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Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study
Kelley Kilpatrick1, Ruth Tewah, Eric Tchouaket
1Author Affiliations: Associate Professor and Susan E. French Chair in Nursing Research and Innovative Practice(Dr Kilpatrick), Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University; Affiliate Faculty (Dr Kilpatrick), Canadian Centre for Advanced Practice Nursing Research (CCAPNR); and Regular Researcher (Dr Kilpatrick), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal-Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada; BScN Student, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal (Ms Tewah); and Full Professor and Canadian Research Chair in the Economics of Infection Prevention and Control, Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada (Dr Tchouaket); University Lecturer (Dr Jokiniemi), Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio; and Associate Professor (Dr Bouabdillah), Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières; Director of Nursing (Dr Biron), McGill University Health Centre, Montréal; Assistant to the Director of Nursing (Ms Emed), Professional Practice and Academic Affairs, Jewish General Hospital, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal; and Assistant Professor (Ms Emed), Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal; Director of Nursing (Ms Martel), Centre hospitalier universitaire (CHU) de Québec-Université Laval; Research Administrator (Ms Atallah), Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University; and Research Professional (Ms Jabbour), CIUSSS de l'Est-de-l'Île-de-Montréal-Hôpital Maisonneuve-Rosemont, Montréal, Québec; and Full Professor and Alba DiCenso Chair in Advanced Practice Nursing (Dr Bryant-Lukosius), School of Nursing, Faculty of Health Sciences, and Associate Member (Dr Bryant-Lukosius), Department of Medical Oncology, Juravinski Cancer Centre, McMaster University; and Codirector (Dr Bryant-Lukosius), Canadian Centre for Advanced Practice Nursing Research, and Health Sciences Centre, Hamilton, Ontario, Canada.
Clinical nurse specialists in Québec spend about one-fifth of their time in direct patient care, with significant variations across roles and regions. A proposed dashboard aims to track their practice and outcomes.
Area of Science:
- Nursing Practice
- Healthcare Management
- Health Services Research
Background:
- Clinical nurse specialist (CNS) roles are crucial for advancing patient care and healthcare systems.
- Understanding the distribution of CNS time across various professional activities is essential for optimizing their impact.
- A standardized method for tracking CNS practice dimensions and outcomes is needed.
Purpose of the Study:
- To delineate the practice patterns of clinical nurse specialists in Québec, Canada.
- To develop a dashboard prototype for monitoring CNS role dimensions and associated outcomes.
Main Methods:
- A sequential mixed-methods study was conducted across six sites in Québec.
- Time and motion studies (n=25, 203 hours) were employed to quantify CNS activities.
- Focus groups and interviews informed the adaptation of tools and dashboard development.
Main Results:
- Clinical nurse specialists dedicated 22.8% to clinical activities, 11.2% to education, 48.6% to administration/leadership, and 9.6% to research.
- Direct patient care averaged 17% of work time, with notable variations by specialty and location.
- Essential characteristics and applications for a CNS practice dashboard were identified.
Conclusions:
- Significant regional and specialty-based variations exist in how clinical nurse specialists allocate their time in Québec.
- Direct patient care constitutes approximately 20% of CNS work time.
- Further research is recommended to explore the relationship between CNS practice and patient outcomes and to implement and evaluate the proposed dashboard.
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