September 25, 2013
Internationally the concept of specialized expert or advanced nursing is not new and can be identified as early as the 19th century in the United States Civil War. (Hamric et al., 2005; Jacobs 2007). Advanced nursing practice, however, became definitively established in the USA in the 1970’s through advances in educational preparation and clinical practice roles for both the CNS and NP (Harmic et al.). The present-day CNS role is also established in Australia, Taiwan, China, Japan, New Zealand and the United Kingdom (Chen, 2009; Hamric et al.). In each country the definition and scope of practice of the CNS are influenced by factors such as the national economy, culture, education, practice standards and models of health care delivery (Chen; Hamric et al.). The Nurse Practitioner/NP is currently the most obvious example of the advanced practice nurse in the US, and there has been a lot written about the role of the NP and its contribution to health care. (Dunn, 1997; Gardner et al., 2004). The role of the Clinical Nurse Specialist or CNS, however, has been much less looked at in the US. Based on internationally and nationally accepted definitions the CNS role falls under the canopy of advanced nursing practice. The International Council of Nurses states: A nurse practitioner/advanced practice nurse is a registered nurse who has the expert Knowledge base, complex decision making skills and clinical competencies for expanded Practice, the characteristics of which are shaped by the context and/or country in which She/he is credentialed to practice. A master’s degree is recommended for entry level (ICN, 2005, p. 5).
The nursing council of New Zealand defined advanced practice as that which “reflects a range of highly developed clinical skills and judgments acquired through a combination of nursing experience and education.” (ICN. 2005, p.4). In Canada a CNS is defined as a Registered Nurse (RN) who, through both practice and masters level education, has become an expert in a clinical area of nursing (Sparacinc, 2005). The American Nurses Association (1996) defines the CNS as an “expert clinician and client advocate in a particular specialty or subspecialty of nursing practice.” (p.3). In the Literature there appears to be a lot of similarities about what constitutes ‘expert’. The qualities most often referred to are: expert delivery of care; facilitating change and quality improvements; education of self (post graduate) and in the workplace to colleagues and patients; active involvement in research; functioning as a leader; and cultural and ethical influence (Borbasi, 1999; Caslledine, 1999; National nursing organization in the US 2005.). The most important quality is considered to be the delivery of expert care (Benner, 1984; Pallerson 1987). More recently it appears the importance is shifting from the delivery of care to the multitude of roles the expert is also expected to fulfill, such as leader, researcher, teacher, change agent, police writer and professional spokesperson (Casiledine; National nursing organizations in the US). Hamric et al. (2005) describes several competencies important to the CNS role. These include clinical practice, coaching and guidance, consultation, research, leadership, collaboration and ethical decision making. There is emphasis on the direct patient care component of the definition, as clinical practice, skills, knowledge and clinical know-how are explained to be the role of CNS practice (Sparacino, 2005). There has been considerable discussion about integration of the NP and CNS roles (Elson, Happel & Manis, 2006; Gardner et al., 2004) because they share similar aspects such as research, education and consulting (Henderson, 2004.). Research, however, explains vital differences in the roles; NPs are, “responsible for diagnosing...
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