Keywords

clinical nurse specialists, acute care, time study, CNS practice model

 

Authors

  1. DARMODY, JULIE V. RN, MSN

Abstract

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.