Executive Practice: PDF OnlyShawler Celeste MSN RN CS; Stepler, Hilde MSN, RN; Kinnaird, Sally MSN, RNClinical Nurse Specialist: July 1990 - p 98-102 Buy Abstract The contemperary health care environment is changing rapidly in response to complex economic factors and changes in patterns of care. Coupled with limited nursing resources, these charges challenge the nursing profession to critically evaluate the effectiveness and quality of care delivery, particularly that of advanced practitioners. This paper presents a model for the integration of Clinical Nurse Specialist (CNS) practice with that of the Clinical Nurse Manager (CNM) and Staff Development Instructor (SDI). The model demonstrates that, although the CNS, CNM, and SDI share the same role dimensions, the central focus of each role determines and differentiates its unique practice arena. The interrelationship of dimensions within roles and the complementarity between roles result in significant, nonduplicative contributions to high-quality, cost effective care by the CNS, as well as the CNM and SDI. © Williams & Wilkins 1990. All Rights Reserved.