The Advanced Practice Clinical Nurse Specialist

Development and validation of the job stressor scale for specialty nurses

Objectives

Specialty nurses play a crucial role in specialized nursing practice, teaching, management, and research. These nurses often face significant work pressure; therefore, scientifically and effectively assessing their job stress and its sources is vital for enhancing the quality of their work. However, there is currently a dearth of verified assessment tools for measuring job stressors among specialty nurses. Therefore, this study aimed to develop and test an instrument to assess the job stressors applicable to specialty nurses.

Methods

We conducted a multiphase mixed-methods study. The initial scale items were developed from a literature review and structured interviews. The scale was then refined through two rounds of expert consultation (N = 14) and a primary test (N = 20). A main survey (N = 552) was then conducted to evaluate the scale's construct validity and reliability using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).

Results

The final scale comprises four dimensions with 27 items. The factors included "specialized nursing and work," "workload and time allocation," "patient care," and "work resources and environment." The EFA explained 69.10% of the variance, while the CFA confirmed a good model fit. The content validity index was 0.980 at the scale level and 0.790-1.000 at the item level. The scale's reliability was supported by its high Cronbach's α (0.958), test-retest reliability (0.946), and split-half reliability (0.868).

Conclusion

Our findings indicate that the job stressor scale developed in this study is valid and reliable, and is recommended for use among specialty nurses to assess their stressors.

A core competency evaluation index system for the graded use of clinical nurse specialists: A Delphi study

AIMS AND OBJECTIVES

To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels.

BACKGROUND

Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession.

DESIGN

This research employed the Delphi method.

METHODS

The STROBE checklist for observational cross-sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications.

RESULTS

The graded competency evaluation system consisted of five first-level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision-making), 15 second level indicators, and 40 third-level indicators. The authority coefficients (Cr) of the experts were .865 and .901. The Kendall's concordance coefficients of the three-level indicators were .417, .289 and .316 for primary CNSs; .384, .294 and .337 for intermediate CNSs; and .489, .289 and .239 for advanced CNSs.

CONCLUSION

The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral.

RELEVANCE TO CLINICAL PRACTICE

The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs.

PATIENT OR PUBLIC CONTRIBUTION

Patients participated in the data collection process, during which they shared their health-seeking experience with our research team.

Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study

BACKGROUND

Infectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses' attitudes toward IPC nursing curriculum and duties.

METHODS

The study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis.

RESULTS

The data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: "Core characteristics of the curriculum", "Expected competencies and skills", and "Evaluation." These themes were derived from nine main categories and 25 subcategories.

CONCLUSIONS

Specialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.

The Role of Researcher for Advanced Practice Nurses in Oncology: Challenges and Lessons Learned

OBJECTIVES

To reflect on current practice analyses regarding the role of advanced practice nurse (APN) researcher in oncology, and report on the challenges that were faced and lessons we have learned when intensively working with APNs on doing research within the domain of oncology.

METHODS

Discussions with APNs supervised by or who collaborated with academics in nursing science during the past 10 years on doing research within the domain of oncology.

RESULTS

Several misconceptions exist regarding the role of APNs as researchers. During the research process, APNs are confronted with a wide range of topics based on evidence gaps and unmet needs, challenges linked to specific research designs, and ethical issues. APNs also face challenges related to the dissemination of research. This step in the research process is often overlooked due to APNs' lack of time, limited financial resources, insufficient support for academic writing, or lower priority for APNs and other healthcare providers.

CONCLUSION

The APN role of researcher in oncology is fundamental for the advancement of oncology nursing care, implementation of evidence-based practice and innovations in oncology patient care, and further development of the nursing profession and nursing science. Participation in research is considered a main function that differentiates APNs from nurses in other clinical roles, such as specialized nurses. By embracing the role of researcher, oncology APNs can achieve professional growth that will stimulate them as an APN, open new opportunities, and keep them challenged.

IMPLICATIONS FOR NURSING PRACTICE

In addition to APN, organizational and structural related factors, support by relevant stakeholders, partnering with (nursing) research units and professional and patient organizations, and dedicated time for research can positively influence uptake of the APN researcher role.

Construction and application of the core competence course training system for infectious disease specialist nurses

OBJECTIVES

This study aims to construct and apply a training course system which was scientific and comprehensive to foster the core competence of infectious disease specialist nurses.

DESIGN

A two-round Delphi consultation survey was carried out to collect feedback from experts on constructing the training course system of core competence for infectious disease specialist nurses. Besides, a non-randomized controlled experimental study was adopted to check the application effect of the courses.

METHODS

This study adopted a series of methods including group discussion, theoretical analysis and Delphi consultation to draft the training course content of core competence of infectious disease specialist nurses. Twenty-one Chinese experts were invited to participate in the Delphi consultation from November 2021 to December 2021. From October 2022 to January 2023, a total of 105 infectious disease specialist nurses from two training bases were selected by the convenience sampling method, of which the nurses in one training base were the control group and the nurses in the other training base were the observation group. The observation group was trained by the constructed core competence training course. Questionnaire evaluation was used to compare the core competence of infectious disease specialist nurses and the training effect.

RESULTS

The experts, regarded as the authorities on the subject, were highly motivated in this study. Besides, they reached a consensus on the results. The final training course system of core competence for infectious disease specialist nurses focused on 5 competence modules and was composed of 12 categories of courses with 66 classes and corresponding objectives. The core competence scores of the observation group were significantly higher than those in the control group after training (P < 0.05), which proved the training system can effectively enhance the core competence of infectious disease specialist nurses.

CONCLUSIONS

The research methods embodied scientific and precise properties. The course system was comprehensive in content and reliable in results. It could serve as a reference for training infectious disease specialist nurses.

The role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease: A scoping review protocol

INTRODUCTION

The number of patients with chronic kidney disease is increasing worldwide; previous studies have suggested that advanced practice nurses, including nurse practitioners and clinical nurse specialists, with expert practice skills can provide high-quality care and solve complex healthcare problems. In general, nurse practitioners are generalist nurses who work as autonomous clinicians with whole personal care. Clinical nurse specialists, in contrast, are nurses with advanced nursing knowledge and skills for individuals or specific populations. Their roles are independent and different; however, similarities exist in their role in potentially improving healthcare outcomes. Although two previous studies described the role of nephrology nurse practitioners, they were systematic reviews, and their outcomes were limited. To clarify the overall aspect of advanced practice nurses' role, it is necessary to extract the studies illustrating advanced practice nurses' practices for patients with chronic kidney disease.

OBJECTIVE

This study aims to map the literature describing the role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease.

MATERIALS AND METHODS

This scoping review will be conducted using the Joanna Briggs Institute methodology for scoping review. Online databases will be searched across MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science. Only studies published in English will be included, and no date limit will be set. Chronic kidney disease, renal replacement therapy, and advanced practice nurses as keywords and related search terms will be used. Two independent reviewers will screen the title and abstract/full-text; in case of discrepancy, a third reviewer will make the final decision. The results will be extracted and presented following the review question concerning the study characteristics, patients' characteristics, condition of chronic kidney disease, and role of advanced practice nurses.

Specialized nurses' role in ensuring patient safety within the context of telehealth in home care: A scoping review

Objectives

Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses' roles in ensuring patient safety within the context of telehealth in home care.

Methods

A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories.

Results

The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses' roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs.

Conclusions

The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.

Construction of an index system of core competence assessment for otolaryngology nurse specialists in China: A Delphi study

BACKGROUND

Clinical nurse specialists play a vital role in the work quality, patient safety and team development of nurses. However, there is currently no prior study constructing the index of core competence assessment for otolaryngology Nurse Specialists.

OBJECTIVES

To establish an index system for the evaluation of Chinese otolaryngology Nurse Specialists' core competence.

DESIGN

A Delphi study.

SETTINGS

The study was mainly conducted in a university-affiliated hospital in China.

PARTICIPANTS

Twenty-two experts with otolaryngology knowledge and practical experience from different regions and organizations in China.

METHODS

We used literature reviews and expert meetings to establish a draft index system . Subsequently, a two-round Delphi survey was utilized to consult opinions from 22 experts about the index for the evaluation of otolaryngology nurse specialists' core competence and provide qualitative comments on their ratings. Consensus was predefined as a mean important score of 4.0 or above and a coefficient of variation is not above 0.25 among the participants.

RESULTS

The final evaluation indexes of the core competencies for otolaryngology Nurse Specialists included 5 first-level indexes (clinical competence, critical thinking competence, leadership, professional development competence, professionalism), 19 second-level indexes, and 85 third-level indexes. The effective response rates of the two expert consultation rounds were 100 %. The expert authority coefficients were 0.864 and 0.859 in the first and second rounds of consultation, respectively. In the second round of consultation, the first, second and third indexes of Kendall's coefficient of concordance were 0.357, 0.330, and 0.232, respectively (P < 0.001).

CONCLUSIONS

The constructed evaluation indexes of the core competencies of otolaryngology Nurse Specialists are scientific, reasonable, comprehensive, and specific and may provide references for the training and evaluation of otolaryngology Nurse Specialists.

A self-directed co-creation process for developing a care pathway for patients on oral anticancer therapy: A qualitative process evaluation

PURPOSE

To provide in-depth insight in stakeholders' experiences with the self-directed co-creation of a care pathway for patients treated with oral anticancer drugs, and to identify influencing factors for the success of the co-creation process that are persistent throughout the prior pilot phase and the scale-up phase.

METHODS

This qualitative process evaluation was performed in 11 Belgian oncology departments participating in a scale-up project. Semi-structured interviews with local coordinators (n = 13) and members of the project teams (n = 19), responsible for the co-creation of the care pathway, were conducted. Data were thematically analyzed.

RESULTS

Despite the external support (including group-level coaching and the use of well-defined supportive tools) to promote self-directedness, the co-creation process was perceived burdensome. Three influencing factors were persistent throughout the pilot and scale-up phase: a) shared leadership among the coordinator, physician and hospital management, b) an intrinsically motivated team driven by additional extrinsic factors, and c) a balance between external support and self-directedness.

CONCLUSION

This study shows that the self-directed co-creation of a care pathway is feasible on the condition that important prerequisites are met, including shared leadership and team motivation. More concrete tools, such as a model care pathway, seem needed to increase feasibility of the self-directed co-creation of the care pathway. Yet, these tools should allow tailoring to the specific hospital context. The findings of this study can be useful for further scale-up to other oncology centers, but can also be extrapolated to other healthcare settings.

Shared decision making on medication use between nurses and patients in an oncology setting: A qualitative descriptive study

PURPOSE

(i) To explore patients' and nurses' experiences with medication-related shared decision making (SDM) (i.e., familiarity with the concept, application of medication-related SDM, barriers and facilitators towards its application) and (ii) to explore their role perceptions, respectively.

METHODS

A qualitative study was conducted in which seven interviews with oncological patients and a focus group interview with six nurses were performed. Prior to the interviews, observations of the application of shared decision making were conducted using the OPTION-12 scale. The observations were used exclusively to trigger the group discussion. Data were collected from November 2020 until March 2021.

RESULTS

According to participants, the application of SDM regarding medication by nurses in oncology is limited. Barriers mentioned were health status, medication-related knowledge, the therapeutic nurse-patient relationship, time pressures and workload. Patients valued nurses' contribution to SDM regarding medication and perceived them as key persons because of their advocating, informative, facilitating and supportive role. Individual and contextual factors determined patients' desire for involvement in medication-related decisions.

DISCUSSION

Participants solely concentrated on SDM concerning drug choice and management of therapeutic and adverse effects. The patients' and nurses' experiences and perceptions towards SDM in other domains of pharmaceutical care need further investigation.

Developing a professional competence framework for the master of nursing specialist degree program in China: A modified Delphi study

BACKGROUND

The urgency of ensuring adequate professional competence in clinical nursing practice is evident. However, there is little formal professional competence framework for the education of master's degree students in nursing specialist programs in China.

OBJECTIVE

To develop a professional competence framework for the Master of Nursing Specialist (MNS) degree program in China.

DESIGN

A modified Delphi study.

PARTICIPANTS

An expert panel discussion was held with 12 experts, and Delphi rounds were conducted with 24 experts.

METHODS

A literature review and an expert panel discussion were conducted to develop an initial competence framework. A two-round Delphi survey was employed to obtain a consensus on the framework through either an online or paper questionnaire. Descriptive statistics were used to analyze the data. The consensus threshold was set according to the mean (≥ 4.0), coefficient of variation (< 0.25), and consensus level of agreement (≥70 %).

RESULTS

A consensus on seven domains and 54 items of the professional framework for the MNS degree program was achieved. The framework domains included clinical practice (12 items), professional attitude (8 items), collaboration and communication (5 items), professional development (8 items), research (7 items), education (7 items), and administration (7 items).

CONCLUSION

The professional competence framework offers guidelines for MNS degree programs in China. Future research should focus on imbedding these competences in MNS degree programs to prepare qualified advanced practice nurses.

Nurses' Perceptions of the Clinical Nurse Specialist Role Implemented in a Highly Specialized University Hospital in Spain: A Qualitative Study

PURPOSE/AIMS

To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain.

DESIGN

A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain.

METHOD

Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used.

RESULTS

Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization.

CONCLUSIONS

The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Association Between Interdisciplinary Collaboration and Leadership Ability in Intensive Care Unit Nurses: A Cross-Sectional Study

BACKGROUND

Interdisciplinary collaboration in the intensive care unit (ICU) is crucial for improving the quality of patient care. Furthermore, interdisciplinary team members need to establish team leadership to function effectively in solving problems. However, the influence of improving leadership ability in nurses on interdisciplinary collaboration efficacy is uncertain.

PURPOSE

This study was designed to clarify the relationship between nursing leadership ability and interdisciplinary collaboration.

METHODS

This cross-sectional study included 3,324 nurses with > 3 years of experience working in an ICU in Japan as participants. The investigation period was from April to September 2016. The developed questionnaire addressed leadership ability (Self-Assessment Inventory of Leadership role for staff nurses) and activities and perceptions related to multidisciplinary collaboration (Collaboration and Satisfaction About Care Decisions). The questionnaires were then collected and mailed.

RESULTS

The 2,063 valid questionnaire responses gave a valid response rate of 61%. Nursing leadership ability was found to be significantly higher in advanced practice nurses (APNs; 78.8 ± 9.5, p < .001) and nurses in higher positions (74.9 ± 8.9, p < .001) than in non-APNs. However, no differences were found in terms of ICU management systems (p = .116). In addition, higher levels of nursing leadership were associated with greater team coordination (β = .212), higher levels of interdisciplinary collaboration in the ICU (β = .196), and the perception of many medical staff members, as well as patients and family members, to be team members (β = .140) and APNs (β = .128; p < .001).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Improving the leadership ability of critical care nurses may impact interdisciplinary collaboration positively. Leadership ability in nurses was shown to be related to a high level of cooperation among multiple healthcare providers. To enhance leadership ability in critical care nurses, nurses must increase their level of knowledge and ability. However, examining and implementing educational methods, including the improvement of coordination ability mainly by APNs, remain a challenge.

A legal framework on advanced practice nursing in Belgium: what do we and don't we know?

OBJECTIVES

Presenting the Belgian new framework for Advanced Practice Nursing (APN) - 'Verpleegkundig Specialist [VS]'/"Infirmier de pratique avancée [IPA]" outlined in the Law of 22 April 2019, followed by a discussion of the lack of clarity, the current challenges and future opportunities.

METHODS

The framework was analyzed by an expert in healthcare legislation and discussed by academics in Nursing Science and members of the board of directors of the Belgian Society of APN.

RESULTS

Relevant paragraphs within this new law are"Article 46 §1. No one is allowed to carry the title of 'VS/IPA' who does not possess a bachelor in nursing mentioned in article 45 and who does not meet the requirements specified in this article. At the minimum, a master's degree in Nursing Sciences is also required. §2. Additional to the scope of practice of nursing as mentioned in article 46, the 'VS/IPA' perform, in the context of complex nursing care, medical interventions in order to maintain, improve or restore the health of the patient. Care is provided in the context of a specific target group of patients and in close concertation with the physician and potential other healthcare professionals.

CONCLUSION

Although the legal recognition of the title of VS/IPA is a major breakthrough that will innovate healthcare, clarification is needed: How do VS/IPA distinguish themselves from other nursing functions, what is complex nursing care, which medical interventions can be performed, what is meant by specific target group of patients, what does 'in close concertation with the physician' entail, and will advisory power be possible?

Informing and Supporting the New Clinical Nurse Specialist Prescriber

Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.

Implementing a surgical first assistant role into that of a clinical nurse specialist at an orthopaedic specialist hospital

BACKGROUND

Clinical nurse specialists (CNSs) are experienced senior nurses with advanced clinical knowledge, communication and leadership skills and commonly take on extended roles to optimise care delivery within health and social care.

AIM

To critically explore the experience of one clinical nurse specialist who undertook an enhanced qualification to become a surgical first assistant.

METHODS

A case-study approach based on Gibbs' reflective model is used to reflect on the experience, its benefits to patient care and the challenges and facilitators related to taking on advanced surgical roles.

FINDINGS

Long-term benefits can be achieved by investing in CNSs educated to hold the enhanced surgical first assistant qualification. Advanced roles enhance evidence-based service delivery, while also benefitting the clinical nurse specialist, the patient and the trust.

Core competencies of clinical nurse specialists: A comparison across three Nordic countries

AIM

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland.

BACKGROUND

Clinical nurse specialist roles were first developed more than 60 years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries.

DESIGN

A descriptive correlational study.

METHODS

An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline.

RESULTS

A total sample of 184 clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate = 72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p = .000) and in organisational competency (p < .05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency.

CONCLUSION

A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries.

RELEVANCE TO CLINICAL PRACTICE

The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.

Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis

AIM

To conduct a construct validity test on a clinical nurse specialist core competency scale.

BACKGROUND

Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research-driven efforts to develop and validate clinical nurse specialist core competencies.

DESIGN

A descriptive study, using an online self-report questionnaire, was conducted from May to September 2019 in three Nordic countries.

METHODS

An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50-item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study.

RESULTS

One hundred and eighty-four responses were obtained (Finland n = 52, Denmark n = 95, Iceland n = 37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale.

CONCLUSIONS

Based on the analysis and subjective interpretation, we suggest a 47-item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study.

RELEVANCE TO CLINICAL PRACTICE

The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate-level programme curricula and inform future competency research.

Demands of experiential training for ICU nurses in Hunan of China

Objective

To assess intensive care unit (ICU) nurses’ demands for specialized experiential training and to provide inputs for developing an experiential training program for ICU nurses.

Methods

A questionnaire for assessing ICU nurses’ demands for experiential specialty training was distributed to 360 ICU nurses, selected through purposive sampling from two secondary hospitals and six tertiary hospitals in Hunan Province, China.

Results

Of the survey participants, 63.6% had undergone a specialty training program for ICU nurses. Of these individuals, 53.0% were satisfied with the training. Certification as a qualified nurse was considered an essential criterion for admission of trainees into the program by 81.8% of respondents, while 77.1% of respondents considered clinical working experience to be a critical requirement for selecting trainers. A total of 48.1% of the respondents preferred part-time training, and 36.1% considered a training cycle of 9–12 weeks to be reasonable. Moreover, they felt that the training methods should be tailored to different stages of the experiential learning cycle. Demands for experiential training among ICU nurses were quantified, with high demand reflected in an overall score of 4.41 ± 0.48. The “intensive care technology” experiential training module was ranked highest in terms of demand, with the top five sub-modules being specialty operating technology (4.67 ± 0.53), care of critically ill patients (4.66 ± 0.55), critical patient rescue procedures (4.65 ± 0.56), assessing monitoring indexes (4.63 ± 0.56), and the application of relevant instruments (4.61 ± 0.57).

Conclusion

Nearly half of the respondents indicated that their experiences of specialty training programs were not satisfactory, and they had high demands for experiential training. Thus, to optimize training outcomes, continuous updating of training methods is essential. Moreover, a systematic, comprehensive, and multilevel experiential training program that targets the specific needs of ICU nurses is essential.

From shadow to change agent: Revitalization of the clinical nurse specialist role

In 2017, A Magnet designated 528-bed tertiary care community hospital underwent significant leadership change. With that, came the opportunity to redefine the Clinical Nurse Specialist (CNS) role within the largest of five hospitals in a two-billion-dollar health care system. Through evidence-based practice, effective leadership, and the vision of a change agent, this is the story of the revitalization of the CNS role.