Clinical nurse specialist: walking the wire

Considered by many to be the panacea for all nursing's problems, the clinical nurse specialist (CNS) has only recently gained widespread recognition as a legitimate role in Australia. The CNS is the equivalent in other states and territories of the clinical nurse consultant, the charge nurse or the nurse unit manager. Implementation of the role has been complicated by inadequately delineated role functions, unrealistic expectations and limited recognition of clinical expertise. Using both quantitative and qualitative exploratory techniques it was found that three critical themes impinged in a negative way on the effectiveness of the CNS. These were role ambiguity, role overload and the 'paradox of power'. Maintaining clinical expertise in the practice setting is essential for high quality cost effective and autonomous nursing care and this can be provided through the effective implementation of the CNS role.