Cost-effectiveness and quality of care provided by clinical nurse specialists.

Clinical nurse specialists in psychiatric-mental health nursing provide primary mental health services to prevent and treat minor mental illnesses and collaborate with physicians to provide mental health services to those with complex mental and/or physical illnesses. CNSs practice in a wide range of settings and in rural and urban areas. Eliminating bureaucratic, attitudinal, legal, and insurance barriers to the services of CNSs in psychiatric mental health nursing can improve access, lower costs, and enhance the quality of mental health delivery systems. Nurses can eliminate some of these barriers. Within bureaucratic organizations, such as hospitals and clinics, nurses can document problems and experiment with collaborative models of practice that make full use of their skills. Nurses must be active participants, including taking on leadership roles, in committees that address changes in patient and health care policies in their organizations. Changing attitudes by educating the public--as well as other health care providers and politicians--about the roles and credentials of nurses is instrumental to removing barriers. Brochures about the roles and credentials of nurses can be prepared and disseminated to patients, civic organizations, other health care providers, and politicians. Nurses should never miss an opportunity to address one of these groups! Demonstrating excellence in nursing practice leaves a lasting impression on patients and other health team members. Implementing innovative approaches to care based on current literature in nursing and related areas is an advanced practice expectation. Further documentation of the impact on cost and quality of care by nurse providers is necessary. Legal and insurance barriers are the most resistant to change.(ABSTRACT TRUNCATED AT 250 WORDS)