title: Clinical nurse specialists as entrepreneurs: constrained or liberated.
abstract: OBJECTIVE
  This qualitative study explored the experiences of two groups of clinical nurse specialists--continence advisors and tissue viability nurses--working in primary care in the UK. In particular, the study focused on how clinical nurse specialists' relationships with other health-care professionals had an impact on their role.
  
  
  BACKGROUND
  Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists' experiences as they attempt to diversify nursing practice.
  
  
  METHODS
  An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face-to-face interviews with 22 clinical nurse specialists.
  
  
  RESULTS
  Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including 'cultivating relationships' with more powerful others, most notably the speciality consultant.
  
  
  CONCLUSIONS
  The UK government has pledged to 'liberate the talents of nurses' so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health-care professionals led to clinical nurse specialists being constrained.
  
  
  CONCLUSIONS
  Health-care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical nurse specialists may remain dependent on the mechanisms witnessed in this study for some time.
authors.affiliation: School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK. lynnaustin@email.com
authors.forename: Lynn
authors.initials: L
authors.lastname: Austin
authors.forename: Karen
authors.initials: K
authors.lastname: Luker
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.forename: Martin
authors.initials: M
authors.lastname: Ronald
mesh_terms: D016520:Entrepreneurship; D006801:Humans; D007400:Interprofessional Relations; D009720:Nurse Clinicians; D024802:Nurse's Role; D011320:Primary Health Care; D012883:Skin Ulcer / Q000451:nursing; D013647:Task Performance and Analysis; D006113:United Kingdom; D014549:Urinary Incontinence / Q000451:nursing