The functions and responsibilities of the clinical nurse specialists in the thirteen western states
by Lani Marie Zimmerman
A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF NURSING
Montana State University
© Copyright by Lani Marie Zimmerman (1975)
Abstract:
The problem dealt with in this study was to determine how the practicing clinical nurse specialists in
the thirteen western states are functioning in their areas of specialization. Defining the role of the
clinical nurse specialist has been a difficult task because the functions are still in the process of
evolution. As the role of the specialist was unfolding in the literature, variations have developed
depending on the nature and needs of the setting. Hospitals were creating several positions for these
nurse specialists, and the roles -were being defined to meet the specific needs.
This study was based upon data received from 97 clinical nurse specialists practicing in the thirteen
western states. A combination of an open and closed ended questionnaire was sent to these specialists.
The findings suggest that generally, the majority of the tasks involved in the questionnaire were being
performed either "sometimes" or "frequently." The findings also suggest there was not a significant
difference between the tasks being performed by respondents with masters level preparation in nursing
and those who did not have masters level preparation. STATEMENT OF PERMISSION TO COPY
In presenting this thesis in partial fulfillment of the require­
ments for an advanced degree at Montana State University, I agree that
the Library shall make it freely available for inspection.
I further
agree that permission for extensive copying of this thesis for scholarly
purposes may be granted by my major professor, or in her absence, by the
Director of Libraries.
It is understood that any copying or publication
of this thesis for financial gain shall not be allowed without my written
permission.
THE FUNCTIONS AND RESPONSIBILITIES OF THE CLINICAL NURSE SPECIALISTS
IN THE THIRTEEN WESTERN STATES
by
LANI MARIE ZIMMERMAN
A thesis submitted in partial fulfillment
of the requirements for the degree
of
MASTER OF NURSING
Approved:
Ul
A
C\
C
\ A/C-yv-A,
.
^5
fc:.PUtfc-
Chairman, Examining Committee
Graduate"Dean
MONTANA STATE UNIVERSITY
Bozeman, Montana
February, 1975
iii
ACKNOWLEDGMENTS
The writer wishes to express her sincere appreciation to the
persons whose assistance contributed to this study:
To Miss Virginia Felton, committee chairman, whose help,
understanding and patience fostered the completion of this thesis.
To her committee members:
Dr. Laura Walker, Dr. Douglas Bishop,
Mrs. Ethel Nelson, and Dr. Richard Horswill for their constructive help
and encouragement. .
To D r ..Erwin Smith for his statistical advice and encouragement
during the study.
TABLE OF CONTENTS
Page
VITA.
............. ................................................
ACKNOWLEDGMENTS............
LIST OF TABLES......................... ..
ABSTRACT.
ii
.
iii
............... . . . . .
vi
............... .........................
. .
vili
CHAPTER
I
II
III
THE PROBLEM AND .ITS SETTING. ..................
I
Introduction ............
I
Statement of the P r o b l e m .............
4
Need, for the Study . . . ................................
4
Objectives ...............................................
5
A s s u m p t i o n s . .......................
.
6
Definition of Terms.................
.
6
REVIEW OF L I T E R A T U R E ............
9
Role of the CNS.........................
10
Educational Preparation..................................,
13
Organizational S t r u c t u r e ............
15
C o n c l u s i o n ..............................................
16
METHODOLOGY............................................
Survey Population.
.
17
......................................
17
In s t r u m e n t ..............................................
18
V
CHAPTER
IV
V
Pags
PRESENTATION OF DATA ............... ' .....................
19
Characteristics ofClinical Nurse Specialists..............
19
Frequency of Tasks Being Performed ............. . . . . .
24
Frequency of Tasks Being Performed According to Their
Specialty Area
andEducational Preparation ...........
33
Conclusions.................. ............. ............ ..
49
SUMMARY, FINDINGS,IMPLICATIONS,
AND RECOMMENDATIONS . . .
Summary............................. ..
F i n d i n g s ................... ..
. . .............
. ........................
Implications ..................................
. . . . .
Recommendations..........................................
50
50
51
52
53
LITERATURE CITED..........
54
APPENDICES........................................ ..
57
A
Letters of I n q u i r y ........................................
57
B
Questionnaire.
60
C
C o m m e n t s ............... ■ ..............................
...................
67
vi
LIST OF TABLES
TABLE
Page
I
SUMMARY OF RESPONSES BY CLINICAL NURSE SPECIALIST
SPECIALTY AREA. . . . . . . . . . . . . . . . . . . . .
19
II
' SUMMARY OF JOB TITLES HELD BY RESPONDENTS . . .. ......
20
III
LEVEL OF EDUCATIONAL PREPAR A T I O N . .......... ............
21
NATURE OF CLINICAL NURSE SPECIALIST'S TRAINING BEYOND THEIR
EDUCATIONAL PREPARATION ............. . . . . . . . . .
21
YEARS OF SERVICE AS A CLINICAL NURSE
SPECIALIST . . . . .
22
YEARS OF SERVICE AS A CLINICAL NURSE SPECIALIST
IN PRESENT POSITION ....................................
23
IV
V
VI
VII
VIII
IX
X
XI
XII
XIII
XIV
XV
TYPE OF EMPLOYMENT..............
TYPE OF WORKING H O U R S ........................
23
.
24
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS ■
IN THE AREA OF PLANNING AND IMPLEMENTING...............
25
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS
IN THE AREA OF T E A C H I N G .............- .................
27
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS
IN THE AREA OF COORDINATION AND LIAISON . .............
29
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS
IN THE AREA OF C O N S U L T I N G ................
30
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS
IN THE AREA OF E V A L U A T I O N ....................
32
A SUMMARY OF THE CLINICAL NURSE SPECIALIST'S PERSONAL
ATTRIBUTES. .....................
33
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE
SPECIALISTS IN THE AREA OF PLANNING AND IMPLEMENTING
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL
P R E P A R A T I O N ............................................
35
vii
TABLE
xvi
Page
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE
SPECIALISTS IN THE AREA OF TEACHING ACCORDING TO THEIR
SPECIALTY AREA AND EDUCATIONAL PREPARATION. . . . . . . .
XVII
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE
SPECIALISTS IN THE AREA OF COORDINATION AND LIAISON
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL
P R E P A R A T I O N .............................................. 40
XVIII
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE
SPECIALISTS IN THE AREA OF CONSULTING ACCORDING TO
THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION........ 43
XIX
XX
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE
SPECIALISTS IN THE AREA OF EVALUATION ACCORDING TO
THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION. . . . .
SUMMARY OF PRACTICING CLINICAL NURSE SPECIALISTS PERSONAL
ATTRIBUTES ACCORDING TO THEIR SPECIALTY AREA AND EDUCA­
TIONAL PREPARATION........................................ 47
37
45
viii
ABSTRACT
The problem dealt with in this study was to determine how the
practicing clinical nurse specialists in the thirteen western states
are functioning in their areas of specialization. Defining the role
of the clinical nurse specialist has been a difficult task because the
functions are still in the process of evolution. As the role of the
specialist was unfolding in the literature, variations have developed
depending on the nature and needs of the setting. Hospitals were
creating several positions for these nurse specialists, and the roles were being defined to meet the specific needs.
This study was based upon data received from 97 clinical nurse
specialists practicing in the thirteen western states. A combination
of an open and closed ended questionnaire was sent to these specialists.
The findings suggest that generally, the majority of the tasks
involved in the questionnaire were being performed either "sometimes" or
"frequently." The findings also suggest there was not a significant .
difference between the tasks being performed by respondents with masters
level preparation in nursing and those who did not have masters level
preparation.
CHAPTER I
THE PROBLEM AND ITS SETTING
Introduction
One of the main goals of nursing is to improve patient care.
Specialty preparation of the nurse is one way of attempting to improve
patient care.
Nurses must have the knowledge along with the skills and
abilities to provide effective health care under today's changing
conditions.
I
Recently great emphasis has been placed on specialization in
nursing.
One of the most important developments in nursing has been
the preparation of clinical specialists.
The title was first used in
1939, but it has only been within the last two decades that there has
been any effort to provide graduate programs to prepare clinical
specialists.
2
The National League for Nursing believes that the practice of
nursing is becoming specialized because of the great amount of
knowledge that is now recognized.
The members of the League feel that
■'"Dolores Little, "The Nurse Specialist," American Journal of
Nursing, March, 1967, p. 553.
2
Hildegarde Peplau, "Specialization in Professional Nursing,"
The Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox McVay
and Joan P. Riehl (New York: Appleton-Century-Crofts Meredith Corpor­
ation, 1973), p. 19.
2
nurses need to specialize as well as do physicians.
It is no longer
feasible to expect a nurse to care for all kinds of patients.
3
Marilee Rhein has said, "For years we have heard the plea to
return the nurse to the bedside of the patient."
4
This can be accom­
plished by the clinical nurse specialist and can also provide the
patient with quality nursing care.
The nurse specialist can be called
a practitioner who works with a group of patients at all levels of their
conditions.
A new concept of nursing has emerged, which is more compre-r
5
hensive than the traditional role of nursing.
Defining the role of the clinical nurse specialist has been a
difficult task because there has been no precedent.
specialist
As the role of the
was unfolding in literature, variants developed depending on
the nature and needs of the setting.
Hospitals were creating several,
positions for nurse specialists, and roles were defined to meet specific
needs.^
3
National League for Nursing, Extending the Boundaries of Nursing
Education— =The Preparation and Roles of the Clinical Specialist, Third
Conference of the Council of Baccalaureate and Higher Degree Programs,
Publication No. 15-1367 (New York: National League for Nursing, 1969),
p. 36.
,
r
4Marilee Rhein, "The Education of the Clinical Specialist," The
Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox McVay and
Joan P. Riehl (New York: Appleton-Century-Cfofts Meredith Corporation,
1973), p. 131.
5Ibid.
^Margaret Vaughan, "Difficult Task: Defining Role of the Clin­
ical Specialist," The Clinical Nurse Specialist:
Interpretations, ed.
Joan Wilcox McVay and Joan P . Riehl (New York: Appleton-Century-Crofts
Meredith Corporation, 1973), pp. 200-201.
t
3
As a result of experience gained in the past few decades, and
because of the growing number of clinical nurse specialists, there is a
need for a current and definitive statement on the position of the nurse
specialist.
The California Nurses' Association has issued a position
paper on the clinical nurse specialist.
The Association stated, "the
lack of uniformity in role requirements from agency to agency, and even
within agencies, has led to misuse of the title of clinical nurse spe­
cialist and to confusion on the part of the consumer and the employer.
The California Nurses' Association defined the clinical nurse specialist
as:
A registered nurse who, by nature of expertise in a
particular field of clinical nursing practice, assumes
responsibility by applying current, knowledge from the
biological, sociological, and psychological disciplines
in the practice of nursing care for the goals of improving
patient care. The requirements for the clinical nurse
specialist:
1. Registered Nurse
2. Prepared in a particular field of Clinical Practice
at the Master's level in an accredited academic program
3. Evidence of a commitment to continuing education
relevant to the area of practice.^
There has been a variety of definitions and role functions
,presented in the literature on the clinical nurse specialist.
California■Nurses Association, Position Statement on the
Clinical Nurse Specialist, 1973.
8Ibid.
4
Statement of the Problem
The nursing profession is continually striving to improve
patient care.
effort.
The clinical nurse specialist has evolved from this
The roles and functions of the clinical nurse specialists have
not been clearly defined.
The purpose of this study was to determine how the practicing
clinical nurse specialists in the thirteen western states are func­
tioning in their own areas of specialization.
Need for the Study.
The clinical nurse specialist is a relatively new term used in
the nursing profession.
The role of the specialist has been discussed
in the literature with growing frequency.
Because there are many varying role descriptions of the clinical
specialist, this researcher feels that a more definite statement will
serve to guide the individual specialists in fulfilling their role.
It
would also be advantageous for the specialist's colleagues, both nursing
and interdisciplinary, to understand exactly the responsibilities and
functions of.the clinical nurse specialist.
Many schools of nursing across the country have recently insti­
tuted training programs or are in the process of designing programs to
prepare nurses to become clinical nurse specialists.
It is believed
that schools of nursing could use this information about the functions
5
of the clinical specialists to adequately prepare their educational
objectives for the school programs.
A clear statement regarding the clinical nurse specialist’s
functions would be beneficial to the perspective clinical nurse spe­
cialist for her to understand role expectations.
It would also provide
the nurse specialist some precedent guidelines to follow.
A concise description of the functions and responsibilities
would be beneficial to hospitals who do not employ a nurse specialist
by showing them what a clinical nurse.specialist may have to offer.
They may find that there is a need in their organization for a clinical
nurse specialist.
It would be advantageous for hospitals who do employ a specialist
to compare respective functions in other hospitals.
This may help them
in setting up and revising their criteria for evaluating the way in
which their clinical nurse specialists are functioning.
There is no precise description of the roles of the clinical
nurse specialists.
Therefore, the intent of this research is to provide
data describing the manner in which the practicing clinical nurse
specialist is functioning.
■ Obj ectives
\
Objectives of this study are:
I.
nurse specialists.
]
To determine those functions being performed by the clinical
I
6
2.
To determine how frequently the practicing clinical nurse
specialists perform their functions and responsibilities.
3.
To determine if there is a difference in the functions
performed by those clinical nurse specialists who have completed a
master's degree program, as compared to those clinical nurse specialists '
with less than a master's degree.
4.
To compare the functions performed by clinical nurse
specialists in the medical, surgical, pediatric, obstetric, and mental
health areas of specialization.
Assumptions
The assumptions of this study are:
1.
The clinical nurse specialists have been prepared, either
through a master's degree program or have received special additional
training beyond their basic nursing program.
2.
The nursing practice being performed, and the authority
given to the clinical nurse specialists will vary from agency to agency.
Definition of Terms
In order to clarify terminology used throughout the study, the
following definitions were established:
Thirteen Western States.— The western regional area represented
by Western Council of Higher Education in Nursing (WCHEN).
The following
7
states are included:
Alaska, Arizona, California, Colorado, Idaho,
Hawaii, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and
Wyoming.
Role Model.— The setting of an example for nursing staff and
co-workers from other disciplines, thereby forming for them a mental
image of nursing which reflects their behavior.
Clinical Nurse Specialist (CNS).— "A registered nurse who, by
nature of expertise in a particular field of clinical nursing practice,
assumes responsibility by applying current knowledge from the biolog­
ical, sociological, and psychological disciplines in the practice of
q
nursing for the goals of improving patient care.
Throughout the study .
the initials 9
llCNSlt will be used to represent clinical nurse specialist.
*
Liaison Nurse.— A consultant in one area of the organization
working with the interdisciplinary team and all levels of nursing
personnel to provide comprehensive, integrated and uninterrupted care.^
Change Agent.— "The clinical nurse specialist is used by the
9
Ibid.
"^Barbara Beal, and Audrey Sakamoto, "Liaison Nurse and Head
Nurse," The Clinical Nurse Specialist: Interpretations, ed. Joan
Wilcox McVay and Joan P. Riehl (New York: Appleton-Century-Crofts
Meredith Corporation, 197.3), p. 233.
8
nursing personnel to help bring about, through conscious, deliberate,
and collaborative effort,
the improvement of patient care.
Medical Specialty Area.— An area of nursing that deals specif­
ically with medical patients.
Surgical Specialty Area.— An area of nursing that deals specif
ically with surgical patients.
Obstetrical Specialty Area.— An area of nursing that deals
specifically with obstetrical patients.
Pediatric Specialty Area.— An area of nursing that deals
specifically with pediatric patients.
Mental Health Specialty Area.— An area of nursing that deals
specifically with mental health patients.
^Marjory Gordon, "The Clinical Specialist as Change Agent,"
The Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox McVay
and Joan P . Riehl (New York: Appleton-Century-Crofts Meredith Corpor­
ation, 1973), p. 202.
CHAPTER II
REVIEW OF LITERATURE
Much of the related research arid literature reviewed in con­
nection with the present study was used in the quest of determining the
roles and functions of CNS’s .
Only that which was most relevant to the
study was included in the present chapter which was organized to include
literature related to the roles of the specialists, educational prepa­
ration, and placement into the organizational structure of an insti­
tution.
"Who is the Clinical Nurse Specialist" was the title of an
article written by Cynthia Kinsella, director of nursing at Mount Sinai
Hospital in New York City.
Kinsella stated "the clinical nurse spe­
cialist exhibits many unique characteristics, but the predominant one
is the high degree of discriminative judgment she uses in assessing
nursing problems, determining priorities of care, and identifying
nursing measures to achieve therapeutic goals.
About two decades ago, the concept of the CNS emerged.
At that
time the American public was dissatisfied with health care, and nurses
were dissatisfied with nursing.
Kinsella believed that nurses were not.
being allowed to practice nursing.
Nurses were being removed from the
I
Cynthia R. Kinsella, "Who is the Clinical Nurse Specialist?"
Hospitals, June, 1973, p. 72.
.10
bedside of the patient and placed into positions of supervision and
2
administration.
Francis Reiter originated the phrase "nurse clinician" in 1943
to describe "a superior kind of nurse, distinguished by the depth of her
clinical knowledge and by her ability to form collegial relationships with
physicians and representatives of other health care disciplines.
Almost 30 years later the American Hospital Association in cooperation
with the American Nurses’ Association met with nurses and hospital
administrators to discuss who is the nurse clinician, what educational
preparation was needed, and how can hospitals best utilize nurse clini4
cians.
Roles of the CNS
There have been several studies conducted to determine the
functions and roles of the specialists.
There are various definitions
of the CNS, just as there are various job titles (i.e. nurse clinician,
master practitioner, or clinical expert).
From agency to agency the
role of the CNS may be defined differently.
2Ibid., p p . 72-80.
O
"The Clinical Nurse Specialist," Hospitals, February, 1973,
p. 135.
4Ibid.
11
Maxine Berlinger worked on a council for the National League for
Nursing which met to determine the preparation and roles of the nurse
specialist.
Berlinger studied several different definitions of the CNS
and found certain common elements in the definitions.
The CNS,
is first a generalist, has broad intellectual competencies,
is an independent practitioner, has depth of knowledge, is an
innovator, has the ability to make decisions and is analytical
in thinking, and is a teacher or a supervisor.^
Berlinger concluded that the specialist has the following
functions:
to deliver expert nursing care; to guide allied nursing
personnel as a teacher and a model, to innovate or to initiate
change; to contribute to nursing knowledge through research
and practice; to coordinate her activities with persons in
allied disciplines; and to consult with those requiring her
. clinical nursing judgment and knowledge.&
The dual role in patient care and student learning has been a
familiar pattern in nursing history.
LaVaun Sutton was a CNS who
worked half-time in nursing service having direct responsibility for
patient care, and half-time in nursing education with responsibility
for student learning.
Sutton said the advantage of having a dual role
was the need for nursing education and nursing service to narrow the
gap between theory and practice.
Sutton explained that "the individual
Maxine R. Berlinger, "The Preparation and Roles of the Clinical
Specialist at the Master’s Level," The Clinical Nurse Specialist: Inter­
pretations . ed. Joan Wilcox McVay and Joan P. Riehl (New York: AppletonCentury-Crofts Meredith Corporation, 1973), p. 102.
• 6Ibid.
12
in a dual role deriving from both areas has the potential for promoting
the testing and incorporation of theory into practice and also for pre­
venting theory from moving too far away from reality to be useful."^
Georgopoulas and Christman conducted a study of the nurse spe­
cialists in medical-surgical nursing at the University Hospital in Ann
Arbor, Michigan.
A carefully defined role model was constructed to
evaluate the effect of the nurse specialist on nursing practice and
patient care.
The experiment was done with 6 medical-surgical units
containing 25 beds each, 3 were experimental units and 3 were controlled
units.
Georgopoulas and Christman concluded that the presence of a CNS
brought about an improvement in patient care and in the performance of .
Q
other staff workers within the experimental area.
Although the functions and responsibilities of the specialists
will vary from one institution to another, there are still several
commonalities in operationalizing the role of the CNS.
Cynthia Kinsella,
who published "Who is the Clinical Nurse Specialist?", has identified
6 commonalities which are:
LaVaun W. Sutton, "The Clinical Nurse Specialist in a Dual
Role," The Clinical Nurse Specialist:
Interpretations, ed. Joan Wilcox
McVay and Joan P. Riehl (New York: Appleton-Century-Crofts Meredith
Corporation, 1973), p. 231.
g
Luther Christman, and Basil S. Georgopoulas, "The Clinical
Nurse Specialist: A Role Model," American Journal of Nursing, May,
1970, p p . 1030-1039.
13
1. The clinical nurse specialist is a patient advocate.
2. While she may use some of the tools of physical diagnosis
in her nursing assessment, the clinical specialist does so in
order to develop her nursing plan and to influence the nursing
care of the patient.
3. The clinical specialist gives care to selected patients.
In doing so, ,she demonstrates excellence in practice to others
in the setting.
4. The clinical specialist identifies problems needing
research and assumes an analytical approach to their solution.
5. The clinical specialist has the autonomy to define nursing
problems and to order nursing care, assuming the responsibility
and holding herself accountable to the patient.
6 . The clinical specialist maintains and advances her skills
constantly.^
Educational Preparation
Another important issue within the nursing profession is the
educational preparation of the nurse specialist.
It is the consensus
of most people in the nursing profession, that the specialist should be
prepared in an institution for higher education at the master's degree
level.
There are a small number of people in the nursing profession
who believe that the CNS does not need academic educational training
and can learn from experience and on the job training.
Thd National League for Nursing developed educational require­
ments for the CNS.
Generally, their requirements include:
q
Kinsella, op. cit., p. 135.
^ J o a n Wilcox McVay and Joan P. Riehl, "Educational Preparation
of the Clinical Nurse Specialist," The Clinical Nurse Specialist:
Interpretations, (New York: Appleton-Century-Crofts Meredith Corpo­
ration, 1973), p p . 49-50.
14
1. A broad base in the psychopathology and pathophysiology
related to the clinical specialty.
2. Knowledge and skills in the clinical practice of the
specialty and in teaching and research.
3. The behavioral sciences essential to the leadership
role and to prepare the person to be a change agent.
4. Knowledge and understanding of the social framework in
which health care is given.H
Maxine Berlinger presented a report to the National League for
Nursing regarding the preparation and roles of the specialist at the
master’s degree level.
Berlinger believes that the preparation should
be individualized for the student.
All things must be taken into
consideration— the student’s experience, preparation, and goals.
Even
with different goals there are certain essentials for all learning
experiences.
The students must be able to express their own philosophy of
nursing and should continuously expand their knowledge of nursing.
Practice is what makes an expert practitioner.
Along with practice,
13
time must be given to investigate their roles as a CNS.
^National League for Nursing, Extending the Boundaries of
Nursing Education— The Preparation and Roles of the Clinical Specialist,
Third Conference of the Council of Baccalaureate and Higher Degree
Programs, Publication No. 15-1367, (New York: National League for
Nursing, 1969), p. 79.
12
Maxine Berlinger, The Preparation and Role of the Clinical
Specialist at the Masters Level, Report presented at the Third
Conference of the Council of Baccalaureate and Higher Degree Programs,
(New York: National League for. Nursing, 1969), pp. 15-21.
Ibid.
15
Organizational Structure
Another important aspect of determining how the CNS is func­
tioning is knowing where the specialist fits into the organizational
structure of the institution.
Bakes and Kramer described some of the various patterns for
placement of the CNS.
One pattern placed the specialist in the staff
position; reporting directly to the nursing service director.
placement allows communication with other nursing personnel.
This
The
specialist must have the support of the director of nursing service;
and keep the channels of communication open with the staff members.
It is important that the staff nurse view the specialist as a role model
and a consultant rather than as a supervisor or authoritative figure.
Another pattern of placement suggested by Bakes and Kramer is
in the line organization.
The specialist may work with the inservice
department or as a supervisor.
Both of these positions call for admin­
istrative tasks which may take the specialist away from giving direct
patient care.
The CNS who is interested in returning the nurse to
nursing, must resist the pressures to remove her from the bedside of
the patient.
15
___________ i_______
"^Constance Bakes, and Marlene Kramer, "To Define or Not to
Define: The Role of the Clinical Specialist," Nursing Forum, JanuaryMarch, 1970, pp. 41-47.
I
16
Conclusion
The CNS is still a developing concept to the nursing profession.
Nurses and administrators are still experimenting with the way this new
type of nurse should be prepared and utilized.
The study of the CNS
is a current issue in the nursing profession and the research in this
chapter has discussed some specific aspects that influence how the
specialist is functioning.
CHAPTER III
METHODOLOGY
This study was a descriptive investigation attempting to:
determine those functions being performed by the CNS's;
(I)
(2) determine
how frequently the practicing CNS's perform their functions and respon­
sibilities;
(3) determine if there is a difference in the functions and
responsibilities performed by those CNS's who have completed a master's
degree program, as compared to those CNS's with less than a master's
degree; (4) compare the functions performed by the CNS's in the medical,
surgical, pediatric, obstetric, and mental health areas of speciali­
zation.
Survey Population
A total of 152 names of CNS's were obtained by writing to the
state nursing association and hospitals in each of the 13 western states.
Copies of these letters are in Appendix A.
were used in this study.
All of the names received
Out of the 152 questionnaires sent out, 107
were returned, 10 of which were reported by the respondents to be "not
applicable" to this study.
use in the study.
Thus the researcher had 97 questionnaires to
This was 71 percent returns and 63 percent usable
returns for the study.
18
Instrument
The tool used to collect the data was an open and closed ended
questionnaire developed by the researcher.
of 52 questions.
The questionnaire consisted
The first 8 questions asked for job title, area of
specialty, educational preparation, years of experience, type of
employment and working hours.
Questions 9 through 46 were tasks being
performed that,were rated on a scale of I to 4 with I being never and 4
being always.
The tasks that were identified in the questionnaire were
constructed from job descriptions of the CNS which were received from
some of the hospitals in the 13 western states, and other research
studies relating to the roles of the CNS.
The last 6 questions were
ratings on how the CNS1s felt they were accepted by others with whom
they were working.
A pilot study was conducted to improve the validity and relia­
bility of the instrument.
The questionnaire was sent to 4 master’s-
prepared CNS's who were on the Montana State University's nursing
faculty, and not participating in the study.
They were asked to
complete the questionnaire, to make notations regarding wording clarity
and construction of the questionnaire, and to make suggestions for any
items which they felt may have been omitted.
As a result of the pilot
study some changes were made in the wording of some of the questions.
The final questionnaire which was sent to the CNS’s is in Appendix B.
CHAPTER IV
PRESENTATION OF DATA
The data for analysis were obtained from 97 questionnaires.
Each response was hand coded and key punched onto data cards.
tabulation was done on various questions.
Cross­
A Chi Square was used to
determine if there was any significant difference at the .01 and .05
level between the responses of master's and non master’s, and among the
different specialty areas.
The computer was programmed and the printout
was utilized for the data presented.
The data has been arranged in tabular form and the accompanying
discussion is an effort to report specific responses to aid in deter­
mining the functions and responsibilities of the CNS.
Characteristics of Clinical Nurse Specialists
Tables in this section will identify.the job title, area of
specialty, educational preparation, years of experience, type of
employment and working hours of the CNS.
TABLE,I
SUMMARY OF RESPONSES BY CLINICAL NURSE SPECIALIST SPECIALTY AREA
N = 97
Specialty Area
Medical
Surgical
Obstetric
Pediatric
Mental Health
Total
No.
37
15
10
12
23
97
%
38.1
15.5
10.3
12.4
23.7
100.0
20
A breakdown of CNS’s by specialty area as shown in Table I
indicate 38.1 percent of the respondents were in the medical specialty
while only 10.3 percent of the respondents indicated they worked in the
obstetrical area.
TABLE II
SUMMARY OF JOB TITLES HELD BY RESPONDENTS
N = 97
Job Title
No.
% .
Clinical Nurse Specialist
46
47.4
Nurse Clinician
24
24.7
Supervisor, Head Nurse, Director
and Assistant Director
10
10.3
Liasion
4
4.1
Instructor
4
4.1
Care Specialist
4
4.1
Nurse Practitioner
2
2.1
Nurse Coordinator
2
2.1
Clinical Consultant
_JL
1.0
Total
97
100.0
The data presented in Table: II indicate
that almost half, 47.4
percent reported that they went by the title of CNS, and 24, or 24.7
percent went by the title of nurse clinician.
These 2 job titles
combined made up a total of 70, or 72.1 percent of the respondents.
21
TABLE III
LEVEL OF EDUCATIONAL PREPARATION
N = 97 .
Educational Preparation
No.
%
Less than a Master's Degree
36
37.1
Master’s Degree
61
62.9
Total
97
100.0
A review of data presented in Table III, show that the majority
or 62.9 percent of the CNS have their master’s degree, while only 36, or
37.1 percent have less than a master's degree.
TABLE IV
NATURE OF CLINICAL NURSE SPECIALIST’S TRAINING BEYOND THEIR
EDUCATIONAL PREPARATION
N = 97
Less than Master's
Training
Master’s
Both Master's
& Non-Master's
No.
%
%
No.
%
3
3.0
0
0
3
3.0
Continuing
. Education
14
15.1
19
19.5
33
34.0
Both
13
13.0
2
2.0
15
16.0
Neither
_6
6.0
40
41.4
46
47.0
Total
36
37.1
61
62.9
97
100.0
Inservice
No.
22
An examination of data presented in Table IV reveals that more
of the respondents with non master's degree had inservice training and
continuing education than did the respondents with a master's degree.
Another interesting fact was that 46, of the 97 respondents had no
inservice training or continuing education beyond their initial educa­
tional preparation.
TABLE V
YEARS OF SERVICE AS A CLINICAL NURSE SPECIALIST
N = 97
Number of Years
No.
%
Less than one year
16
16.5
One to two years
22
22.7
Two to three years
19
19.6
Three to four years
17
17.5
More than four years
23
23.7
Total
97
100.0
.
.
The study participants were asked tc) report the length of time
they have been functioning as a CNS.
The greatest number 23, or 23.7
percent said they have been functioning as a CNS for more than 4 years.
The smallest number 16, or 16.5 percent said they have been functioning
for less than I year.
23
TABLE VI
YEARS OF SERVICE AS A CLINICAL NURSE SPECIALIST
IN PRESENT POSITION
N = 97
Number of Years
No.
%
Less than one year
23
23.7
One to two years
25
25.8
Two to three years
18
18.6
Three to four years
19
19.6
More than four years
12
12.4
Total
97
100.0
The data in Table VI show the length of time the CNS's have
been functioning in their present position.
The largest group, 25.8
percent, have been in their current position for I to 2 years, while
only 12, or 12.4 percent have been functioning for more than 4 years.
This data would support the fact that the CNS is a relatively new
position in the nursing field.
TABLE VII
TYPE OF EMPLOYMENT
N = 97
Employment
No.
%
Full time job
74
76.3
Part time job
23
23.7
Total
97
100.0
24
The data in Table VII indicate that 76.3 percent of the CNS's
work full time, and only 23.7 percent work on a part time basis.
The
study participants who reported they work on a part time basis were also
asked to report their other functions which consisted of administrative
work and educational teaching.
TABLE VIII
TYPE OF WORKING HOURS
N = 97
No.
Working Hours
%
Flexible
85
87.6
Non-flexible
12
12.4
Total
97
100.0
An examination of data presented in Table VIII reveals that the
majority, 87.6 percent had flexible working hours and only 12.4 percent
had non-flexible working hours.
Frequency of Tasks Being Performed
The following tables indicate the frequency which tasks being
performed by the CNS's in the areas of planning and implementing,
teaching, coordination and liaison, consulting and evaluation.
The
last table in this section indicates how the CNS believed they were
accepted by others with whom they were working.
In this section, no
25
distinction was made between their educational preparation and their
area of specialization.
TABLE IX
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS
OF PLANNING AND IMPLEMENTING
Never
IN THE AREA
Sometimes Frequently
Always
N=
No.
%
No.
Developing new programs
for staff
97
5
5.2
25
25.8
57
58.8
10
10.3
Developing new programs
for patients
97
0
0
25
25.8
52
53.6
20
20.6
Assisting with the formu­
lation of nursing care
plans
96
4
4.1
30
30.9
53
54.6
9
9.3
Making patient assign­
ments to the staff in
the units
95
72
74.2
22
22.7
0
0
I
1.0
Performing direct
patient care
97
2
2.1
51
52.6
32
33.0
12
12.4
Communicating with the
medical staff and other
relevant personnel re­
garding patient assess­
ment
97
0
0
7
7.2
58
59.8
32
33.0
Introducing new nursing
practices to your units
97
7
7.2
32
33.0
49
50.5
9
9.3
Refining nursing proce­
dure and techniques to
your units
96
8
8.2
37
38.1
39
40.2
12
12.4
Tasks
Other
3
I
%
No.
I
No.
%
I
%
26
The frequency of which tasks in planning and implementing are
being performed are arrayed in Table IX.
The most significant fact of
this table was that over half, or 52.6 percent, of the specialists
perform direct patient care "sometimes," and only 12, or 12.4 percent
of the specialists perform direct patient care "always."
None of the specialists responded "never" to the task of
communicating with the medical staff and other relevant personnel
regarding patient assessment while 59, or 59.8 percent indicated they
performed this task "frequently."
It was also noted that 52, or 53.6
percent participated in developing new programs for staff "frequently,
and 57, or 58.8 percent developed new programs for patients "fre­
quently. "
Another interesting fact was that 72, or 74.2 percent of the
respondents "never" made patient assignments to the staff in the units
and only I, or I percent indicated they performed this task "always."
Three of those responding identified I other function of
planning and implementing which were as follows:
administrative
functions and public relations; developing environmental and construc­
tional changes; and developing program philosophies for units.
27
TABLE X
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN
THE AREA OF TEACHING
Never
Tasks
Sometimes Frequently
Always
N=
No.
%
No.
%
No.
Improving the clinical
competencies of the
■nursing staff
97
6
6.2
8
8.2
51
52.6
32
33.0
Identifying needs of
the staff in develop­
ing inservice education .
97
5
5.2 .22
22.7
47
48.5
23
23.7
Insuring that the nursing
staff understands and
knows skilled nursing
practice
97
8
8.2 .20 20.6
44
45.4
25
25.8
Providing reference
material for the nursing
staff
97
4
4.1
22
22.7
52
53.6
19
19.6
Patient education in the
clinical setting
97
2
2.1
21
21.6
45
46.4
29
29.9
Patient education in the
home setting
95
41
42.3
36
37.1
14
14.4
4
4.1
5
Other
2
%
No.
%
3
Table X presents the frequency of tasks performed by the CNS's
in the area of teaching.
A very interesting fact was that 41, or 42.3
percent of the respondents "never" performed the task of patient educa­
tion in the home setting, while 45, or 46 percent responded "frequently"
for performing the task of patient education, in the clinical setting.
28
About half, or 52.6 percent reported "frequently" to performing
the task of improving the clinical competencies of the nursing staff,
and 33 percent responded "always" to performing this task.
Another interesting fact presented in Table X was that 47, or
48.5 percent responded "frequently" to performing the task of identi­
fying needs of the staff in developing inservice education, as compared
to only 5, or 5.2 percent who responded "never" to performing this task.
Five of those responding identified I other function of
teaching which were as follows:
teaching undergraduated and graduate
nursing students; family education for patients going home with reduced
competencies; preparing teaching tools and materials for patients and
house staff; orient new staff; and family counseling.
The frequency of functions performed in the area of coordi­
nation and liaison are presented in Table XI.
The most significant
fact was that 58, or 59.8 percent reported they "frequently" performed
the task of collaborating with the medical staff in implementing patient
care, and.only I, or I percent responded "never" to performing this
task.
Another interesting point indicated in this Table XI was that
22, or 22.7 percent responded "never" to making clinical rounds with
the nursing staff, and only 6 , or 6.2 percent responded "always" to
performing this task.
29
TABLE XI
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN
THE AREA OF COORDINATION AND LIAISON
N=
Tasks
Never
No.
%
Sometimes Frequently Always
No.
%
No.
%
No.
%
Collaborating with the
medical staff in imple­
menting care for the
patient
97
I
1.0
18
18.6
58
59.8
20
20.6
Determining, setting,
maintaining and
modifying nursing
practice standards with
the head nurse
95
9
9.3
22
22.7
45
46.4
19
19.6
Determining, setting,
maintaining and
modifying nursing
practice standards with
the director of nurses
95
18
18.6
37
38.1
31
32.0
9
9.3
Determining, setting,
maintaining and
modifying nursing
practice standards with
the staff nurses
96
6
6.2
31
32.0
51
52.6
8
8.2
Assisting nursing staff
to identify and solve
nursing problems
97
3
3.1
18
18.6
57
58.8
19
19.6
Making clinical rounds
with the nursing staff
96
22
22.7
39
40.2
29
29.9
6
6.2
Making team rounds with
the hospital staff
94
26
26.8
33
34.0
26
26.8
9
9.3
Other
7
5
2
This table also indicates that the CNS'.s perform the tasks of
determining, setting, maintaining, and modifying nursing practice
30
standards more often with the head nurses and staff nurses, than with
the directors of nursing.
Seven of those responding identified I other function of coor­
dination and liaison which were as follows:
initiating and coordinating
referrals to other agencies; liaison with schools of nursing, attending
hospital wide policy meetings; coordinating with recommending services;
team conferences with patients, family, and staff; staff meetings; and
providing continuity of care to patients transferring to other units.
TABLE XII
TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN
THE AREA OF CONSULTING
Tasks
N=
Never Sometimes Frequently Always
No.
% No.
%
No.
%
No.
%
Consulting with other
CNS1s for clinical use
97
9
9.3
38
39.2 38
39.2
12
12.4
Consulting with the
medical staff in pre­
paring nursing care
97
6
6.2
35
36.1 47
48.5
9
9.3
Consulting with and
referring patients
to social agencies
97
7
7.2
34
35.1 43
44.3
13
13.4
Consulting families and
individuals concerning
their health needs
97
6
6.2
24
24.7 46
47.4
21
21.6
Serving as a consultant
on patient care
97
I
1.0
10
10.3 61
62.9
25
25.8
Investigation on clinical
patient problems
95
3
3.1
23
23.7 49
50.5
20
20.6
Assisting with research
studies performed in
your area
96
15
15.5
48
49.5 26
26.8
7
7.2
I
2
Other
3
31
The frequency in which the tasks of consulting are being
performed are arrayed in Table XII.
The most significant fact of this
table was that 62.9 percent of the specialists responded "frequently"
to performing the task of serving as a consultant on patient care, and
25.8 percent performed this task "always."
Another interesting fact was that 15, or 14.5 percent responded
"never" to performing the task of assisting with research studies in
their area, while 48, or 49.5 percent responded "sometimes" to performing
this task.
Three of those responding identified I other function of
consulting which were as follows:
consulting with school's of nursing;
consulting with nursing homes; and consulting with nursing ,students.
The data in Table XIII indicates the frequency of which tasks
in the area of evaluation are being performed.
The most significant
fact in Table XIII was that 39, or 40.2 percent responded "never" to
performing the task of evaluating the home environment of the patients
they are following, and only 35, or 36.1 percent responded "sometimes"
to performing this task.
A review of data also indicates that 52, or 53.6 percent
responded "frequently" to performing the task of interpreting the
nursing assessments of patient care, and only 4, or 4.1 percent "never"
perform this task.
32
TABLE XIII
TASKS PERFORMED'BY PRACTICING CLINICAL NURSE SPECIALISTS
IN THE AREA OF EVALUATION
Never
Tasks
N=
No. . %
Sometimes Frequently
No.
%
No.
%
Always
No.
%
Interpreting the nursing
assessments of patient
care
95
4
4.1
26
26.8
52
53.6
13
13.4
Evaluating the clinical
practice performed
96
10
10.3
33
34.0
37
38.1
16
16.5
Assisting nursing staff
in developing standard
care routines
97
8
8.2
38
39.2
43
44.3
8
8.2
Evaluating staff-patient
teaching
97
9
9.3
42
43.3
42
43.3
4
4.1
Evaluating the home
environment of the
patients you are
following
96
39
40.2
35
36.1
12
12.4
10
10.3
3
Other
I
2
Three of those responding identified I other function of eval­
uation which were as follows:
evaluating family communication patterns;
evaluating nursing team performances; and evaluating students.
The study participants were asked to rate their acceptance by
those with whom they were working.
Table XIV.
The responses were reported in
The most significant fact was that none of the specialists
responded "never" to being accepted by the medical staff, director
of nursing, head nurses, registered nurses, licensed practical nurses,
33
and auxiliary workers.
A fairly even distribution of frequencies was
observed.
TABLE XIV
A SUMMARY OF THE CLINICAL NURSE SPECIALIST'S PERSONAL ATTRIBUTES
Never
Personal Attributes
N=
Accepted by the medical
staff
96
Accepted by the director
of nurses
%
No.
0.
0
12
12.4
52
91
0
0
6
6.2
Accepted by the head
nurses
90
0
0
5
Accepted by the registered
nurses
95
0
0
Accepted by the licensed
practical nurses
91
0
Accepted by the auxiliary
workers
94
0
Other
No.
Sometimes Frequently
% ' No.
Always
No.
%
53.6
32
33.0
23
23.7
62
63.9
5.2
32
33.0
53
54.6
4
4.1
49
50.5
42
43.3
0
5
5.2
44
45.4
42
43.3
0
6
6.2
47
48.5
41
42.3
%
0
Frequency of Tasks Being Performed According to Their Specialty
Area and Educational Preparation
Tables XV through XIX indicate the frequency of tasks being
performed by the CNS's in the area's of planning and implementing,
teaching, coordination and liaison, consulting, and evaluation,
according to the CNS's specialty area and educational preparation.
Table XX shows how the CNS's believed they were accepted by others with
34
whom they were working according to their specialty area and educa­
tional preparation.
The Chi Square statistical test was used for
determining .01 and .05. levels of significance for existent differences
between frequencies.
The data presented in Table XV show the frequency with which
the non master's and master's respondents perform those tasks included
in the area of planning and implementing according to their specialty
area.
An examination of the data indicate there was a significant
difference at the .05 level between the 2 groups of respondents relative
to the frequency they performed 3 of the 8 tasks.
The non master's
respondents in the surgical specialty performed the task of "developing
new programs for staff" more frequently than, the master's respondents.
The task of "communicating with the medical staff and other relevant
personnel regarding patient assessment!' was performed more frequently by
the mental health master's respondents than the non master's respondents.
Finally, the master's respondents in the obstetrical specialty performed
the task, of "introducing new nursing practices to their units" more
frequently then the non master's respondents.
In general, the respondents indicated they performed the tasks
the planning and implementing category either "sometimes" or "fre­
quently."
An exception was the task of "making patient assignments to
the staff in the units."
In this case many of the specialists indicated
they "never" perform this task.
TABLE XV
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN THE AREA OF PLANNING AND
IMPLEMENTING ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Never
Tasks
Less than Master's Degree
Sometimes Frequently
Always
No.
%
No.
Developing new programs
for staff
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
0
0
2
2
0
0.0
0.0
20.0
16.7
0.0
6
0
I
0
I
16.2
0.0
10.0
0.0
4.3
11
6
I
2
I
Developing new programs
for patients
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 2 3
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
3
I
I
2
0
8.1
6.7
10.0
16.7
0.0
Assisting with the formu­
lation of nursing care plans
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 22
2
0
0
2
0
5.4
0.0
0.0
16.7
0.0
5
0
2
I
0
2
2
0
I
I
Making patient assignments
to the staff in the unit
Medical - N = 36
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 22
17
4
4
3
I
47.2
26.7
40.0
25.0
4.5
%
Always
No.
%
No.
%
No.
29.7
40.0
10.0
16.7
4.3
3
0
0
0
0
8.1
0.0
0.0
0.0
0.0
0
0
0
0
I
0.0
0.0
0.0
0.0
4.3
4
5
I
I
6
10.8
33.3
10.0
8.3
26.1
8
3
5
7
13
21.6
20.0
50.0
58.3
56.5
5
I
0
0
I
13.5
6.7
0.0
0.0
4.3
11
4
3
2
2
29.7
26.7
30.0
16.7
8.7
6
I
0
0
0
16.2
6.7
0.0
0.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
3
6
4
I
4
8.1
40.0
40.0
8.3
17.4
10
2
2
4
12
27.0
13.3
20.0
33.3
52.2
4
I
0
3
5
10.8
6.7
0.0
25.0
21.7
13.5
0.0
20.0
8.3
0.0
12
5
2
I
2
32.4
33.3
20.0
8.3
9.1
I
I
0
0
0
2.7
6.7
0.0
0.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
8
2
3
2
7
21.6
13.3
30.0
16.7
31.8
8
7
3
5
8
21.6
46.7
30.0
41.7
36.4
I
0
0
I
5
2.7
0.0
0.0
8.3
22.7
5.6
13.3
0.0
8.3
4.5
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
15
6
6
4
12
41.7
40.0
60.0
33.3
54.5
2
5.6
20.0
0.0
33.3
31.8
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
I
0.0
0.0
0.0
0.0
4.5
%
No.
Master's Degree
Sometimes Frequently
Never
3
0
4
7
%
No..
%
No.
%
Chi
Square
.05
Ui
TABLE XV (continued)
Less than Master's Degree
Never
Tasks
No.
Sometimes
Z
No.
%
Frequently
No.
Z
Master'si Degree
Always
Never
Sometimes
Frequently
No.
Z
No.
Z
No.
Z
No.
Z
Always
No.
a/
Performing direct patient
care
Medical - N = 3 7
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
0
0
0
5.4
0.0
0.0
0.0
0.0
8
3
3
3
0
21.6
20.0
30.0
25.0
0.0
7
3
0
I
2
18.9
20.0
0.0
8.3
8.7
3
0
I
0
0
8.1
0.0
10.0
0.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
9
4
4
5
12
24.3
26.7
40.0
41.7
52.2
6
4
2
I
6
16.2
26.7
20.0
8.3
26.1
2
I
0
2
3
5.4
6.7
0.0
16.7
13.0
Communicating with the medical
staff and other relevant
personnel regarding patient
assessment
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 2 3
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
I
0
0
2.7
0.0
10.0
0.0
0.0
14
4
0
0
I
37.8
26.7
0.0
0.0
4.3
5
2
3
4
I
13.5
13.3
30.0
33.3
4.3
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
2
I
0
2
0.0
13.3
10.0
0.0
8.7
13
4
4
4
14
25.1
26.7
40.0
33.3
60.9
4
3
I
4
5
10.8
20.0
10.0
33.3
21.7
Introducing new nursing
practices to your units
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 2 3
3
0
I
I
0
8.1
0.0
10.0
8.3
0.0
9
I
3
2
0
24.3
6.7
30.0
16.7
0.0
4
5
0
I
2
10.8
33.3
0.0
8.3
8.7
4
0
0
0
0
10.8
0.0
0.0
0.0
0.0
I
0
0
0
I
2.7
0.0
0.0
0.0
4.3
4
3
I
I
8
10.8
20.0
10.0
8.3
34.8
12
4
5
6
10
32.4
26.7
50.0
50.0
43.5
0
2
0
I
2
0.0
13.3
0.0
8.3
8.7
Refining nursing procedures
and techniques to your units
Medical - N = 36
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
I
2
0
5.6
0.0
10.0
16.7
0.0
8
3
3
I
0
22.2
20.0
30.0
8.3
0.0
6
3
0
I
I
16.7
20.0
0.0
8.3
4.3
3
0
0
0
I
8.3
0.0
0.0
0.0
4.3
0
0
0
I
2
0.0
0.0
0.0
8.3
8.7
7
3
2
5
5
19.4
20.0
20.0
41.7
21.7
9
4
3
0
12
25.0
26.7
30.0
0.0
52.2
I
2
I
2
2
2.8
13.3
10.0
16.7
8.7
Chi
Square
.05 &
.05
TABLE XVI
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN THE AREA OF TEACHING
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Master1s Degree
Less than Master's Degree
Never
Tasks
Sometimes
Frequently
No.
%
No.
%
No.
Improving the clinical compe­
tencies of the nursing staff
Medical - N = 3 7
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
I
2
0
5.4
0.0
10.0
16.7
0.0
0
0
0
I
0
0.0
0.0
0.0
8.3
0.0
10
5
3
0
2
Identifying needs of the staff
in developing inservice edu­
cation
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
I
I
0
5.4
0.0
10.0
8.3
0.0
5
2
2
2
0
13.5
13.3
20.0
16.7
0.0
Insuring that the nursing staff
understands and knows skilled
nursing practice
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
I
I
0
5.4
0.0
10.0
8.3
0.0
3
2
I
I
I
8.1
13.3
10.0
8.3
4.3
Always
Never
Sometimes
Frequently
No.
Always
No .
%
No.
%
No.
27.0
33.3
30.0
0.0
8.7
8
I
0
I
0
21.6
6.7
0.0
8.3
0.0
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
I
I
I
I
3
2.7
6.7
10.0
8.3
13.0
10
3
3
6
9
27.0
20.0
30.0
50.0
39.1
5
5
2
I
9
13.5
33.3
20.0
8.3
39.1
7
2
I
I
2
18.9
13.3
10.0
8.3
8.7
6
2
0
0
0
16.2
13.3
0.0
0.0
0.0
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
2
2
I
2
4
5.4
13.3
10.0
16.7
17.4
9
5
3
5
12
24.3
33.3
30.0
41.7
52.2
5
2
2
I
5
13.5
13.3
20.0
8.3
21.7
8
4
2
I
0
21.6
26.7
20.0
8.3
0.0
7
0
0
I
I
18.9
0.0
0.0
8.3
4.3
2
0
0
I
I
5.4
0.0
0.0
8.3
4.3
4
2
I
I
4
10.8
13.3
10.0
8.3
17.4
6
5
4
6
8
16.2
33.3
40.0
50.0
34.8
5
2
I
0
8
13.5
13.3
10.0
0.0
34.8
%
%
%
No.
Z
Chi
Square
U>
TABLE XVI (continued)
Master's Degree
Less than Master's Degree
Never
Tasks
Always
Sometimes
Frequently
%
No.
%
No.
Never
Sometimes
Frequently
%
No.
%
No.
%
Always
No.
%
No.
%
No.
No.
%
Providing reference material
for the nursing staff
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 2 3
I
0
I
I
0
2.7
0.0
10.0
8.3
0.0
4
I
I
2
I
10.8
6.7
10.0
16.7
4.3
8
4
2
0
I
21.6
26.7
20.0
0.0
4.3
7
I
0
I
0
18.9
6.7
0.0
8.3
0.0
0
0
0
0
I
0.0
0.0
0.0
0.0
4.3
6
I
0
3
3
16.2
6.7
0.0
25.0
13.0
8
8
5
4
12
21.6
53.3
50.0
33.3
52.2
3
0
I
I
5
8.1
0.0
10.0
8.3
21.7
Patient education in the
clinical setting
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
I
0
0
I
0
2.7
0.0
0.0
8.3
0.0
2
0
0
0
I
5.4
0.0
0.0
0.0
4.3
6
6
I
I
I
16.2
40.0
10.0
8.3
4.3
11
0
3
2
0
29.7
0.0
30.0
16.7
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
4
3
0
3
8
10.8
20.0
0.0
25.0
34.8
10
4
5
3
8
27.0
26.7
50.0
25.0
34.8
3
2
I
2
5
8.1
13.3
10.0
16.7
21.7
Patient education in the
home
Medical - N = 36
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 11
Mental Health - N = 23
8
4
2
4
I
22.2
26.7
20.0
36.4
4.3
6
I
2
0
I
16.7
6.7
20.0
0.0
4.3
4
I
0
0
0
11.1
6.7
0.0
0.0
0.0
I
0
0
0
0
2.8
0.0
0.0
0.0
0.0
5
3
3
I
10
13.9
20.0
30.0
9.1
43.5
8
5
3
3
7
22.2
33.3
30.0
27.3
30.4
3
I
0
2
3
8.3
6.7
0.0
18.2
13.0
I
0
0
I
I
2.8
0.0
0.0
9.1
4.3
Chi
Square
U)
Oo
39
The frequency with which the non master’s and master’s respon­
dents perform those tasks included in the area of teaching according
to their specialty area are presented in Table XVI.
The data in this table show there was not a significant dif­
ference between the non master's and the master's in responding to the
tasks of teaching.
In general, the respondents indicated they performed the tasks
in the teaching area either "sometimes" or "frequently."
was the task of "patient education in the home."
An exception
In performing these
tasks many of the specialists indicated they "never" perform this task.
The data presented in Table XVII show the frequency with which
the non master's and master's respondents perform those tasks included
in the area of coordination and liaison according to their specialty
area.
An examination of the data indicate there was a significant
difference between the 2 groups of respondents.
The master's respon­
dents in the medical specialty performed the task of "assisting nursing
staff to identify and solve nursing problems" more frequently than the
non master's respondents at the .01 level of significance.
Also in
performing this task the master's respondents in the pediatric specialty
performed this function more frequently than did the non master's
respondents at the .05 level of significance.
TABLE XVII
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN THE AREA OF COORDINATION
AND LIAISON ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
No.
%
Master's Degree
Frequently
Always
No.
No.
%
%
Never
No.
%
Sometimes
No.
Z
Frequently
Always
No.
%
No.
Z
Collaborating with the medical
staff in implementing care
for the patient
Medical - N = 37
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 23
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
4
2
0
0
0
10.8
13.3
0.0
0.0
0.0
10
4
2
I
2
27.0
26.7
20.0
8.3
8.7
5
0
2
3
0
13.5
0.0
20.0
25.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
2
I
3
0
6
5.4
6.7
30.0
0.0
26.1
13
7
3
5
11
35.1
46.7
30.0
41.7
47.8
2
I
0
3
4
5.4
6.7
0.0
25.0
17.4
Determining, setting, main­
taining, and modifying
nursing practice standards
with the head nurse
Medical - N = 36
Surgical - N = 1 5
Obstetrics - N = 10
Pediatrics - N = I l
Mental Health - N = 23
4
0
0
I
0
11.1
0.0
0.0
9.1
0.0
4
3
2
I
I
11.1
20.0
20.0
9.1
4.3
8
2
2
I
I
22.2
13.3
20.0
9.1
4.3
3
I
0
0
0
8.3
6.7
0.0
0.0
0.0
2
0
0
0
2
5.6
0.0
0.0
0.0
8.7
4
I
2
I
3
11.1
6.7
20.0
9.1
13.0
7
5
5
6
10
19.4
33.3
50.0
54.5
43.5
4
3
I
I
6
11.1
20.0
10.0
9.1
26.1
Determining, setting, main­
taining, and modifying
nursing practice standards
with the director of nurses
Medical - N = 37
Surgical - N = 14
Obstetrics - N = 10
Pediatrics - N = I l
Mental Health - N = 23
2
I
2
2
0
5.4
7.1
20.0
18.2
0.0
8
3
I
I
2
21.6
21.4
10.0
9.1
8.7
9
0
I
0
0
24.3
0.0
10.0
0.0
0.0
I
2
0
0
0
2.7
14.3
0.0
0.0
0.0
3
2
0
2
4
8.1
14.3
0.0
18.2
17.4
5
2
I
6
8
13.5
14.3
10.0
54.5
34.8
8
4
4
0
5
21.6
28.6
40.0
0.0
21.7
I
0
I
0
4
2.7
0.0
10.0
0.0
17.4
Chi
■P-
O
TABLE XVII (continued)
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
No.
%
Master1s Degree
Frequently
Always
No.
%
No.
%
Never
No.
%
Sometimes
No.
%
Frequently
Always
No.
%
No.
%
Determining, setting, main­
taining, and modifying
nursing practice standards
with the staff nurse
Medical - N = 36
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 23
0
0
I
I
0
0.0
0.0
10.0
8.3
0.0
8
2
2
2
2
22.2
13.3
20.0
16.7
8.7
10
4
I
0
0
27.8
26.7
10.0
0.0
0.0
I
0
0
I
0
2.8
0.0
0.0
8.3
0.0
I
0
0
2
I
2.8
0.0
0.0
16.7
4.3
3
3
I
I
7
8.3
20.0
10.0
8.3
30.4
11
5
4
4
11
30.6
33.3
50.0
33.3
47.8
2
I
0
I
2
5.6
6.7
0.0
8.3
8.7
Assisting nursing staff to
identify and solve nursing
problems
Medical - N = 3 7
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 23
I
0
0
I
0
2.7
0.0
0.0
8.3
0.0
8
I
0
2
I
21.6
6.7
0.0
16.7
4.3
8
5
4
0
I
21.6
33.3
40.0
0.0
4.3
3
0
0
I
0
8.1
0.0
0.0
8.3
0.0
0
0
0
0
I
0.0
0.0
0.0
0.0
4.3
0
I
0
0
5
0.0
6.7
0.0
0.0
21.7
15
7
3
5
9
40.5
46.7
30.0
41.7
39.1
2
I
3
3
6
5.4
6.7
30.0
25.0
26.1
Making clinical rounds with
the nursing staff
Medical - N = 3 7
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = I l
Mental Health - N = 23
7
0
2
2
0
18.9
0.0
20.0
18.2
0.0
7
4
0
0
I
18.9
26.7
0.0
0.0
4.3
4
2
2
I
I
10.8
13.3
20.0
9.1
4.3
2
0
0
0
0
5.4
0.0
0.0
0.0
0.0
3
I
2
I
6
8.1
6.7
20.0
9.1
26.1
9
6
3
3
6
24.3
40.0
30.0
27.3
26.1
4
I
5
4
7
10.8
6.7
50.0
36.4
30.4
I
I
0
0
2
2.7
6.7
0.0
0.0
8.7
Making team rounds with the
hospital staff
Medical - N = 3 5
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = I l
Mental Health - N = 23
2
3
I
0
I
5.7
20.0
10.0
0.0
4.3
11
I
I
2
0
31.4
6.7
10.0
18.2
0.0
3
2
2
I
I
8.6
13.3
20.0
9.1
4.3
2
0
0
0
0
5.7
0.0
0.0
0.0
0.0
3
3
3
I
9
8.6
20.0
30.0
9.1
39.1
5
5
I
2
5
14.3
33.3
10.0
18.2
21.7
8
I
2
2
4
22.9
6.7
20.0
18.2
17.4
I
0
0
3
3
2.9
0.0
0.0
27.3
13.0
Chi
Square
.01
.05
■C*
H
42
In general, the respondents Indicated they performed the tasks
in the coordination and liaison category either, "sometimes" or
"frequently."
An exception was the tasks of "making clinical rounds
with the nursing staff," and "making clinical rounds with the hospital
staff."
In response to these tasks the specialists indicated they
"never" and only "sometimes" performed these tasks.
An examination of the data presented in Table XVIII show the
frequency with which the non master's and master's respondents perform
the tasks included in the area of consulting according to their .
specialty area.
The data presented indicate there was a significant difference
at the .05 level between the 2 groups of respondents.
The master's
medical specialists performed the task of "consulting families and
individuals concerning their health needs" more frequently than the
non master's respondents.
The task of "investigation of clinical
patient problems" was performed more frequently by the non master's
respondents in the medical specialty than the master's respondents.
In general, the respondents indicated they performed the
tasks in the consulting category either "sometimes" or "frequently."
TABLE XVIII
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN THE AREA OF CONSULTING
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Master1s Degree
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
No.
%
Frequently
Always
No.
No.
X
%
Consulting with other clinical
nurse specialists for clinical
use
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
2
0
0
I
0
5.4
0.0
0.0
8.3
0.0
9
I
0
0
I
24.3
6.7
0.0
0.0
4.3
7
5
3
2
I
18.9
33.3
30.0
16.7
4.3
Consulting with the medical
staff in preparing nursing
care
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
I
0
0
I
0
2.7
0.0
0.0
8.3
0.0
6
16.2
6.7
20.0
0.0
0.0
11
29.7
26.7
10.0
8.3
8.7
2
I
I
Consulting with and referring
patients to social agencies
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
3
0
0
0
0
8.1
0.0
0.0
0.0
0.0
10
I
16.2
13.3
10.0
16.7
4.3
Consulting families and indi­
viduals concerning their
health needs
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
I
I
0
0
0
2.7
6.7
0.0
0.0
0.0
5
3
I
I
I
13.5
20.0
10.0
8.3
4.3
14
I
2
0
0
6
2
I
2
4
I
I
2
4
3
I
I
2
2
0
I
2
Never
No.
%
Sometimes
No.
%
5.4
0.0
10.0
8.3
0.0
0
I
0
0
5
0.0
6.7
0.0
0.0
21.7
0
0
I
0
3
0.0
0.0
10.0
0.0
13.0
7
5
4
0
5.4
6.7
10.0
16.7
0.0
27.0
26.7
30.0
8.3
4.3
I
0
0
I
0
2.7
0.0
0.0
8.3
0.0
0
I
I
0
0.0
6.7
10.0
0.0
8.7
6
37.8
13.3
20.0
0.0
4.3
0
0
I
3
0
0.0
0.0
10.0
25.0
0.0
0
I
I
0
0.0
6.7
10.0
0.0
8.7
3
0
I
I
0
2
2
2
7
3
4
5
8
3
7
4
I
4
7
2
0
2
6
Frequently
Always
No.
%
No.
%
3
18.9
20.0
40.0
41.7
34.8
7
4
2
3
4
18.9
26.7
20.0
25.0
17.4
I
0
0
4
8.1
6.7
0.0
0.0
17.4
18.9
33.3
40.0
25.0
30.4
9
4
I
4
10
24.3
26.7
10.0
33.3
43.5
I
0
0
I
I
2.7
0.0
0.0
8.3
4.3
16.2
26.7
10.0
33.3
30.4
8
3
3
21.6
20.0
30.0
16.7
34.8
3
I
I
8.1
6.7
10.0
16.7
17.4
8.1
13.3
0.0
16.7
26.1
8
5
2
8
3
4
7
21.6
33.3
30.0
33.3
30.4
2
4
6
I
2
2
6
16.2
6.7
20.0
16.7
26.1
Chi
Square
.05
TABLE XVIII (continued)
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
No.
%
Master's Degree
Frequently
Always
No.
%
No.
%
Never
No.
%
Sometimes
No.
%
Frequently
Always
No.
X
No.
%
Serving as a consultant on
patient care
Medical - N = 37
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 23
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
3
0
0
0
0
8.1
0.0
0.0
0.0
0.0
15
4
3
I
I
40.5
26.7
30.0
8.3
4.3
I
2
I
3
I
2.7
13.3
10.0
25.0
4.3
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
I
2
3
2.7
0.0
10.0
16.7
13.0
12
6
3
4
12
32.4
40.0
30.0
33.3
52.2
4
3
2
2
6
10.8
20.0
20.0
16.7
26.1
Investigation of clinical
patient problems
Medical - N = 37
Surgical - N = 14
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 22
2
I
0
0
0
5.4
7.1
0.0
0.0
0.0
4
0
I
0
0
10.8
0.0
10.0
0.0
0.0
11
5
2
2
I
29.7
35.7
20.0
16.7
4.5
3
0
I
2
I
8.1
0.0
10.0
16.7
4.5
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
10
0
I
3
4
27.0
0.0
10.0
25.0
18.2
7
5
2
3
11
18.9
35.7
20.0
25.0
50.0
0
3
3
2
5
0.0
21.4
30.0
16.7
22.7
Assisting with research
studies performed in your
area
Medical - N = 36
Surgical - N = I S
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 23
Chi
Square
05
-O
4
0
2
I
I
11.1
0.0
20.0
8.3
4.3
10
4
0
I
0
27.8
26.7
0.0
8.3
0.0
3
I
2
2
0
8.3
6.7
20.0
16.7
0.0
2
I
0
0
I
5.6
6.7
0.0
0.0
4.3
I
0
2
0
4
2.8
0.0
20.0
0.0
17.4
11
5
2
0
9
30.6
33.3
20.0
0.0
39.1
5
4
I
6
6
13.9
26.7
10.0
50.0
26.1
0
0
I
2
2
0.0
0.0
10.0
16.7
8.7
TABLE XIX
SUMMARY OF TASKS PERFORMED BY PRACTICING CLINICAL NURSE SPECIALISTS IN THE AREA OF EVALUATION
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Less than Master's Degree
Tasks
Never
I•Jo.
X
Sometimes
No.
%
Master's Degree
Frequently
Always
No.
No.
%
X
Interpreting the nursing assess­
ments of patient care
Medical - N = 37
0
Surgical - N = 15
0
Obstetrics - N = 10
0
Pediatrics - N = 10
I
Mental Health - N = 23
0
0.0
0.0
0.0
10.0
0.0
7
I
3
I
0
18.9
6.7
30.0
10.0
0.0
10
Evaluating the clinical nursing
practice performed
2
Medical - N = 37
Surgical - N = 15
I
Obstetrics - N = 10
0
Pediatrics - N = 11
I
Mental Health - N = 23
0
5.4
6.7
0.0
9.1
0.0
10
I
3
I
0
Never
No.
X
Sometimes
No.
X
Frequently
Always
No.
%
No.
%
3
0
I
I
0
8.1
0.0
10.0
10.0
0.0
I
I
0
0
I
2.7
6.7
0.0
0.0
4.3
4
3
I
2
4
10.8
20.0
10.0
20.0
17.4
11
4
0
I
2
27.0
33.3
0.0
10.0
8.7
27.0
6.7
30.0
9.1
0.0
7
4
I
I
I
18.9
26.7
10.0
9.1
4.3
I
0
0
I
I
2.7
0.0
0.0
9.1
4.3
2
I
0
I
2
5.4
6.7
0.0
9.1
8.7
6
3
2
2
5
16.2
20.0
20.0
18.2
21.7
6
4
3
3
7
9
5
5
4
10
7
29.7
26.7
50.0
40.0
43.5
I
I
0
0
6
2.7
6.7
0.0
0.0
26.1
16.2
26.7
30.0
27.3
30.4
3
I
I
I
7
8.1
6.7
10.0
9.1
30.4
24.3
33.3
20.0
25.0
43.5
I
I
I
I
0
2.7
6.7
10.0
8.3
0.0
0
0
0
0
I
0.0
0.0
0.0
0.0
4.3
3
I
I
2
2
8.1
7.1
10.0
16.7
8.7
Assisting nursing staff in
developing standard care
routines
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
I
0
I
I
0
2.7
0.0
10.0
8.3
0.0
11
I
2
I
0
29.7
6.7
20.0
8.3
0.0
3
I
I
2
18.9
20.0
10.0
8.3
8.7
I
2
0
I
0
2.7
13.3
0.0
8.3
0.0
0
I
I
0
3
0.0
6.7
10.0
0.0
13.0
7
2
2
4
8
18.9
13.3
20.0
33.3
34.8
Evaluating staff-patient
teaching
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 23
3
I
0
0
0
8.1
6.7
0.0
0.0
0.0
8
I
3
3
2
21.6
6.7
30.0
25.0
8.7
7
3
I
I
0
18.9
20.0
10.0
8.3
0.0
2
I
0
0
0
5.4
6.7
0.0
0.0
0.0
2
I
0
0
2
5.4
6.7
0.0
0.0
8.7
4
5
I
4
11
10.8
33.3
10.0
33.3
47.8
11
3
5
4
7
29.7
20.0
50.0
33.3
30.4
16.2
28.6
20.0
16.7
8.7
6
2
2
2
0
16.2
14.3
20.0
16.7
0.0
7
0
0
0
0
18.9
0.0
0.0
0.0
0.0
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
5
13.5
42.9
10.0
25.0
34.8
7
I
4
I
10
18.9
7.1
40.0
8.3
43.5
2
0
0
2
I
5.4
0.0
0.0
16.7
4.3
Evaluating the home environment
of the patients you are following
Medical - N = 37
6
4
Surgical - N = 14
2
Obstetrics - N = 10
2
Pediatrics - N = 12
Mental Health - N = 23
2
6
I
3
8
5
2
3
10
Chi
Square
46
The frequency with which the non master’s and master's
respondents perform those tasks included In the area of evaluation
according to their specialty area are arrayed in Table XIX.
An examination of the data reported in this table show there
was not a significant difference between the non master's and master's
in responding to the task of evaluation.
In general, the respondents indicated they perform the tasks
in the category of evaluation either "sometimes" or "frequently."
An exception was the task of "evaluating the home environment of the
patients they are following."
In responding to this task many of the
specialists indicated they "never" performed this task.
The data presented in Table XX show the frequency with which
the non master's and master's respondents rated their acceptance by
those with whom they were working, according to their specialty area.
The data in this table show there was not a significant
difference between the non master's and master's in responding to how
they rated their acceptance by others.
In general, the respondents indicated they were accepted by the
medical staff, director of nursing, head nurses, registered nurses,
licensed practical nurses and auxiliary workers either "frequently" or
"always."
A fairly even distribution of frequencies was observed.
TABLE XX
SUMMARY OF PRACTICING CLINICAL NURSE SPECIALISTS PERSONAL ATTRIBUTES
ACCORDING TO THEIR SPECIALTY AREA AND EDUCATIONAL PREPARATION
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
No.
Z
Master's Degree
Frequently
Always
No.
Z
No.
Z
Never
No.
Z
Sometimes
No.
Z
Frequently
Always
No.
Z
No.
Z
Accepted by the medical staff
Medical - N = 37
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 12
Mental Health - N = 22
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
11
2
2
3
2
29.7
13.3
20.0
25.0
9.1
8
4
2
I
0
21.6
26.7
20.0
8.3
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
3
2
2
0
4
8.1
13.3
20.0
0.0
18.2
7
5
3
6
11
18.9
33.3
30.0
50.0
50.0
7
2
I
2
5
18.9
13.3
10.0
16.7
22.7
Accepted by the director of
nurses
Medical - N = 36
Surgical - N = 14
Obstetrics - N = 10
Pediatrics - N = 10
Mental Health - N = 21
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
3
2
2
0
2
8.3
14.3
20.0
0.0
9.5
16
4
2
4
0
44.4
28.6
20.0
40.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
3
0
0
2
2.8
21.4
0.0
0.0
9.5
3
I
2
3
5
8.3
7.1
20.0
30.0
23.8
13
4
4
3
12
36.1
28.6
40.0
30.0
57.1
Accepted by the head nurse
Medical - N = 35
Surgical - N = 14
Obstetrics - N = 10
Pediatrics - N = 11
Mental Health - N = 20
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
2
0
0
0
0
5.7
0.0
0.0
0.0
0.0
4
2
2
0
2
11.4
14.3
20.0
0.0
10.0
13
4
2
3
0
37.1
28.6
20.0
27.3
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
2
I
0
0
0.0
14.3
10.0
0.0
0.0
3
3
4
4
8
8.6
21.4
40.0
36.4
40.0
13
3
I
4
10
37.1
21.4
10.0
36.4
50.0
Chi
Square
■c-
TABLE XX (continued)
Less than Master's Degree
Tasks
Never
No.
%
Sometimes
%
No.
Master's Degree
Frequently
Always
No.
No.
%
%
Never
No.
%
Sometimes
No.
%
Frequently
Always
No.
%
No.
%
Accepted by the registered
nurses
Medical - N = 37
Surgical - N = I S
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 21
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
0
0
0
2.7
0.0
0.0
0.0
0.0
10
4
I
I
2
27.0
26.7
10.0
8.3
9.5
9
2
3
3
0
24.3
13.3
30.0
25.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
I
0
0
2
0.0
6.7
0.0
0.0
9.5
6
6
5
4
10
16.2
40.0
50.0
33.3
47.6
ii
2
I
4
7
29.7
13.3
10.0
33.3
33.3
Accepted by the licensed
practical nurses
Medical - N = 3 5
Surgical - N = 15
Obstetrics - N = 10
Pediatrics - N = 11
Mental Health - N = 20
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
0
0
0
2.9
0.0
0.0
0.0
0.0
9
4
2
I
2
25.7
26.7
20.0
9.1
20.0
9
2
2
2
0
25.7
13.3
20.0
18.2
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
2
I
I
0
0.0
13.3
10.0
9.1
0.0
3
5
4
3
11
8.6
33.3
40.0
27.3
55.0
13
2
I
4
7
37.1
13.3
10.0
36.4
35.0
Accepted by the auxiliary
workers
Medical - N = 36
Surgical - N = 15
Obstetrics - N = I O
Pediatrics - N = 12
Mental Health - N = 21
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
I
0
0
0
0
2.8
0.0
0.0
0.0
0.0
9
5
I
I
2
25.0
33.3
10.0
8.3
9.5
10
I
3
27.8
6.7
30.0
25.0
0.0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0
2
I
I
I
0.0
13.3
10.0
8.3
4.8
5
5
4
4
11
13.9
33.3
40.0
33.3
52.4
11
2
I
3
7
30.6
13.3
10.0
25.0
33.3
3
0
Chi
Square
-PCO
49
The questionnaire allowed for additional comments to be made by
the study participants.
A tabulation of these comments are in Appendix
C.
Conclusions
The major purpose of this chapter was to describe certain general
characteristics of the CNS's, and to determine what are the functions
and responsibilities of the CNS's.
Specifically, the writer set forth to present data about the:
(I) general characteristics of the specialists— including job title,
area of specialty, educational preparation, years of experience, type
of employment and working hours; (2) frequency of tasks being performed
by the CNS's in the area of planning and implementing, teaching,
coordination and liaison, consulting and evaluation;
(3) frequency of
tasks being performed in the above areas according to their, educational
preparation and their specialty area.
In summarizing the data presented in this chapter, 62.9 percent
of the study participants have their master's degree.
Generally, the
majority of the tasks involved in the questionnaire are being performed
either "sometimes" or "frequently," and there was not a significant
difference between the master's and non master's, responses to the tasks
being performed according to their specialty area.
CHAPTER V
SUMMARY, FINDINGS, IMPLICATIONS, AND RECOMMENDATIONS ■
A brief review of the study and the major findings are presented
in this chapter, along with some major conclusions, implications, and
recommendations.
Summary
The central purpose of the study was to determine how the
practicing clinical nurse specialists in the thirteen western states
are functioning in,their own areas of specialization.
objectives of this study were:
(I)
The specific
to determine those functions being
performed by the clinical nurse specialists;
(2)
to determine how
frequently the practicing clinical nurse specialists perform their
functions and responsibilities;
(3)
to determine if there is a
difference in the functions and responsibilities performed by those
clinical nurse specialists who have completed a master's degree program,
as compared to those clinical nurse specialists with less than a
master's degree; (4) to compare the functions performed by the clinical
nurse specialists in the medical, surgical, pediatric, obstetric, and
mental health areas of specialization.
The study was based upon data received from 97 clinical nurse
specialists in the thirteen western states.
The tool used to collect
the data was a combination of an open and closed ended questionnaire
51
developed by the researcher.
questions.
The questionnaire consisted of 52
The first 8 questions were identifying data which asked
for job title, area of specialty, educational preparation, years of
experience, type of employment and working hours.
Questions 9 through
46 were tasks being performed in the areas of planning and imple­
menting, teaching, coordination and liaison, consulting and evaluation
that were rated on a scale of I to 4 with I being never and 4 being
always.
The last 6 questions were ratings on how the clinical nurse
specialists felt they were accepted by others with whom they were
working.
Findings
With reference to the foregoing data presented in Chapter IV,
the following findings have been formulated.
1.
The majority of tasks listed in the questionnaire are
being performed by the clinical nurse specialists as indicated by
their responses.
2.
A few of the tasks listed in the questionnaire that are
being performed infrequently by the clinical nurse specialists are as
follows:
making patient assignments in the units; patient education
in the home; making clinical rounds with the nursing staff; making
clinical rounds with the hospital staff; and evaluating the home
environment of the patients they are following.
52
3.
Sixty-one, or 62.9 percent of the clinical nurse specialists
were prepared at the masters level.
4.
The responses to the tasks listed in the questionnaire
indicate that in general there was not a significant difference between
the functions and responsibilities of those clinical nurse specialists
who have completed a masters degree program as compared to those clinical
nurse specialists with less than a masters degree preparation, according
to their specialty area.
5.
The general comments in Appendix C indicate that the
clinical nurse specialists with a masters degree have more adminis­
trative responsibilities than the non masters prepared clinical nurse
specialists.
Implications
As a result of the foregoing data, the researcher feels the
following implications can be made.
1.
The clinical nurse specialist is still a developing concept
to the nursing profession and cannot be clearly defined.
Because the
concept of the clinical nurse specialist is not clearly defined, there
are many nurses practicing as specialists with different job titles,
functions and responsibilities, and educational preparation.
2.
Within the next few years, the nursing profession should
53
be able to arrive at a more precise definition regarding the functions
and responsibilities of the clinical nurse specialists.
3.
It appears from the general comments in Appendix C that
the clinical nurse specialists with a masters degree have more admin­
istrative functions than the non masters prepared clinical nurse
specialists.
Recommendations
As a result of this study the following recommendations are
made.
1.
This study should be repeated to compare the changes in the
functions and responsibilities of the clinical nurse specialists, and
at the same time send a questionnaire to the employers of the clinical
nurse specialists to compare how they report the clinical nurse
specialists are functioning.
2.
A study should be conducted in various schools that prepare
nurses to become clinical nurse specialists which compare the different
curriculums, objectives and goals of the school's.
3.
A study should be done to determine if there is a difference
in the quality of care given by clinical nurse specialists than by
other methods of delivery of care.
LITERATURE CITED
X
LITERATURE CITED
Articles and Periodicals
Bakes, Constance, and Kramer, Marlene, "To Define or Not to Define:
The Role of the Clinical Specialist," Nursing Forum, JanuaryMarch, 1970.
Beal, Barbara, and Sakamoto, "Liaison Nurse and Head Nurse," The
Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox McVay
and Joan P. Riehl, New York: Appleton-Century-Crof ts Meredith
Corporation, 1973.
Berlinger, Maxine R . , "The Preparation and Roles of the Clinical
Specialist at the Master's Level," The Clinical Nurse Specialist:
Interpretations, ed. Joan Wilcox. McVay and Joan P. Riehl, New
York: Appleton-Century-Crofts Meredith Corporation, 1973.
Christman, Luther, and Georgopoulos, Basil, S., "The Clinical Nurse
Specialist: A Role Model," American Journal of Nursing, May, 1970.
Gordon, Marjory, "The Clinical Specialist as Change Agent," The
. . Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox
McVay and Joan P. Riehl, New York: Appleton-Century-Crofts
Meredith Corporation, 1973.
Kinsella, Cynthia R . , "Who is the Clinical Nurse Specialist?"
Hospitals, June, 1973.
Little, Dolores, "The Nurse Specialist,"
March, 1967.
American Journal of Nursing,
McVay, Joan Wilcox, and Riehl, Joan P., "Educational Preparation of
the Clinical Nurse Specialist," The Clinical Nurse Specialist:
Interpretations, ed. Joan Wilcox McVay and Joan P. Riehl,
New York: Appleton-Century-Crofts Meredith Corporation, 1973.
Peplau, Hildegarde, "Specialization in Professional Nursing," The .
Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox
McVay and Joan P. Riehl, New York: Appleton-Century-Crofts
Meredith Corporation, 1973.
Rhein, Marilee, "The Education of the Clinical Specialist," The
Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox McVay
and Joan P. Riehl, New York: Appleton-Century-Crofts Meredith
Corporation, 1973.
L
56
Sutton, LaVaun W . , "The Clinical Nurse Specialist in a Dual Role,"
The Clinical Nurse Specialist: Interpretations, ed. Joan Wilcox
McVay and Joan P. Riehl, New York: Appleton-Century-Crofts
Meredith Corporation, 1973.
Vaughan, Margaret, "Difficult Task: Defining Role of the Clinical
Specialist," The Clinical Nurse Specialist: Interpretations, ed.
Joan Wilcox McVay and Joan P. Riehl, New York: Appleton-CenturyCrofts Meredith Corporation, 1973.
"The Clinical Nurse Specialist,"
Hospitals, February, 1973.
Other Sources
Berlinger, Maxine, The Preparation and Role of the Clinical Specialist
at the Masters Level. Report presented at the Third Conference
of the Council of Baccalaurate and Higher Degree Programs, New York,
New York, National League for Nursing, 1969.
California Nurses' Association, Position Statement on the Clinical
Nurse Specialist, 1973.
National League for Nursing, Extending the Boundaries of Nursing
Education— The Preparation and Roles of the Clinical Specialist,
Third Conference of the Council of Baccalaurate and Higher Degree
Programs, Publication number 15-1367. New York, New York,
National League for Nursing, 1969.
APPENDIX A
58
February 20, 1974
Lani Zimmerman
1410 W. Babcock, Apt. A
Bozeman, Montana 59715
Director of Nursing
Wyoming State Hospital
Box 177
Evanston, Wyoming 82930
Dear Madam:
I am a graduate student in Nursing at Montana State University in
Bozeman, Montana, and am currently working on my research paper.
My major area of interest is finding out how the clinical nurse
specialists are functioning.
I am defining my area to cover the
thirteen western states that are represented by WCHEN. Your hospital
has been referred to me by your state nursing association, as a possi­
bility that you may employ clinical nurse specialists.
If available,
I would like the names and addresses of the clinical nurse specialists
practicing in your hospital.
Thank you for your consideration.
Sincerely,
Lani Zimmerman R.N.
59
February 20, 1974
Lani Zimmerman
1410 W. Babcock, Apt. A
Bozeman, Montana 59715
Ex. Director, Marjorie E. Neff
Nevada Nurses Association
Room I
1450 E. 2nd St.
Reno, Nevada 89502
Dear Madam:
I am a graduate student in Nursing at Montana State University in
Bozeman, Montana, and am currently working on my research paper.
My major area of interest is finding out how the clinical nurse
specialists are functioning. I am defining my area to cover the
thirteen western states that are represented by WCHEN.
If available, I would like the names and addresses of the clinical
nurse specialists practicing in your state.
If it is not possible
for you to give me this information, I would appreciate your advising
me where I can obtain it. Possibly, you could send me a list of the
hospitals in your state which might employ clinical nurse specialists.
Thank you.
Sincerely,
Lani Zimmerman, R.N.
appendix
B
61
May 25, 1974
Dear Colleague:.
As a graduate student at Montana State University, I am
conducting some research to identify the functions and responsibilities
of practicing clinical nurse specialists in the thirteen western states
represented by WCHEN. I received the names of clinical nurse special­
ists by writing to the state nurses* associations and hospitals
throughout the states.
From extensive readings and job descriptions, I have compiled
a list of functions and responsibilities of clinical nurse specialists
which are in the questionnaire.
I am requesting the clinical nurse
specialists to assist me by filling out this questionnaire.
It should
take no more than 10 or 15 minutes to fill out.
This questionnaire has been coded in order for me to identify
the area in which you reside. Your name will not be used in connection
with the data.
'
ience.
A stamped pre-addressed envelope is enclosed for your conven­
Would you please mail it back to me as soon as possible?
I will greatly appreciate your assistance in helping me with
my research project. Thank you.
Very truly yours,
.
Lahi Zimmerman, R.N.
1410 West Babcock, Apartment A.
Bozeman, Montana 59715
L Z :cbm
Enclosures
62
QUESTIONNAIRE FOR THE CLINICAL NURSE SPECIALISTS
Working Conditions and Preparation of the Clinical Nurse Specialists
01.
What is your area of clinical speciality?^_________________________
02.
What is your current job title?_____________________________________
03.
Check appropriate answers for your preparation as a clinical nurse
specialist.
_____ Associate Degree
_____ Diploma
_____ Bachelor Degree .
.M asters. Degree
04.
How long have you been functioning as a clinical nurse specialist?
_____ less than one year
_____ one to two years
_____ two to three years
05.
_____ Doctorate Degree
_____ Inservice Education
_____ Continuing educational courses
■' in your speciality area
_____ Other______________________________
_____ three to four years
_____ other
How long have you been functioning as a clinical nurse specialist
in your present position?
_____ less than one year
_____ one to two years
_____ two to three years
three to four years
other
06.
Are you employed as a full time clinical nurse specialist?
_____ yes
_____ no
07.
If "no" to the above, please briefly explain your other duties.
08.
Are your working hours flexible?
_____ yes
_____ no.
63
Please indicate how frequently you perform each of the tasks
below by circling the appropriate number. Each task statement
should be rated on a scale of I to 4, with I being NEVER and 4
being ALWAYS.
'r s Q ubi
Planning and Implementing;
Responsible For:
09.
Planning and implementing new programs for staff.
10.
Planning and implementing new programs for
patients.
11.
Assisting with the formulation of nursing
care plans.
1
2
3
4
Making patient assignments to the staff in
the unit.
1
2
3
4
13.
Performing direct patient care.
1
2
3
4
14.
Communicating with the medical staff and other
relevant personnel regarding patient assessment.
1
2
3
4
15.
Introducing new nursing practices
1
2
3
4
16.
Refining nursing procedures and techniques to
your units.
1
Other.
1
12.
17.
to your units.
2
.
2
3
3
4
4
t
Teaching:
Responsible For:
.18.
19.
Improving the clinical competencies of the
nursing staff.
I
2 3 .
4
Identifying needs of the staff in developing
inservice education.
I
2
4
3
20.
__ ter.
AlW&Ys
Responsible For:
fkeQvently
64
Insuring that the nursing staff understands
and knows skilled nursing practice.
I
2
3
4
Providing reference material for thenursing
staff.
I
2
3
.4
22.
Patient education in. the clinical setting.
I
2
3
4
23.
Patient education in the home.
I
2
3
4
24.
Other.
I
2
3
4
Collaborating with the medical staff in imple­
menting care for the patient.
I
2
3
4
Determining, setting, maintaining, and
modifying nursing practice standards with
the head nurse;
I
2
3
4
Determining, setting, maintaining, and
modifying nursing practice standards with the
director of nurses.
I
2
3
4
Determining, setting, maintaining, and modifying
nursing practice standards with the staff nurses. I
2
3
4.
Assisting nursing staff to identify and solve
nursing problems.
2
3 . 4
2
3
4
I
2
3
4
I
2
3
4
21.
Coordination - Liaison:
Responsible For:
25.
26.
27.
28.
29.
30.
Making clinical roundswith
31.
Making team rounds with
32.. Other.
thenursing staff.
the hospital staff.
I
I
CO
M
Consultant;
.
^
Q
ALRAYs
FREQUENTLY
65
Responsible For:
33.
Consulting with other clinical nurses
specialists for clinical use.
I
2
3
4
Consulting with the medical staff in preparing
nursing care.
I
2
3
4
Consulting with and referring patients to
social agencies.
I
2
3
4
Consulting families and individuals
concerning their health needs.
I
2
3
4
37.
Serving as a consultant on patient care.
I
2
3
4
38.
Investigation of clinical patient problems.
I
2
3
4
39.
Assisting with research studies performed
in your area.
I
2
3
4
Other.
I
2
3
4
Interpreting the. nursing assessments of patient
care.
I
2
3
4
Evaluating the clinical nursing practice
performed.
I
2
3
4
Assisting nursing staff in developing standard
care routines.
I
2
3
4
Evaluating staff-patient teaching.
I
2
34.
35.
36.
40.
Evaluation;
Responsible For:
41.
42.
43.
44.
3
4
Responsible For:
45.
46.
o
CO
always
I
frequently
66
Evaluating the home environment of the
patients you are following.
I
2
3
4
Other.
I
2
3
4
Personal Attributes:
Are You:
47.
Accepted by the. medical staff.
I
2
3
4
48.
Accepted by the director of nurses.
I
2
3
• 4
49.
Accepted by the head nurses.
I
2
3
4
50.
Accepted by the registered nurses.
I
2
3
4
51.
Accepted by the licensed practical nurses.
I
2
3
.4
52.
Accepted by the auxiliary workers.
I
2
3
4
Comments:
(e.g. Functions and responsibilities not covered in the
questionnaire.)
APPENDIX C
68
Comments:
A.
(e.g. Functions and responsibilities not covered in the
questionnaire.)
Master's
1.
Medical
a.
b.
c.
d.
e.
f.
g.
h.
2.
Surgical
a.
b.
c.
d.
e.
3.
Responsible for all nursing care in my unit 24 hours a day.
Also responsible, for creating climate conducive for learning.
I do outside teaching in local hospitals.
Consult with ANA in respect to defining the role of CNS.
Consult with other CNS's in the community.
Serve as liaison between hospital and community agencies.
I am used largely as a change agent— I have been sent into
each unit at our hospital, one at a time to work with head
nurses and staff.
The only real change in my job when we changed our title
from supervisor to CNS was that we were no longer respon­
sible for schedules.
I am involved in administrative responsibilities, e.g.
grant proposals, research proposals.
The CNS has had little support from the hospital admin­
istrator. He has been instrumental in curtailing a
worthwhile program.
Professional responsibilities in the professional
organization.
Responsible to the patients rather than the staff.
My title is misleading, I am probably more like a clinical
supervisor.
I have a great deal of committee responsibility.
Obstetrics
a.
Teaching at the university cuts into other activities
that I would like very much to do.
b.
Responsible for orientation of all new employees. I spend
at least 24 hours with each new employee, including follow
up evaluation.
69
4.
Pediatrics
a.
b.
c.
d.
e.
5.
Mental Health
a.
b.
c.
d.
B.
My role is supported by American Cancer Society Grant.
My closest associations is with patient-family-Doctor,
then with nurses and house staff. I follow the patient
in the hospital, clinic, and home, for the purpose of
continuity of care.
I have my own case load.
Conduct my own research.
Position is in the line,, not staff. It includes some
administrative responsibilities.
Supervise masters students.
More administrative functions,
e.g. covering the floor for
nursing service.
Liaison and in-patient program director with comprehensive
Mental Health Center.
Extensive individual and group therapy with patient.
I work as the only nurse in out-patient psychiatric
setting.
Non-Master's
1.
Medical
a.
b.
c.
d.
2.
Surgical
a.
3.
Teaching coronary care and elementary ECG interpretations
for nursing staff.
Research new products and equipment used in respiratory care.
Active in the professional organization.
Assist with pre-employment and annual physicals and follow
up on health problems.
Checking and taking of orthopedic equipment.
Obstetrics
a.
Pre-natal exams, plus routine post-partum examinations
of patients on the wards.
b.
Daily rounds on all uncomplicated, non-surgical postpartum
patients.
70
c.
4.
5.
Active prenatal program.
Pediatrics
a.
I function more as a nurse practitioner
b.
Responsible for Innoculation surveys
c.
Case coordinator
Mental Health— no comments.
MONTANA STATE UNIVERSITY LIBRARIES
3 1762 10022743
N378
Z66
cop.2
Zimmerman, Lani M
Tiie functions and re­
sponsibilities of the
clinical nurse special­
ists ...
__
tX -