A Statewide Survey of Clinical Nurse Specialist Practice: Opportunities and Challenges.

Clinical nurse specialists are the second largest advanced practice nursing role in the United States and remain underused in many states. Expanding access to care to improve patient outcomes is a national priority, which prompted this state clinical nurse specialist association to identify practice barriers, identify opportunities for practice expansion, differentiate registered nurse from clinical nurse specialist practice, and describe differences in those who have practiced in other states. This study was composed of a 15-question online survey, including demographic information, collected over a 4-week period in 2016. Sixty-one respondents (7% of eligible clinical nurse specialists in the state) completed the survey. Regulations limiting the scope of practice in the state were identified by 75% of participants as a practice barrier. Work environment, educational factors, and organizational support contributed to limitations in practice as delineated in the Consensus Model for Advanced Practice Registered Nurses. Participants support increasing public awareness of clinical nurse specialists as advanced practice nurses. Survey results confirm the need for a multifaceted approach in removing clinical nurse specialist practice barriers and improving access to their care by aligning state law and regulation with the National Council of State Boards of Nurses' Model Nurse Practice Act.