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Expert Practice of Clinical Nurse Specialists

The results of an ethnographic study of the expert practice of clinical nurse specialists are described. The purpose of the study was to identify the clinical competencies and skilled performance of clinical nurse specialists. The seven domains of skilled performance that Benner describes as reflective of expert clinical practice formed the conceptual framework for the investigation, and vignettes of actual practice from taped interviews and participant observations illustrate the process. The findings confirm that clinical nurse specialists demonstrate Benner's expert practice domains. In addition, these domains are expanded to include new competencies more reflective of the wide range of clinical, educational, and consultant responsibilities that master's–prepared clinical nurse specialists have in their roles in a large health science center.