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Observing the Work of the Clinical Nurse Specialist: A Pilot Study

The Clinical Nurse Specialist (CNS) is an advanced practice nurse (APN) with graduate preparation as a clinical expert within a specialty area of nursing practice. There is a need for information about the work of the CNS in order to link CNS activities to outcomes and costs of care. Purpose: To describe the work of the CNS in the acute care setting using the National Association of Clinical Nurse Specialists (NACNS) model as an organizing framework. Design: Descriptive pilot study of the work of the CNS in acute care. Setting: A 500-bed academic medical center located in the Midwestern United States. Sample: Five masters-prepared APNs in a unit-based CNS role. Methods: Direct observation and time study were used to record activities and time for 4 hours with each CNS (n = 5) for a total of 20 hours of observation. Findings: CNS activity and time within each practice domain included patient/client (30%), nursing (44%), organization/system (10%), and other activities (16%). Specific activities observed were linked to possible outcomes in the NACNS framework. Conclusions: The NACNS model provided a useful framework for developing a data collection tool that can be used in a larger study that analyzes the work of the acute care CNS. Implications: Describing the work of the CNS is an important preliminary step to measuring outcomes and costs of care.