Patricia S. A. Sparacino

Applying Theory and Research to Clinical Practice: A CNS Responsibility

clinical practice. The meaning of enhance is to better, strengthen, or augment. Promoting research-based clinical practice means to apply new knowledge to the improvement of patient care. The two clinical practice articles in this issue illustrate these qualities of the advanced practice nurse. In The Role of the Nurse in Advanced Practice in Bereavement Care, Glass reviews the theoretical and research literature on grief, physical and emotional responses to grief, factors that influence the bereavement process, and the role of the CNS as educator and consultant for persons experiencing grief. Glass’ article describes grief as a complex phenomenon: it is a psychological process that transcends cultural influences. Bereavement is the healing process. Nurses are key in working with grieving families in clinical settings, but the ability to be an effective facilitator is influenced by whether the nurses’ past experiences

Role Advancement for the Experienced Clinical Nurse Specialist

As the number of experienced clinical nurse specialists increases, serious consideration of their career advancement opportunities is indicated. An exploratory study was conducted using a role perception questionnaire distributed at a regional meeting of clinical nurse specialists. The results showed that most of the specialists (n=36) were satisfied in their present position (82.8%) and that many have reached role maturity (70.6%). A move to an administrative position was not perceived as a role advancement for 78.8% and private practice was not a career option for 60.6% of the sample. Data on employment characteristics and variables are presented. Implications include the need for role enhancement and creative challenges for role stimulation and retention of experienced nurse specialists.

Re: editorial entitled "clinical nurse specialist as attending nurse".

We could not agree more strongly with Jan Fulton’s suggestion that the clinical nurse specialist (CNS) as ‘‘attending nurse’’ is an idea whose time has come. In our agreement, we do not imply a need for change of title or regulation but rather a recognition of stature earned. The need in hospitals and health facilities for patient care quality and safety and the development of both expertise and collaborative teamwork of nurses and other healthcare providers are clear and recognized. The CNS is well prepared as an attending nurse. However, we would not have gone to the physician literature to find the kernel of the idea. Diane Cooper, attributing the idea to her colleague Mildred Czar, wrote in 1983 that the CNS with more than 5 years of experience ‘‘should be the essence of the refined expert,’’ or the attending nurse. According to Cooper, CNSs should achieve the refinement, excellence, stature, and desire for learning exemplified by top attending physicians. Later, in our book Clinical Nurse Specialist: Implementation and Impact, Cooper described a statue in Philadelphia named Consultation, which depicts a group of 5 physicians in different roles and which captures the peer esteem earned by each. The attending physician in the statue stands as a resource for others; they value his direction because it is based in deep clinical experience, and he listens and hears differently compared to the others in the group. Then Cooper envisioned a future time (now?) when a similar statue will exist but the depicted professionals will be nurses and the focal point of the statue will be the CNSVthe attending nurse exuding confidence and the skill of years of direct clinical activity with patients. The literature now yields models for attending nurses. The attending nurse model in adolescent psychiatry was developed by Niemela et al and further described by Moreau et al. Watson and Foster described the attending nurse caring model as a way to address the nursing shortage, the crisis of patient safety, and care dilemmas of our current healthcare system. We suspect that there are many more examples of effective attending nurse models. Yes! The time is now. However, we have promulgated the idea in the past, and now it is time to publish exemplars of CNSs as attending nurses.