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Substantive Areas of Clinical Nurse Specialist Practice: A Comprehensive Review of the Literature


doi: 10.1097/NUR.0b013e31819971d0

Aim: A comprehensive review of the literature was performed to describe the substantive clinical areas of clinical nurse specialist (CNS) practice.

Background: There is lack of understanding about the role of CNSs. Debates over blending CNS and nurse practitioner roles are common, as are questions and uncertainties about new models of advanced practice nursing endorsed by the American Association of Colleges of Nursing. To better understand the role of the CNSs and plan for new models of advanced practice nursing, it is important to know what CNSs say about the nature of their work and examine research related to CNS practice.

Method: The following databases were searched using the terms clinical nurse specialist or advanced nursing practice: Cumulative Index to Nursing and Allied Health Literature, Medline, PsychInfo, Academic Search Premier, ProQuest Dissertations and Theses, PapersFirst, and ProceedingsFirst. Criteria for inclusion in the sample were determined a priori. Data were extracted from each article and abstract using thematic content analysis.

Findings: The final sample included anecdotal articles (n = 753), research articles (n = 277), dissertation/thesis abstracts (n = 62), and abstracts from presentations (n = 181). Three substantive areas of CNS clinical practice emerged: manage the care of complex and vulnerable populations, educate and support interdisciplinary staff, and facilitate change and innovation within healthcare systems.

Conclusions: There is a clear conceptual basis for CNS practice, which is substantiated in the literature. Clinical nurse specialists must continue to define this scope of practice to organizations, administrators, healthcare professionals, and consumers.

Author Affiliations: Kent State University, College of Nursing, Ohio.

Support for this project was given by the National Association of Clinical Nurse Specialists.

Corresponding author: Wendy Lewandowski, PhD, 5431 Brainard Road, Solon, OH 44139 (

© 2009 Lippincott Williams & Wilkins, Inc.