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advanced nurse practitioner, audit, case study, clinical midwife specialist, clinical nurse specialist, evidence-based practice, mixed methods, nurses/midwives, research leadership, research role



  1. Begley, Cecily PhD, MA, RGN, RM, RNT, FFNMRCSI, FTCD
  2. Elliott, Naomi PhD, MA, RGN, RNT
  3. Lalor, Joan G. PhD, MA, MSc, RGN/RCN, RM, RNT
  4. Higgins, Agnes PhD, MA, RPN, RGN


Objectives: The objectives of this study were to ascertain whether clinical specialists in Ireland were fulfilling role expectations in terms of their involvement in audit, evidence-based practice, and research activities; to examine the perceived impact on practice of clinical specialists'/advanced practitioners' research and audit roles and activities; and to compare research and audit activity in sites with and without clinical specialists/advanced practitioners.


Design: This was a sequential, mixed-methods case study.


Setting: The study was performed in clinical specialists'/advanced practitioners' hospital and community practice settings, and matched sites with no specialist/advanced practitioner, in each healthcare region in Ireland.


Sample: A purposive sample of 17 clinical nurse or midwife specialists and 6 advanced nurse practitioners was selected, and 23 "matched" sites in hospital/services that provided similar client care were chosen. Midwifery and all branches of nursing were included.


Methods: Data were collected January 2008 to December 2010, using nonparticipant observation (184 hours) of specialist/advanced practitioners and matched clinicians in practice, interviews with directors of nursing/midwifery (n = 23) and clinicians (n = 41), and analysis of documents from each case-study site. Pairs of researchers checked each other's work, negative case analysis was used, and the whole team agreed with the final findings.


Results: Clinical specialists/advanced practitioners demonstrated more evidence-based practice and greater use of audit than did other clinicians fulfilling comparable clinical roles in matched sites. Fifteen specialist/advanced practitioners (65%) compared with 7 clinicians in matched sites (30%) conducted research (P < .04).


Conclusions: Clinical specialists in Ireland were fulfilling role expectations in terms of audit, evidence-based practice, and research. The impact of clinical specialists' activities in this area, as perceived by clinical colleagues and managers, is considerable and is documented as greater than the impact of nonspecialist colleagues in comparable sites.


Implications: Increased investment in specialist/advanced practitioner posts, with resources and support for research activity, will increase evidence-based care, strengthen quality, and lead to improved practice.