Academic journal article Nursing Praxis in New Zealand

The Clinical Nurse Specialist in New Zealand: How Is the Role Defined?

Academic journal article Nursing Praxis in New Zealand

The Clinical Nurse Specialist in New Zealand: How Is the Role Defined?

Article excerpt


The concepts of advanced nursing roles and specialisation in nursing practice are not new, and they remain internationally relevant issues (Hamric, Spross, & Hanson, 2005; Jacobs, 2007). It is widely acknowledged that advanced nursing practice roles make valuable and positive contributions towards achieving better health outcomes for a variety of patient populations (Gardner, Carryer, Dunn, & Gardner, 2004). Much has been written aboutthe newly established Nurse Practitioner (NP) role in New Zealand, but considerably less aboutthe Clinical Nurse Specialist (CNS) who operates within many New Zealand District Health Boards (DHBs).

It is unclear when CNSs became widely employed throughout New Zealand DHBs, although the title was mentioned in the New Zealand Nurses' Association policy statement as early as 1976. It appears that the CNS role became fairly common in the late 1990s with key discussion about it appearing in the report of the Ministerial Taskforce on Nursing (1998). In 1998 the Nurse Executives of New Zealand released a role definition which stated,

A Clinical Nurse Specialist role is undertaken by a nurse with experience in the clinical specialty and advanced learning in that area of specialist cares. The nurse, during episodes of care, undertakes assessment, organizes tests, plans and initiates care to meet the special needs of an individual or group of patients with particular health problems (Peach, Cooper-Liversedge, Russell, & Hayes, 1998, P.3).

The CNS role is now widespread throughout New Zealand and is deemed a senior nurse role in the DHB Multi-Employer Collective Agreement (MECA) (New Zealand Nurses Organisation, 2007). However, although there are many CNSs employed by DHBs around the country, the role remains unclear and lacks national definition.

Literature Review

Internationally the concept of specialised expert or advanced nursing is not new and can be identified as early as the nineteenth century in the United States Civil War (Hamric et al., 2005; Jacobs, 2007). Advanced nursing practice, however, became decisively established in the USA in the 1970s through advances in educational preparation and clinical practice rolesfor both the CNS and NP (Hamric et al.). The contemporary CNS role is also established in Australia, Taiwan, China, Japan, New Zealand and the United Kingdom (Chen, 2009; Hamric et al.). In each country, the definition and practice scope of the CNS role are influenced by factors such as the national economy, culture, education and practice standards, and models of health care delivery (Chen; Hamric et al.). Currently in New Zealand the most obvious example of the advanced practitioner is the NP, and much has been written about this role and its contribution to health care (Dunn, 1997; Gardner et al., 2004). However, the specific role and contribution of the CNS in New Zealand remains much less explored.

Based on internationally and nationally accepted definitions, the CNS role falls under the umbrella of advanced nursing practice. The International Council of Nurses (ICN) states,

A nurse practitioner/advanced practice nurse is a registered nurse who has the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master's degree is recommended for entry level (ICN, 2005, p. 5).

The Nursing Council of New Zealand defines advanced practice as that which "reflects a range of highly developed clinical skills and judgments acquired through a combination of nursing experience and education" (ICN, 2005, p. 4).

Elsewhere, a CNS is defined as a Registered Nurse (RN) who, through both practice and masterate level education, has become an expert in a clinical area of nursing (Sparacino, 2005). The American Nurses Association (1996) defines the CNS as an, "expert clinician and client advocate in a particular specialty or subspecialty of nursing practice" (p. …

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