title: Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study).
abstract: OBJECTIVE
  To report a study designed comparing the roles, responsibilities, and perceived outcomes of Clinical Nurse Specialists, Clinical Midwife Specialists, and Advanced Nurse Practitioners in Ireland.
  
  
  BACKGROUND
  A clinical career pathway that encompasses progression from staff nurse or midwife through clinical specialist to advanced practitioner level was introduced in Ireland in 2000. Such roles are common internationally, but little evaluation has been conducted and few comparisons have been made between roles.
  
  
  METHODS
  A mixed-method case-study design was used.
  
  
  METHODS
  Following Research Ethics Committee Approval, data were collected in 2009-2010, using non-participant observation (92 hours) of 23 Clinical Specialists and Advanced Practitioners, interviews with 21 clinicians and 13 Directors of Nursing or Midwifery. A survey was completed by 154 service-users.
  
  
  RESULTS
  A clear difference was seen between Clinical Specialist and Advanced Practitioners, with advanced practice roles providing improved service delivery, greater clinical and professional leadership, increased research, and a clear governance and accreditation structure. Clinical Midwife Specialists were rated at a similar level to Advanced Nurse Practitioners for certain aspects and rated more highly for 'continuity of care and carer'.
  
  
  CONCLUSIONS
  Advanced Practitioners do give a higher level of care, particularly at a strategic level. Existing Clinical Specialists should therefore be encouraged to develop their skills and education to achieve advanced practice level and more specialist and advanced practice posts should be instituted.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Ireland. cbegley@tcd.ie
authors.forename: Cecily
authors.initials: C
authors.lastname: Begley
authors.forename: Naomi
authors.initials: N
authors.lastname: Elliott
authors.forename: Joan
authors.initials: J
authors.lastname: Lalor
authors.forename: Imelda
authors.initials: I
authors.lastname: Coyne
authors.forename: Agnes
authors.initials: A
authors.lastname: Higgins
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Comiskey
mesh_terms: D000328:Adult; D036262:Empirical Research; D005260:Female; D006801:Humans; D007494:Ireland; D007857:Leadership; D008297:Male; D009720:Nurse Clinicians / Q000592:standards*; D009721:Nurse Midwives / Q000592:standards*; D009722:Nurse Practitioners / Q000592:standards*; D024802:Nurse's Role; D015399:Nursing Research; D017009:Professional Autonomy; D011795:Surveys and Questionnaires