Clinical nurse specialists and the practice of community nurses

This paper presents the findings of a study of the roles of Clinical Nurse Specialists and community nurses working in primary care.

Clinical Nurse Specialists are recognized internationally as expert practitioners who could facilitate the implementation of evidence-based practice. However, others may misunderstand their role and greater support may be required if organizations are to capitalize on the skills of Clinical Nurse Specialists.

Elements of 'Glaserian' grounded theory in a broadly ethnographic approach were used to gain an understanding of the perspectives of 22 Clinical Nurse Specialists working as tissue viability nurses or continence advisors and 19 district nurses in one health region in the United Kingdom. The data were collected in 2001-02.

Clinical Nurse Specialists were keen to use their expertise to inform the practice of community nurses. However, they encountered difficulties when seeking to introduce changes in practice. Although Clinical Nurse Specialists were acknowledged as enabling rather than deskilling community nurses, receptivity to Clinical Nurse Specialists' ideas was dependent on what community nurses viewed as their own roles. As advisors, Clinical Nurse Specialists were dependent on the use of persuasion and vicarious power to bring about desired changes. These approaches are consistent with traditional approaches to change management as opposed to contemporary approaches to practice development.

If Clinical Nurse Specialists are to reach their full potential and use their expertise to inform the practice of others, organizations need to recognize these posts as central to practice development. In particular, a framework is required which enables practice developers to use more inclusive approaches when seeking to bring about changes in practice.