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Clinical nurse specialists

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Clinical nurse specialists are senior nurses who have acquired additional knowledge, skills and experience, together with a professionally and/or academically accredited post-registration qualification (if available) in a clinical specialty.

They practise at an advanced level and may have sole responsibility for a specific case or defined client/group.

Several clinical nurse specialist titles exist including nurse practitioner, lead nurse, nurse lead, nurse consultant, nurse specialist, senior nurse and specialist practitioner.

They work in various areas including cancer, diabetes, cardiac care, surgery, infection control, palliative care, A&E and mental health.

Nurses in these roles spend, it is estimated, about 60% of their time in clinical activity, 17% in education, 14% in management activity and 4% in research.

Nurses in these roles are generally considered to have high levels of job satisfaction and enjoy the level of control they have in their careers.

However, there is sometimes a lack of understanding of these roles, which can be frustrating for the clinical nurse specialists as they feel the NHS is not getting the most out of their role for the benefit of patients.

The RCN has also identified other frustrations felt by this group of nurses and in a survey published last year, found 23% of those who make referrals, have had them refused because they are a nurse rather than a doctor. The survey also found that 33% of those who order investigations had been refused on the same grounds.

Nurses at this level have been appointed as managers of day surgery units rather than surgeons, anaesthetists and non-clinical managers and are seen as having particular talents including clinical skills, ability to develop multidisciplinary teams, waiting list knowledge, contract knowledge, financial knowledge, leadership skills and communication skills.

Some trusts have also created clinical nurse specialists in emergency surgery, posts created to speed up the process of getting emergency patients needing surgery into the hospital’s theatres.

These nurses act as a go-between for trauma, general surgery and A&E departments. Similar posts have been created to carry out the same role in medicine and vascular surgery.

Nurse consultants are one of the better known of clinical nurse specialists and were introduced in 1999 by the government and hailed in the media as ‘super nurse’. This new type of nurse was created to allow highly-qualified staff to continue nursing and teaching rather than going into management. At least half of their time is spent on direct patient care, but they also have a professional leadership role and develop best practice and implement clinical governance.

Updated: September 2006

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