Introduction
The field of the advanced nursing actively develops in the United States because advanced practice nurses (APNs) can perform the variety of functions and activities similar to the tasks of health care practitioners, and the quality of the care delivery increases. Among the APNs roles, Clinical Nurse Specialists (CNSs) are often regarded as high-class clinical experts, whose specific roles and duties are numerous (Gordon, Lorilla, & Lehman, 2012). In spite of the fact that CNS’s roles are unique and extremely important in the area of advanced nursing practice, there are also challenges that can be faced by nurses, and it is necessary to focus on defining the nursing practice and discuss the CNS’s roles and associated issues in detail.
Definition of CNS Advanced Nursing Practice
The advanced nursing practice can be defined as the process of providing the high-quality nursing care to patients when advanced nurses have the appropriate education in the field, the in-depth knowledge, and developed skills; cover the range of tasks; perform their duties at the highest level. In relation to the CNS’s advanced nursing practice, the focus should be on the practice in the clinical settings where CNSs can perform such tasks as the provision of certain services and procedures and the work with analyses (Campbell & Profetto-McGrath, 2013, p. 247). From this perspective, the advanced nursing practice related to CNSs’ roles can be defined as the process of providing the advanced level nursing care in the clinical setting by the high-class specialists who have the expertise in conducting health assessment and health procedures, make analyses, and evaluate the treatment results. As a consequence, the advanced nursing practice of CNSs includes the prevention of the health problems, assessment of the patients’ health state, diagnosing, and the provision of the required treatment. In addition, the CNSs’ nursing practice can be discussed as advanced as the nurses are expected to perform as educators, leaders, consultants, and experts in the variety of nursing areas (Penzias, Cadman, Sullivan, & McIntosh, 2015, p. 152). From this perspective, the advanced nursing practice remains one of the significant and challenging areas of the U.S. healthcare system as it requires advanced nurses, including CNSs, with the deep knowledge and developed skills and expertise in the area.
Roles of Clinical Nurse Specialists
While relying on the definition of the advanced nursing practice related to CNSs, it is also important to discuss such roles associated with the work of CNSs as an educator, a researcher, an expert, a consultant, a leader, and a change agent.
Educator
A CNS performs the role of an educator when she educates the other nurses in the clinical unit in order to practice certain skills and prepare for the active work in the clinical setting (Kirk, McGlinsey, Beckett, Rudd, & Arbour, 2015). CNSs often perform as educators when they communicate with clients and their families regarding the aspects of the health lifestyle, prevention activities, interventions, and aspects of the treatment.
Researcher
The role of a researcher is also important for CNSs because they often search the data and the evidence-based practices, as well as conduct studies in order to provide the support to the used or new procedures, approaches, and methods. A good nurse is usually a researcher who investigates the innovative approaches and grounds her practice on the evidence from the previous studies.
Expert
Another essential role is an expert. CNSs are responsible for making decisions regarding the treatment plans for patients and certain procedures in complicated cases. In these situations, CNSs are expected to perform as experts in their specific fields, depending on the clinical setting. In addition, CNSs perform the functions of experts at conferences and participating in the consultation session (Penzias et al., 2015). Experts are responsible for providing the high-quality care to patients.
Consultant
The other role is a consultant. Similar to the expert role, CNSs perform as consultants when it is necessary to make decisions regarding the prevention procedures, interventions and treatment and when nurses participate in the consultation session. CNSs are often consulted in order to make the judgment regarding the treatment or intervention results and changes in the approaches. As a consultant, a CNS can provide nurses and other colleagues with a variety of alternatives to choose from based on her expertise.
Leader
Working with a group of nurses, a CNS can also perform as a leader. Experienced CNSs often function as leaders when it is necessary to organize the work of other nurses, share the experience, coordinate the activities, and monitor the results of working with clients and colleagues (Campbell & Profetto-McGrath, 2013). In these situations, CNSs can coordinate the work of the determined group of nurses to improve their performance in relation to the set goals.
Change Agent
A change agent is one more role of CNSs that is characterized by promoting the changes in the clinical settings. It is expected that performing as a change leader, a CNS will propose new ideas regarding the improvements in the practice and environments, and she will encourage other nurses to accept the change initiatives. In addition, being a change agent, a CNS not only promotes the change initiative, but she also works with nurses to determine what areas need to be improved in the concrete organization and facilities.
In spite of the fact that it is possible to identify six main roles performed by CNSs in their practice, the role of the expert can be discussed as the most important one. The reason is that functioning as an expert, a CNS demonstrates the nursing knowledge, applies the experience, and develops advanced skills while resolving the problems and making decisions (Gordon et al., 2012). CNSs are expected to perform as experts in their daily activities; therefore, this role can be viewed as the most important to demonstrate the level of the nurse’s expertise and competency.
Challenges Faced by CNSs
While working in the clinical settings, CNSs perform a variety of roles, and they can influence the patients’ health and treatment using different strategies and approaches. Thus, a CNS can provide the direct care to patients while taking the role of an expert in the specialized field or she can influence the patient’s treatment indirectly, while leading the group of nurses, providing the consultations, and giving the recommendations (Kirk et al., 2015). As a result, different organizations and units expect CNSs to perform numerous direct and indirect roles and duties depending on the tasks and rules accepted in the concrete facility. Thus, in their professional relationships, CNSs can face such challenges as the necessity of defining the roles and sharing the responsibilities according to duties and the expertise among the colleagues; the necessity to combine direct and indirect nursing roles; the necessity of taking the leading or mentoring roles among other challenges.
In one organization, a CNS can be expected to work primarily with patients and provide the interventions and treatment, and colleagues will not support performing other roles by a CNS if her role is not defined effectively. In other organization, the focus can be on both the leader role and the practitioner role when a CNS is challenged to combine the variety of tasks and duties. Moreover, CNSs are often expected to perform as both leaders and change agents, and in this case, the direct communication with patients becomes limited. From this point, the main challenge is the lack of the role clarity as skills of CNSs cover the variety of tasks and duties (Gordon et al., 2012). If a CNS does not respond to the authority’s expectations, there can be problems in professional relationships. Additional challenges include the necessity of combining multiple roles, time management, and references to principles of the evidence-based practice in order to support the work of the team in the organization and meet the requirements in professional relationships.
From this perspective, it is possible to predict such two main challenges associated with professional interactions in the clinical settings as the limitations in responsibilities and prevention from participating in the direct or indirect patient care because of the staff’s uncertainty regarding the CNS’s expertise. The other extreme is the overuse and exploitation. Thus, a young CNS can be asked to perform the variety of roles without the required compensation. In the first case, colleagues can demonstrate the lack of respect to the CNS’s expertise. In the second case, the CNS can fail to manage all the tasks, and the underutilization will lead to the lack of respect and support. In order to deal with these challenges, it is important to clarify with the authorities in the organization what duties are expected to be performed by a CNS in this facility. In addition, it is necessary to articulate the role of a CNS according to the standards and ask to address this aspect (Campbell & Profetto-McGrath, 2013). It is also important to determine who traditionally perform the roles of nurse leaders and mentors in this organization in order to develop the supportive relationships with these persons and avoid the situation of misunderstanding the role distribution. The effective communication with the authorities and colleagues regarding the CNS’s roles can contribute to predicting the possible confusion.
Conclusion
The roles of CNSs are numerous, and this fact creates the problematic situation when there is a lack of clarity regarding the duties and responsibilities of CNSs. Thus, the education of a CNS allows performing the roles of not only the practitioner in the specialized field but also a researcher, an educator, a leader, an expert, a consultant, and a change agent. All these roles can also be performed by other nurse specialists, but in the context of the CNS’s practice, these roles allow providing the complex direct and indirect care to patients in order to address their needs. From this perspective, knowing their essential roles, CNSs should be ready to possible challenges in developing their professional relationships and formulate strategies to address these issues while focusing on the role clarity.
References
Campbell, T. D., & Profetto-McGrath, J. (2013). Skills and attributes required by clinical nurse specialists to promote evidence-based practice. Clinical Nurse Specialist, 27(5), 245-254.
Gordon, J. M., Lorilla, J. D., & Lehman, C. A. (2012). The role of the clinical nurse specialist in the future of health care in the United States. Perioperative Nursing Clinics, 7(3), 343-353.
Kirk, A. P., McGlinsey, A., Beckett, A., Rudd, P., & Arbour, R. (2015). Restraint reduction, restraint elimination, and best practice: Role of the clinical nurse specialist in patient safety. Clinical Nurse Specialist, 29(6), 321-328.
Penzias, A., Cadman, S., Sullivan, A., & McIntosh, K. (2015). Mentoring the nurse of the future: Clinical nurse specialist students in the radiology setting. Journal of Radiology Nursing, 34(3), 150-156.