The objectives of this study were to ascertain whether clinical specialists in Ireland were fulfilling role expectations in terms of their involvement in audit, evidence-based practice, and research activities; to examine the perceived impact on practice of clinical specialists’/advanced practitioners’ research and audit roles and activities; and to compare research and audit activity in sites with and without clinical specialists/advanced practitioners.
This was a sequential, mixed-methods case study.
The study was performed in clinical specialists’/advanced practitioners’ hospital and community practice settings, and matched sites with no specialist/advanced practitioner, in each healthcare region in Ireland.
A purposive sample of 17 clinical nurse or midwife specialists and 6 advanced nurse practitioners was selected, and 23 “matched” sites in hospital/services that provided similar client care were chosen. Midwifery and all branches of nursing were included.
Data were collected January 2008 to December 2010, using nonparticipant observation (184 hours) of specialist/advanced practitioners and matched clinicians in practice, interviews with directors of nursing/midwifery (n = 23) and clinicians (n = 41), and analysis of documents from each case-study site. Pairs of researchers checked each other’s work, negative case analysis was used, and the whole team agreed with the final findings.
Clinical specialists/advanced practitioners demonstrated more evidence-based practice and greater use of audit than did other clinicians fulfilling comparable clinical roles in matched sites. Fifteen specialist/advanced practitioners (65%) compared with 7 clinicians in matched sites (30%) conducted research (P < .04).
Clinical specialists in Ireland were fulfilling role expectations in terms of audit, evidence-based practice, and research. The impact of clinical specialists’ activities in this area, as perceived by clinical colleagues and managers, is considerable and is documented as greater than the impact of nonspecialist colleagues in comparable sites.
Increased investment in specialist/advanced practitioner posts, with resources and support for research activity, will increase evidence-based care, strengthen quality, and lead to improved practice.
Author Affiliations: Chair of Nursing and Midwifery (Dr Begley), Associate Professor in General Nursing (Dr Elliott), Associate Professor in Midwifery (Dr Lalor), and Professor in Mental Health Nursing (Dr Higgins), School of Nursing and Midwifery, Trinity College Dublin, Ireland.
The study was funded by the National Council for the Professional Development of Nursing and Midwifery in Ireland.
The authors report no conflicts of interest.
Correspondence: Cecily Begley, PhD, MA, RGN, RM, RNT, FFNMRCSI, FTCD, School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland (email@example.com).