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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.
Purpose/Aims:
To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes.
Design:
Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022).
Methods:
Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data.
Results:
The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified.
Conclusions:
Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.
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