Scott R A
South Fulton Medical Center, Atlanta, Georgia, USA.
Clin Nurse Spec. 1999 Jul;13(4):183-90. doi: 10.1097/00002800-199907000-00010.
Clinical nurse specialists (CNSs) frequently adapt to meet the challenging and changing needs of patients, families, nurses, physicians, and institutions, thus creating an advance practice role that is problematic in definition and description. The two dilemmas associated with CNSs have been role confusion and ambiguity, and the inability to explicate CNSs' value in economic terms. The purpose of this study was to describe the roles, activities, skills, and the cost-saving and revenue-generating activities of Master's-prepared nurses who function in traditional CNS roles in the United States. A descriptive research design was employed, using Role Theory as a framework to guide the study. The tool used to measure CNS practice included a 68-item instrument. It was pretested and used in two pilot studies. Content validity was supported by three experienced CNSs who were, at the time, in a doctoral nursing program. Instrument reliability was 0.89. Surveys were mailed to all individuals who subscribed (n = 2379) to the Clinical Nurse Specialist Journal. From the convenience sample, 724 CNSs participated, providing a margin of error of +/- 4 percentage points with a 99% confidence level. Regarding the five role components, CNSs reported (listed from most frequently to least frequently) spending time in the role of expert practitioner, educator, consultant, administrator, and researcher. Most of the activities listed in each of the roles were typical of CNS practice. Of the advanced practice roles, the two with the most surprising results were the expert practitioner and administrator roles. The results indicated a trend toward performing advanced skills that have been in the past considered solely medical practice and toward increasing administrative responsibilities. A small number of CNSs were able to identify cost-saving and revenue-generating activities, including the monetary value of the activity.
临床护理专家（CNSs）经常进行自我调整，以满足患者、家庭、护士、医生和机构不断变化的挑战性需求，从而形成了一个在定义和描述上都存在问题的高级实践角色。与临床护理专家相关的两个困境一直是角色混淆和模糊不清，以及无法从经济角度阐明临床护理专家的价值。本研究的目的是描述在美国担任传统临床护理专家角色的硕士学历护士的角色、活动、技能以及节省成本和创造收入的活动。采用了描述性研究设计，以角色理论为框架来指导研究。用于衡量临床护理专家实践的工具包括一个68项的量表。该量表经过了预测试，并在两项试点研究中使用。内容效度得到了三位当时正在攻读护理学博士学位的经验丰富的临床护理专家的支持。量表的信度为0.89。调查问卷被邮寄给了所有订阅《临床护理专家杂志》的个人（n = 2379）。在这个便利样本中，有724名临床护理专家参与，在99%的置信水平下，误差幅度为±4个百分点。关于五个角色组成部分，临床护理专家报告（从最常到最少）花费时间扮演专家从业者、教育者、顾问、管理者和研究者的角色。每个角色中列出的大多数活动都是临床护理专家实践的典型活动。在高级实践角色中，结果最令人惊讶的两个角色是专家从业者和管理者角色。结果表明，存在一种趋势，即执行过去仅被视为医疗实践的高级技能，并增加管理职责。少数临床护理专家能够识别节省成本和创造收入的活动，包括活动的货币价值。
