Reporting relationships of clinical nurse specialists in acute care

Reporting relationships between clinical nurse specialists (CNSs) and administrators (ADMs) can facilitate or constrain CNS practice and affect patient outcomes. Limited information is available comparing reporting relationships and perspectives of CNSs and ADMs.

The purpose of the present study was to describe CNS and ADM reporting relationships and compare their perspectives about the activities and outcomes of CNS practice in acute care settings.

The present study uses a descriptive survey.

Four healthcare organizations in the midwestern United States.

Clinical nurse specialist participants (n = 30) were master's degree prepared and employed in an acute care setting. Administrator participants (n = 7) were responsible for supervision and evaluation of CNSs in their organization.

Questionnaires were developed from literature and content review by experts. The CNS and ADM questionnaires contained separate sections for CNS and organization information with parallel construction of questions about CNS activities and outcomes.

There was variability across organizations related to reporting relationships and structure of CNS work. No significant differences were found when comparing CNS and ADM perspectives of work activity proportions and the importance of 10 activities and 7 outcomes. The most important CNS activities included developing clinical protocols and guidelines, quality improvement, and coordination of care. The most important outcomes included evidence-based nursing care and skilled and competent nursing staff.

Comparing perspectives of work activity time, priority activities, and outcomes provides a basis for collaboration between CNSs and ADMs in reporting relationships.

Clinical nurse specialists should develop positive interactions and shared understanding with ADMs to improve effectiveness and enhance patient outcomes.