1. Fulton, Janet S. PhD, RN, ACNS-BC, ANEF, FCNS, FAAN

Article Content

Collectively nurses are committed to assuring care and comfort to our fellow humans by preventing or reducing risk of disease and harm, relieving distressing symptoms, promoting physical and cognitive functioning, and maximizing quality of life. All nurses are dedicated to that one same mission. However, globally nursing practice varies, influenced by local traditions, cultural norms, national policies, and politics on all levels. In our daily work, we forget that our understanding of nursing is colored by the socio-political context of our environment.


Specialization in nursing practice results from increasing knowledge about disease and human behavior. Nurses with a specialty-focused practice are meeting important public needs. Specialty nurse is a title used in many countries to designate nurses with a specialty practice focus. The specialty nurse role is different from the clinical nurse specialist role. A graduate degree in nursing, the foundational preparation for clinical nurse specialists in the United States, is not widely available globally, in some countries few nurses hold baccalaureate degrees. According to International Council of Nurses (ICN), a specialty nurse completes generalist nursing education (registered nurse) and additional post-generalist training in a specialty area.1 Specialty nurses are a mid-step between generalist registered nurse and a graduate degree prepared clinical nurse specialist. Where specialty nurses are present, nurse leaders are developing standards for education and identifying core responsibilities and evaluation parameters.


This issue of the journal features two articles describing findings from research designed to clarify the role and practice of specialty nurses in China. Zhao and colleagues characterized specialty nurses as holding a college degree, completing 3 to 5 years of clinical experience, attending 3 to 6 months of post-degree academic training courses, and completing additional specialty clinical experiences. A clinical nurse specialist is described as a senior specialty nurse with the highest level of training. Cai and colleagues noted that training standards for specialty nurses are vague, short term, and non-degree based. Performance expectations are inconsistent with job responsibilities largely defined by individual hospitals. Both research teams used a Delphi method to identify expectations for specialty nurse performance, evaluation, and promotion. The findings of the two studies are similar. And interestingly, the findings overlap with some of the National Association of Clinical Nurse Specialist (NACNS) core practice competencies. For specialty nurses in China, expert clinical practice is foundational. System level leadership, teaching nursing students and staff, conducing quality improvement initiatives, and engaging in research and publication are required. These studies can be instructive to others as a methodology for identifying nursing practice competencies and performance expectations. Moreover, the authors provide a window into the role of specialist nurse and initial alignment with the advanced practice nursing role of clinical nurse specialist.


The journal commends our colleagues in China for sharing their research findings and work to further defining specialty nurse practice. Specialty nurses are making important contributions to healthcare in China. Many countries are on the journey from specialty nurse to clinical nurse specialist. The journal invites additional manuscripts discussing the specialty nurse and clinical nurse specialist roles as they exist across the globe. Through continued scholarly dialogue we will discover new perspectives and expand our understanding of nursing, specialty practice, and advanced practice nursing.




1. Guidelines on Advanced Practice Nursing (2019). International Council of Nurses: Geneva, Switzerland. [Context Link]