1. Darmody, Julie MSN, RN, ACNS,-BC

Article Content


The purpose of this research was to describe the work of the clinical nurse specialist (CNS) in the acute care setting using the National Association of Clinical Nurse Specialists model as a framework. The specific objective was to collect random work sampling data on the activities of CNSs with patients, nurses, and the organization/system.



Clinical nurse specialists are a group of advanced practice nurses who have been recognized as clinical experts and leaders in nursing for almost 50 years. However, the work of the CNS has not always been visible to patients and families, nursing personnel, other providers, and administrators.



This was a descriptive study of CNS practice using Multidimensional Work Sampling to collect data about the work activities of acute care CNSs at 4 healthcare organizations in the Midwestern United States.



Clinical nurse specialists carried the Divilbiss Random Reminder instrument and recorded their work activity and contacts on a checklist each time a random signal was received. The CNS Activity Checklist was developed in a pilot study and based on the National Association of Clinical Nurse Specialists model.



Clinical nurse specialists (n = 30) self-reported 7,564 data points or observations during 518 work days and 4,216 hours. The proportion of CNS work time spent within each practice domain included patient/client (28.7%), nursing (22.7%), organization/system (33.3%), and other activities (15.3%). The most common patient/client activities included interdisciplinary rounds and patient consultation. Nursing education was the most common activity with nursing personnel. The most frequent organization/system activities included committee meetings and quality improvement. The most frequent contacts during work activities included self (37.6%), group (22.5%), nurse (16.7%), patient (5%), and manager (5%).



This study provided quantitative information about the work activities and contacts of acute care CNSs within 4 organizations. Organization/system activities comprised the greatest proportion of CNS work time in acute care. Clinical nurse specialists reported that they were in contact with other people for almost two-thirds of their work time.


Implications for Practice:

Work measurement data can be used to describe and analyze CNS work activities, link work activity to clinical and fiscal outcomes, and articulate CNS practice to multiple stakeholders.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.