title: Substantive areas of clinical nurse specialist practice: a comprehensive review of the literature.
abstract: OBJECTIVE
  A comprehensive review of the literature was performed to describe the substantive clinical areas of clinical nurse specialist (CNS) practice.
  
  
  BACKGROUND
  There is lack of understanding about the role of CNSs. Debates over blending CNS and nurse practitioner roles are common, as are questions and uncertainties about new models of advanced practice nursing endorsed by the American Association of Colleges of Nursing. To better understand the role of the CNSs and plan for new models of advanced practice nursing, it is important to know what CNSs say about the nature of their work and examine research related to CNS practice.
  
  
  METHODS
  The following databases were searched using the terms clinical nurse specialist or advanced nursing practice: Cumulative Index to Nursing and Allied Health Literature, Medline, PsychInfo, Academic Search Premier, ProQuest Dissertations and Theses, PapersFirst, and ProceedingsFirst. Criteria for inclusion in the sample were determined a priori. Data were extracted from each article and abstract using thematic content analysis.
  
  
  RESULTS
  The final sample included anecdotal articles (n = 753), research articles (n = 277), dissertation/thesis abstracts (n = 62), and abstracts from presentations (n = 181). Three substantive areas of CNS clinical practice emerged: manage the care of complex and vulnerable populations, educate and support interdisciplinary staff, and facilitate change and innovation within healthcare systems.
  
  
  CONCLUSIONS
  There is a clear conceptual basis for CNS practice, which is substantiated in the literature. Clinical nurse specialists must continue to define this scope of practice to organizations, administrators, healthcare professionals, and consumers.
authors.affiliation: Kent State University, College of Nursing, Ohio, USA. wlewando@kent.ed
authors.forename: Wendy
authors.initials: W
authors.lastname: Lewandowski
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adamle
mesh_terms: D004509:Education, Nursing, Continuing; D007318:Inservice Training; D009726:Nurses; D036301:Qualitative Research; D013041:Specialties, Nursing; D000078329:Workforce