The Clinical Nurse Specialist

It is suggested by Hunt (1999) in the UK nurses have 'specialised' since the Nightingale era. But the Clinical Nurse Specialist role as it is today began to appear in the United States in the 1930s. It didn't reach the UK until the 1980s, and has continued to evolve across a wide range of specialties (Bous-field, 1997). Although role development has been ad hoc (Gibson & Bamford, 2001), it was expected that one should have considerable experience in the field and a post-registration qualification. In the USA Clinical Nurse Specialists are educated to Master's degree level, and it is considered that they are 'advanced practice nurses'. Gibson and Bamford (2001) suggested that there is a lack of evidence in the UK to support Master's education for nurse specialists, while Bousfield proposed (1997) that the literature suggests that, for role recognition to occur, practitioners would need to be educated to an advanced level. A brief appraisal of the literature yields a broad consensus of opinion on the key components of the Clinical Nurse Specialist role, identifying the four main themes as follows: clinical, consultative, educational and research roles.

However, some of the other components that were identified from the literature were those of Role Model (Wright, 1997), Leader (Bousfield, 1997), Patient Advocate (Wright, 1997; Bousfield, 1997), Change Agent (Ormond-Walshe & Newham, 2001; Wright, 1997), Developer of Procedures and Protocols (McCreaddie, 2001) or Administrator (McCreaddie, 2001; Gibson & Bamford, 2001). These other very different key components could be attributed, as was mentioned earlier, to the fact that specific aspects of the role would depend on the practice setting and client group (Kleinpell, 1998). Sidani & Irvine (1999) did, however, determine that prescribing pharmacological treatments was beyond the Clinical Nurse Specialist's scope of practice.


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