Clinical nurse specialist practice: facilitators and barriers

Responding to a survey containing open-ended questions, 288 Master's-prepared CNSs across the United States identified role components that are a part of their practice, described health care system changes affecting implementation of their roles, and described resources that were or would be supportive of successful role implementation. Role categories related to patient care/consultation, education, research, administration, and professional development were ranked in that order according to time spent in each activity. Issues related to institutional cost containment and employment of CNSs were described most frequently as affecting role implementation. Nursing administrative support was indicated as the resource most crucial for role success. Specific suggestions for successful implementation of CNS role are described.