59 (67%) had a consultation with a medical oncologist, 29 (33%) received chemotherapy. Fifty-nine (67%) were referred to a palliative care/hospice program. In the pre-implementation period, 24 (38%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 44 (50%) in the post-implementation period (p = 0.0154). Conclusions: This novel approach demonstrates CNS assessment & education soon after diagnosis of PANC, at the time of referral to CCMB, results in an increased proportion of patients being referred for community-based palliative care/hospice within 8 weeks of diagnosis. Exploring patient goals early may also spare patients from invasive & timely procedures, allowing those with a life limiting illness to focus on quality of life.

E050 Developing multidisciplinary models of care in rheumatology at University College London Hospital: 18 months of learning from conception to delivery and beyond

Abstract Background/Aims The COVID-19 pandemic has placed unprecedented pressures on NHS departments, with demand rapidly outstripping capacity. The British Society for Rheumatology ‘Rheumatology Workforce: a crisis in numbers (2021)’ highlighted the need to provide innovative ways of delivering rheumatology specialist care. At University College London Hospitals (UCLH) we created a rheumatology multidisciplinary team (MDT) clinic to meet rising demands on our service. The aims of the Rheumatology MDT clinic were to: reduce new appointment/follow-up waiting times, increase clinic capacity, incorporate musculoskeletal (MSK) point of care ultrasound, reduce number of hospital visits and add value to each clinic encounter. Methods We ran a 6-month pilot, supported by our outpatient transformation team, incorporating a Rheumatology Advanced Practice Physiotherapist (APP), Clinical Nurse Specialist (CNS) and MSK ultrasound within a Consultant clinic. The success of the pilot helped secure funding for a further 12 months. Over 18 months we have implemented: APP/Consultant enhanced triage - up to 40% of referrals were appropriate for APP assessment, including regional MSK problems and back pain. This increased capacity for consultant-led appointments. Standardisation of time-lapse between CNS and consultant follow-up appointments to ensure appropriate spacing between patient encounters. Facilitated overbooking of urgent cases afforded by additional capacity provided by the APP. MSK ultrasound embedded in the clinic template. ‘Zoom’ patient education webinars facilitated by MDT members and wider disciplines e.g. dietetics, to empower self-management and reduce the administrative burden of patient emails/phone calls occurring outside the clinic. Patient participation sessions and feedback to help shape the service. Results During the 6-month pilot we reduced our waiting time for follow-up appointments from 9 months to 2. We now have capacity to book 1-2 urgent cases each week. Pre-MDT the average wait from consultant referral to physiotherapist appointment was 55 days. The MDT allows for same day assessment (reducing 2-3 patient journeys a clinic) and where suitable, facilitates discharge or onwards referral to the appropriate service. A dedicated MDT CNS has shortened treatment times, reduced email traffic between CNS and consultant and allows for same day, joint decision-making resulting in fewer appointments. Zoom webinar feedback has been positive. Patients value the broad expertise of allied health professionals which supports self-management. Embedding ultrasound allows for same day diagnostics, decreased referrals to radiology and reduced hospital visits. Conclusion Our MDT model has reduced waiting lists, decreased treatment delays and cut hospital attendances. Point of care ultrasound allows for same day decision making and abolishes the cost and diagnostic delay associated with referrals to radiology or outsourced providers. Shared decision-making adds value to outpatient attendances, which is reflected in patients’ positive feedback. The MDT model maximises the existing workforce skill set by enhancing the APP and CNS role, allowing patients immediate access to their expertise. Disclosure F. Higgs: None. D. Ludwig: None. N. Allotey: None. S. Begum: None. J. Burton: None.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. This study used a quantitative exploratory descriptive approach using survey data. A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.

Demonstrating the Value of the Clinical Nurse Specialist: A "How-to" Guide.

The purpose of this article is to provide a guide to identifying measurements of value and how to calculate different types of return on investment (ROI). Exemplars of clinical nurse specialist (CNS) work efforts with ROI will be presented. The CNS is the oldest advanced practice role; however, the role can be vague, making it difficult to articulate the value of the CNS in the organization. Functioning in 3 spheres of impact, the CNS can easily impact practice; however, demonstrating the value of this work is not always on top of mind and is rarely taught in academic programs. This article describes the difference between revenue generation, cost savings, and cost avoidance, as well as various structural, process, and outcome measures that can be used to calculate ROI. Resources available for performing ROI calculations will be described and shared. Distributing work across the 3 spheres creates various opportunities for the CNS to demonstrate value; however, the CNS must be able to articulate that value to the organization. Developing the skill set to consistently identify metrics can be challenging; however, it is critical to the ongoing success and future of the CNS role. Utilizing these metrics to demonstrate the value and then disseminating the outcomes of these contributions will continue to promote the value of the CNS in the future.

Nurses' Perceptions of the Clinical Nurse Specialist Role Implemented in a Highly Specialized University Hospital in Spain: A Qualitative Study.

To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain. Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Clinical Nurse Specialist Transition to Practice.

A quality improvement/evidence-based practice project identified the critical components of clinical nurse specialist (CNS) transition-to-practice (TTP) needs based on the experiences and perceptions of entry-level CNSs (n = 4), experienced CNSs (n = 7), and directors of nursing (n = 6) employed in a tertiary healthcare center. Structured 60- to 90-minute face-to-face discussions were conducted. As knowledge workers, CNSs are critical to investigating, solving, and transforming some of the most challenging current and future healthcare problems. Lack of standardized CNS TTP may result in variable levels of practice, knowledge, skill attainment, and ability to attain interdisciplinary practice competencies. Findings included identification of entry-level CNS TTP key components: 16 categories with 8 critical categories identified as imminent needs. Challenges identified included stakeholders' lack of knowledge/understanding of the CNS role and scope; enormous TTP expectations of entry-level CNSs; transdisciplinary relationships and collaboration; leadership culture and collaboration; organizational culture; deliberate practice; and lack of support, resources, and basic needs. Critical components for advanced deliberate practice within a CNS TTP program include an organizational culture and subculture that understands and values the CNS, along with tiered sustainable support from preceptors, mentors, and support CNSs across the setting and system.