1. Cox, Erin MS, RN, CCRN
  2. Jeffries, Marian MSN, APRN,BC, FNP-C
  3. Martin, Ann
  4. Phipps, Marion MS, RN, CCRN, FAAN

Article Content


The purpose of this presentation is to identify and review the most frequently encountered common clinical problems found in clinical nurse specialist (CNS) and staff nurses practice, to address levels of preparedness, and to address the problems and resource adequacy.



The role of the CNS is multifaceted, with a focus on patient healthcare that is evidence-based, cost-effective, interdisciplinary, safe, and produces positive, measurable outcomes. The CNS may practice in a variety of clinical roles and settings when working with the patient, clinical staff, administration, or management. Responsibilities vary from consultation to research development and from the bedside to the boardroom. The scope of CNS practice is often wide and varied. Identification of common patient problems may enhance understanding of the CNS role, focus staff development, and identify the complexity of the spheres of practice.



A survey tool was developed by a group of CNSs at the Massachusetts General Hospital (MGH) in Boston. The focus of the tool was to identify common clinical problems being seen in clinical practice by nursing staff that might benefit from a CNS intervention. CNSs have found that these data have been helpful in guiding evidence-based practice initiatives, focusing staff development issues, and further articulating the role of the CNS. This survey tool was composed of a list of 27 patient problems. Using a 4-point Likert scale, participants were asked to determine problem frequency, preparedness to address these problems, and resource availability. Demographic information was also obtained.



After a brief explanation, a voluntary 4-page questionnaire was given to any willing CNS present at the NACNS national meeting in Orlando, Florida, in March 2005. Prior to participants' leaving the main meeting room, these completed questionnaires were collected by the MGH CNS group and collated (not all were returned; N = 122). Data were also compared with findings from 2 other groups, including staff nurses and CNSs at a Boston medical center



The results of this survey indicate that many of the problems seen in Boston are also problems being identified by CNSs throughout the United States.



Of the 27 problems addressed, the top 5 problems frequently seen were the same ones identified by our CNS group in Boston. The level of preparedness of the CNS was high for most problems and most CNSs felt comfortable with accessing appropriate resources. When data were compared with other data sets, there were several similarities and a few differences.