Adult - Gerontology Clinical Nurse Specialist Role

2012 Adult - Gerontology Clinical Nurse Specialist Role Delineation StudyNational Survey Results

June 2013 © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved

About this Report This report pertaining to the practice of adult-gerontology clinical nurse specialist was

based on the results of a national study of practice of adult-gerontology and pediatric clinical nurse specialists.

Table of Contents

ACKNOWLEDGEMENTS................................................................................................................ 3 BACKGROUND ............................................................................................................................... 4

ROLE DELINEATION STUDY OVERVIEW ........................................................................................... 4 UPDATED TEST CONTENT OUTLINES .............................................................................................. 4 ROLE OF THE CONTENT EXPERT PANELS ........................................................................................ 4

SURVEY METHODOLOGY ............................................................................................................. 5 SURVEY CHRONOLOGY .................................................................................................................. 5 SAMPLE SELECTION ....................................................................................................................... 5 SURVEY DEVELOPMENT AND MEASURES ........................................................................................ 6 DATA COLLECTION ........................................................................................................................ 7 DATA ANALYSIS ............................................................................................................................ 8

SURVEY RESULTS ....................................................................................................................... 10 DEMOGRAPHIC INFORMATION ....................................................................................................... 10 PRACTICE DESCRIPTIONS ............................................................................................................. 11

APPENDICIES

WORK ACTITIVIES STATEMENTS .................................................................................... APPENDIX A DEMOGRAPHIC DATA SUMMARY .................................................................................... APPENDIX B WORK ACTIVITIES DESCRIPTIVE STATISTICS .................................................................. APPENDIX C WORK ACTIVITIES MEAN OVERALL CRITICALITY -- RANK ORDER .................................... APPENDIX D

2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results 2© Copyright 2013 American Nurses Credentialing Center, All Rights Reserved

Acknowledgements The American Nurses Credentialing Center (ANCC) wishes to thank a number of

content experts who served on the 2012 ANCC Adult-Gerontology Clinical Nurse Specialist and Pediatric Clinical Nurse Specialist Role Delineation Study panels for sustaining this effort and producing a role delineation study of such high caliber. Without their numerous hours of input and feedback, the study would not be possible.

Adult-Gerontology Clinical Nurse Specialist

• Amanda Segrest, MSN, ACNS-BC, RN-BC• Elizabeth Bauer, MSN, ACNS-BC• Julie Ponto, PhD, ACNS-BC• Mary Francisco, MSN, GCNS-BC, CCRN• Ann Jacobson, PhD, ACNS-BC• Ann Marie Lazarus, MSN, ACNS-BC• Chanda Harrison, MSN, ACNS-BC• Deborah Messecar, PHD, GCNS-BC• Mary Strickland, MSN-ACNS-BC• Linda Hoke, PhD, ACNS-BC

Pediatric Clinical Nurse Specialist

• Heidi McNeely, MSN, PCNS-BC• Patricia Conlon, MS, PCNS-BC, PNP, BC• Maureen O’Brien, PhD, PCNS-BC• Jerithea Tidwell, PhD, PCNS-BC, PNP-BC• Cynthia Wall, MSN, PCNS-BC• Angela Scott, MNSc, APN, PCNS-BC• Heather Walsh, MSN, PCNS-BC• Sharon Barton, PhD, PCNS-BC• Rhonda Werner, MS, PCNS-BC

We also would like to thank the ANCC staff who also spent numerous hours working tomake this study possible:

• Christine DePascale, MS (Project Manager)• David Paulson, PhD, CAE• Chie Ohba, PhD• Cheray Jones

Finally, we would like to thank the ANCC-certified clinical nurse specialists whosupported this study by completing the survey questionnaire.

The contributions that all of these people made to the study were essential to its success.


Background The American Nurses Credentialing Center (ANCC), which was incorporated in 1991 as

a subsidiary of the American Nurses Association, is the largest nursing credentialing organization in the United States. Its vision is to drive nursing excellence, quality care and improved outcomes. Currently, ANCC offers 25 examinations at various levels including diploma and associate degree, baccalaureate, and advanced practice for nurse practitioners, clinical nurse specialists, and other disciplines. More than 14,000 candidates take an ANCC certification examination each year. In addition to certification, ANCC provides services such as the Magnet and Pathways to Excellence recognition programs for hospitals and other facilities that demonstrate excellence in nursing services, accreditation of continuing education programs, education and consultation services, and outreach to nursing organizations around the globe.

Role Delineation Study Overview

Role delineation or job analysis studies are typically carried out at the national level with the goal of describing current practice expectations, performance requirements, and environments. ANCC has a current goal of conducting a study of clinical nurse specialists approximately every three years in order to capture changes in work activities and the knowledge and skill areas required to perform those activities. The findings are used to update the content of its respective certification examinations.

The 2012 Adult-Gerontology Clinical Nurse Specialist and Pediatric Clinical Nurse Specialist Role Delineation Study involved two sets of processes or activities that ran more or less concurrently: a national web-based survey and a linking activity. The national survey was designed to collect information on the work activities clinical nurse specialist actually perform in practice, while the linking activity identifies the major knowledge and skill areas required to perform the work activities listed in the survey. The results of both of these processes were used in the updating of the test content outlines for each examination contained within the study.

Updated Test Content Outlines

The results of this role delineation study were used in developing or updating the test content outline for each examination contained within the study. Examination forms produced based on the adult-gerontology clinical nurse specialist test content outline developed through this study are scheduled to go into effect April 17, 2014. A copy of the test content outline is available on the American Nurses Credentialing Center website.

Role of the Content Expert Panels

Throughout the study, ANCC invited professionals in practice and educators who teach courses relevant to clinical nurse specialists to serve on content expert panels for this study. They developed the work activities and demographic items for the survey, linked knowledge and skill areas to the work activities list, and finalized the test content outlines for the respective certification examinations. All of the content experts serving on the panels were certified by ANCC in the clinical nurse specialist population they represented and were invited to serve on the panels based upon expertise in their specialties.


Survey Methodology The purpose of the development and administration of the national survey was to collect

information on the work activities clinical nurse specialists actually perform in practice. Since the survey instrument that was used for the purposes of this study would be used across two clinical nurse specialist populations, representatives from each of these two population-based role delineation study panels were also asked to serve as members of a ten member initial study workgroup that acted as a sort of steering committee for the panels. This initial workgroup met for three days May 21-23, 2013 to draft a single pilot version of the survey and to construct the initial map of knowledge and skill areas relevant to the work activities included in the survey. Survey Chronology The survey development and administration timeline was as follows:

May – July 2012 • The initial study workgroup along with staff from ANCC drafted the survey • The survey was pilot tested and revised.

August - September 2012

• The final survey was administered on the web. September – October 2012

• The survey activity results were analyzed, and activity weights were determined. • Each panel met to review the survey results and activity weights.

Sample Selection On May 17, 2013, there were 3,554 actively certified ANCC clinical nurse specialists in adult health nursing and 585 actively certified ANCC clinical nurse specialists in gerontological nursing. A random sample of ANCC 559 adult health clinical nurse specialists stratified by region and all ANCC certified gerontological clinical nurse specialists (except 25 who were selected to participate in the pilot survey) were selected from the ANCC certification database. Table 1 presents the numbers of ANCC certified adult health clinical nurse specialists and ANCC certified gerontological clinical nurse specialists that were selected from each region. Table 1. Number of Surveys Mailed Out per Geographic Region

Geographic Region

Number of ANCC Certified Adult Health

CNS Selected (percent of total pop.)

Number of ANCC Certified GerontologyCNS Selected

(percent of total pop.)

Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI 71(12.70) 125 (22.36)

South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC, WV, DE, KY

201 (35.96) 155 (27.73)

Midwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI 227 (40.61) 206 (36.85)

West – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MT

58 (10.38) 73 (13.06)

Other – AE, AP, APO 2 (0.36) 0 (0.00)

Total 559 (100.00) 559 (100.00)

2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results 5 © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved

Survey Development and Measures On May 21-23, 2013, the initial study workgroup met in Silver Spring, MD in order to draft the national Adult-Gerontology Clinical Nurse Specialist and Pediatric Clinical Nurse Specialist Role Delineation Study survey for the 2012 role delineation study. The panel members reviewed the work activities which had been used in the ANCC's 2009 Role Delineation Survey of Clinical Nurse Spcialists as well as the following documents:

• Consensus Model for APRN Regulation (2008) • American Association of Colleges of Nurses Essentials of Master’s Education of Nursing

(2011) • National Association of Clinical Nurse Specialist Clinical Nurse Specialist Core

Competencies (2008) • American Association of Critical-Care Nurses Scope and Standards for Acute and Critical

Care Clinical Nurse Specialist Practice (2010) • American Association of Colleges of Nursing and National Association of Clinical Nurse

Specialists Adult-Gerontology Clinical Nurse Specialist Competencies (2010) During the meeting, they discussed any additions, deletions, and changes they would make to update the 2009 work activity list to reflect current practice of clinical nurse specialists working within either of the two population areas. The goal of this process was to create a comprehensive list of relevant work activities that were potentially performed by clinical nurse specialist in either of the population areas, regardless of whether it was performed in the other. As a result of this meeting, the panel reached consensus on a list of 124 work activities to be used in the 2012 pilot survey. These work activities were divided into seven domains: Direct Care; Consultation; Systems; Coaching/Education; Collaboration; Evidence-based practice and Research; and Ethical Decision-making, Moral Agency and Advocacy. The complete text of the work activities list is presented in Appendix A. The workgroup also identified and finalized a set of 17 demographic questions. (See Appendix B). During the same meeting, the workgroup reviewed and approved three scales that respondents would use to rate the work activities listed in the survey — Frequency (the frequency with which a work activity is performed), Performance Expectation (how soon on the job the performance of an activity is expected), and Consequence (the consequence of performing an activity incorrectly). The performance expectation scale was specifically designed to distinguish entry-level skills. These three questions and the instructions for answering them are presented in Table 2.


Table 2. Survey Questions for Rating Work Activity Statements In this section, activities potentially performed by clinical nurse specialists working with adult-gerontology and pediatric populations are listed. As you complete this section of the survey, please respond from the persective of one who is newly certified as a clinical nurse specialist working with the population of patients with whom you are certified to work and has the following qualifications: -- a current, active RN license -- a master's from a clinical nurse specialist program specific to the population of the certification -- 500 faculty supervised clinical hours -- Course work in advanced health assessment, advanced pharmacology, and advanced pathophysiology Please respond to each activity with three separate responses, one response in each category. When considering a response for one category, do not consider the other categories. For example: When considering the consequences of incorrect performance of an activity, do not worry about whether you perform or are expected to perform the activity; the possibility exists that an activity has severe consequences, even if you never perform it. Performance Expectation: When is a newly certified clinical nurse specialist working with your specific population first expected to perform this activity? -- Within the first 6 months of working within the role. -- After the first 6 months of working within the role. -- Never expected to perform this activity within the role. Frequency: How often does a newly certified clinical nurse specialist working with your specialty perform this activity (consider within a one year period)? -- Frequently -- Often -- Occasionally -- Seldom -- Never Consequences: Does incorrect performance of this activity cause: -- Little or no harm (i.e. negative consequences)? -- Mild harm (i.e. negative consequences)? -- Moderate harm (i.e. negative consequences)? -- Severe harm (i.e. negative consequences)? The study design included combining each respondent’s responses to each of the three rating scales in a hierarchical manner into one overall ranking of criticality. To select a procedure for combining the three scales, importance of each scale to the performance of the work activity was considered. Performance expectation scale was determined to be regarded as more critical than the other two scales for representing entry-level practice. The consequence scale was then regarded as more critical than the frequency scale. Therefore, the scales were combined so that a particular value on the performance expectation scale would outweigh or outrank all values on the consequence and frequency scales. This hierarchical scheme emphasized the work activities that are required of new practitioners immediately on the job and have the greatest impact on public health or safety. Thus this scheme was selected as the organizing mechanism for combining the responses from the three survey scales into an overall measure of criticality. Data Collection Pilot Testing. Using the same procedures intended for administering the national data collection, the survey was piloted in June and July 2012. Twenty-five ANCC certified adult health clinical nurse specialists and 25 gerontological clinical nurse specialists randomly selected from across the nation were included in the sample of 75 ANCC certified clinical nurse specialists


invited to take the pilot survey. Overall, 24 of the clinical nurse specialists invited to take the pilot survey responded; nine of these respondents were adult health clinical nurse specialists and eight were gerontological clinical nurse specialists. The respondents of the pilot test in general indicated that the work activities were appropriate and reflective of the job of the clinical nurse specialist. National Survey. On August 13, 2012, the 1,300 clinical nurse specialists (including 559 adult health clinical nurse specialists and 559 gerontological clinical nurse specialist) selected to take the national web-based survey were sent an alert letter explained the purpose and importance of the study, the eligibility criteria of the study, and stated how to access the survey via the internet. The letter indicated that the participant’s responses would be kept confidential. The letter also notified that respondents completing the survey receive a 5 hour reduction of their continuing education requirement for their ANCC recertification. A follow-up reminder letter was sent approximately two-weeks after the alert letter. It thanked recipients if they had already submitted their completed survey and encouraged them to do so if they had not already. A final follow-up reminder letter was sent out only to those who had not yet responded to the survey and was sent out approximately two-weeks prior to the end of the survey. Data Analysis The three rating scales used in the survey were combined into a single measure of overall criticality using a hierarchical method. As agreed by the initial study workgroup, the three rating scales were combined into a single measure in such a manner that a particular value on the performance expectation scale would outweigh or outrank all values on the consequence and frequency scales, and that a particular value on the consequence scale would outweigh or outrank all values on the frequency scale. Table 3 displays how the values of the overall criticality rating were constructed according to all the possible survey response patterns that might be given to rate an individual work activity by its frequency, performance expectation, and consequence. For example, if a respondent indicated that a particular work activity was expected to be performed within the first six months of assuming the role of a clinical nurse specialist, could cause severe harm if it was performed incorrectly, and is performed occasionally, the overall criticality rating for that response pattern would be 39. A score of 32 suggests that a work activity is generally expected to be performed within the first six months of assuming the role of a clinical nurse specialist and could cause moderate harm if incorrectly performed. Therefore, work activities with scores of 32 or higher on the overall criticality variable may be considered as highly critical. When a work activity was rated as never expected on the performance expectation scale, it would receive an overall criticality score of 1 as the bottom row in Table 3 indicates.


Table 3. Construction of the Overall Criticality Variable

Criticality Ranking Performanc Expectations Consequences Frequency Within the first 6 months of working within the role

Severe Harm Frequently 41 Often 40 Occasionally 39 Seldom 38 Never 37

Moderate Harm Frequently 36 Often 35 Occasionally 34 Seldom 33 Never 32

Mild Harm Frequently 31 Often 30 Occasionally 29 Seldom 28 Never 27

Little or no Harm Frequently 26 Often 25 Occasionally 24 Seldom 23 Never 22

After the first 6 months of working within the role

Severe Harm Frequently 21 Often 20 Occasionally 19 Seldom 18 Never 17

Moderate Harm Frequently 16 Often 15 Occasionally 14 Seldom 13 Never 12

Mild Harm Frequently 11 Often 10 Occasionally 9 Seldom 8 Never 7

Little or no Harm Frequently 6 Often 5 Occasionally 4 Seldom 3 Never 2

Never Expected to perform this activity within the role

1


Survey Results The total sample size of the national survey included 1,118 adult health and gerontological clinical nurse specialists (559 each per adult health clinical nurse specialist and gerontological clinical nurse specialist). A total of 397 adult health clinical nurse specialist and gerontological nurse specialist responses were returned. Of these 107 respondents indicated they were not currently practicing. The overall response rate was 35.51% percent and a total usable response rate was 28.68% percent. Table 4 shows the percent of surveys per population returned in each geographic region compared to the number of ANCC certified adult health clinical nurse specialist and gerontological clinical nurse specialist selected within the region. Table 4. Number of Surveys Returned per Geographic Region

Geographic Region

Adult Health CNS Gerontological CNS

Number Selected (percent of total

pop.)

Number Return (percent of total

pop.)

Number Selected

(percent of total pop.)

Number Return (percent of total

pop.)

Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI

71(12.70) 18 (12.77) 125 (22.36) 32 (21.48)

South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC, WV, DE, KY

201 (35.96) 40 (28.37) 155 (27.73) 38 (25.50)

Midwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI

227 (40.61) 61 (43.26) 206 (36.85) 62 (41.61)

West – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MT

58 (10.38) 21 (14.89) 73 (13.06) 17 (11.41)

Other – AE, AP, APO 2 (0.36) 1 (0.71) 0 (0.00) 0 (0.00)

Total 559 (100.00) 141 (100.00) 559 (100.00) 149 (100.00)

Demographic Information Appendix B details the adult-gerontological clinical nurse specialist survey respondents’ responses to the survey’s 17 demographic questions which included inquiry on the clinical nurse specialist’s background and practice setting. Demographic Background Ninety seven percent of the respondents were female and 93 percent reported to be white. Seventy one percent of the adult-gerontological clinical nurse specialist respondents indicated they were between the ages of 45 and 64. Ninety percent of the adult-gerontological clinical nurse specialists reported having a Masters in Nursing as one of their highest degrees. Seven percent of the respondents indicated having a Masters in a field other than nursing and six percent indicated having a Doctorate in Nursing Research.


The average number of years of experience that the adult-gerontological clinical nurse specialists had as a registered nurse was 29 years and as a clinical nurse specialist was 13 years. Practice Settings Overall, approximately 41 percent of the adult-gerontological respondents indicated that they practiced in cities with populations between 50,000 and 249,999. Metropolitian areas with populations between 250,000 – 999,999 had the second highest percent of respondents (23 percent). Just over one percent of the respondents indicated working in rural communities with populations less than 2,500. The Hospital, Inpatient setting had the highest percent of adult-gerontological clinical nurse specialist respondents indicating that it was among their primary work setting (50 percent). Outpatient settings, University School or College of Nursing, and Owned Practice (group) came in next with 18, 17, and 16 percent respectively. Eighty percent of the adult-gerontological clinical nurse specialist respondents indicated that their primary patient/client base included Patients with Chronic Conditions. Sixty two percent of the respondents reported working with Patients with Acute Conditions, while 53 percent reported working with Patients with Geriatric Syndromes. The adult-gerontological clinical nurse specialist respondents also reported spending on average approximately 25 – 28 percent of their time with each of the following age groups: adults (18 – 64 years old); Young-Old (65 to 74 years old); and Middle-Old (75-84 years old). On average, approximately nineteen percent of their time was spent providing care for patients 85 years old or older. When asked what percent of time they spend in direct care, the adult-gerontological clinical nurse specialist indicated on average approximately 33 percent of their time. They reported on average 17 percent of their time in Consultation/Collaboration and 15 percent of their time in Education/Coaching. Overall, 54 percent of the adult-gerontological clinical nurse specialist respondents indicated that they are required to have a physician collaborator/supervisor for their practice. Twenty three percent of the respondents indicated that their services are billed directly and 15 percent indicated they are billed under another provider. Finally, 14 percent indicated they have staff privilieges to admit/discharge patients/clients from a facility. Practice Descriptions Descriptive statistics (means, standard deviations, and medians) for the three ratings of all 124 work activities—performance expectation, consequence, and frequency—and mean overall criticality are listed in Appendix C. The scales were highly reliable. Cronbach’s coefficient alpha estimates for the performance expectation, consequence, and frequency scales when applied to all the data were 0.9620, 0.9909, and 0.9777 respectively. (Cronbach's coefficient alpha, a measure of internal stability, ranges in value between 0 and 1.) In Appendix D, the overall criticality statistics are presented in rank order of criticality. As indicated in Table 5, six work activity statements were rated by the adult-gerontology clinical nurse specialist respondents as highly critical (with a mean overall criticality rank of 32 or above).


Table 5. Number of Work Activities by Mean Overall Criticality Range for Adult-Gerontological Clinical Nurse Specialist Mean Overall Criticality Score

37.0 and

above

Between 32.0 and

36.9

Between 27.0 and

31.9

Between 22.0 and

26.9

Between 17.0 and

21.9

Between 12.0 and

16.9

Between 7.0 and

11.9

Between 6.9 and

under

Total number

above 32.0

Number of Work

Activities 0 6 26 21 39 29 3 0 6

Table 6 and 7 displays the 20 highest-ranking and the 20 lowest-ranking work activities by mean overall criticality respectively. The grey shading in Table 6 indicates the six work activities that received criticality ratings of 32 and above. Three of these tasks, including the highest task fell into the domain Ethical Decision-making, Moral Agency and Advocacy. The other three of the highest ranked tasks fell into the domain Direct Care. The three lowest ranked work activities that received criticality rankings less than 12 are are shaded in grey in Table 7. Two of these three tasks fell into the domain Evidence-base Practice and Research. The other task among these three was part of the Systems domain. Table 6. Top 20 Work Activities Ranked by Mean Overall Criticality

Work Activity Number and Name

Mean Overall

Criticality

Std Dev

26 Document in accordance with regulatory requirements 36.29 5.48 110 Advocate for the patient and/or family when there is concern about abuse, neglect or other forms of

violence 35.92 7.96

117 Promote professional accountability in self and others 35.26 7.82 116 Promote a practice climate conducive to providing ethical care 33.68 9.08

4 Interprets values/results of laboratory and diagnostic tests with consideration of age, ethnicity, and health status

33.66 8.75

2 Perform a problem-focused assessment and examination (e.g., functional assessment, physical assessment)

33.61 7.09

8 Collaborate with the patient, family and interprofessional team to develop plan of care to achieve desired outcomes

31.83 7.00

1 Perform a comprehensive, holistic, age-appropriate assessment using advanced assessment techniques

31.79 8.77

6 Prioritize health problems/needs in collaboration with patient and family, nurse and interdisciplinary team

31.62 7.82

18 Provide education for patient and/or family with complex learning needs 31.46 7.45 17 Employ evidence-based clinical practice guidelines to guide prevention, screening, diagnosis and

treatment 31.41 9.18

22 Evaluate the plan of care based on patient and family response 31.11 7.80 23 Modify the plan of care based on patient and family response 30.95 8.30 44 Promote compliance with regulatory (i.e. local, state, federal), accreditation (e.g. Magnet, The Joint

Commission) and professional standards 30.92 11.10

122 Address patient-specific ethical and/or moral dilemmas 30.70 10.67 100 Incorporate evidence into clinical practice (e.g., clinical decision-making, policies and

procedures/protocols, standards, guidelines, products and technologies) 30.05 10.49

82 Serve as a role model to colleagues, patients, families, community 29.92 10.26 45 Promote a supportive and healthy work environment (e.g. team development, conflict resolution,

respect, accountability, civility, Just Culture) 29.77 10.67

3 Assess the effects of interactions among the patient, family, community, social systems, and physical environment on health and illness

29.15 9.08

120 Identify ethical implications of complex care situations, e.g. use of technology and end of life care 29.05 11.34 Grey shading represent work activities that received criticality ranking of 32 and above.


Table 7. Bottom 20 Work Activities Ranked by Mean Overall Criticality

Work Activity Number and Name

Mean Overall

Criticality

Std Dev

52 Analyze the impact of social, political, regulatory and economic forces on the delivery of care 15.24 10.78 89 Mentor professional colleagues through the process of quality improvement 15.12 10.61 95 Evaluate the effectiveness of interprofessional, intra-agency, and inter-agency collaboration 14.78 10.73

102 Conduct a study/investigation to evaluate new products, technologies, and techniques 14.70 10.87 43 Evaluate population specific programs/innovative models of practice across the continuum of care 14.61 9.48

106 Establish collaborative relationships with nurse scientists 14.54 11.70 81 Mentor professional colleagues (e.g., nurses, administrators, physicians, therapist) 14.43 9.99 41 Design population specific programs/innovative models of practice across the continuum of care 14.29 9.79

109 Disseminate evidence-based practice and/or research findings locally, nationally, or internationally 14.28 10.63 38 Evaluate impact of CNS and nursing practice on systems of care 14.27 10.17 79 Precept graduate nursing students 14.17 9.39 30 Serve as content expert for legal and/or health policy issues 13.55 9.83 46 Analyze fiscal and budgetary implications of practice and system modifications 13.51 10.63 31 Serve as content expert in the development of population specific documentation systems 13.48 10.14 78 Coach others in creating presentations and generating publications 13.33 10.57 58 Assist in the mobilization of organizational resources for local, state, and national emergencies 12.63 11.90 80 Precept new clinical nurse specialists to the role 12.59 7.74

104 Interact with an institutional review board 11.71 10.76 47 Analyze programs, processes and technologies based on business and economic principles 11.48 9.93

103 Apply for grants or local/organizational research funding 8.67 8.00 Grey shading represent work activities that received criticality rankings less than 12.


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Appendix A Work Activities Statements

2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved

Task List for Final Survey

I. Direct Care 1. Perform a comprehensive, holistic, age-appropriate assessment using advanced assessment techniques 2. Perform a problem-focused assessment and examination (e.g., functional assessment, physical assessment) 3. Assess the effects of interactions among the patient, family, community, social systems, and physical environment on

health and illness 4. Interprets values/results of laboratory and diagnostic tests with consideration of age, ethnicity, and health status 5. Formulate differential diagnoses 6. Prioritize health problems/needs in collaboration with patient and family, nurse and interdisciplinary team 7. Evaluate the impact of health care delivery options on the plan of care and treatment choices 8. Collaborate with the patient, family and interprofessional team to develop plan of care to achieve desired outcomes 9. Design strategies and therapies to meet the multifaceted needs of the complex patient or a population 10. Prescribe pharmacologic therapies 11. Prescribe non-pharmacologic therapies (e.g., wound care, behavioral therapies, physical therapies) 12. Prescribe durable medical equipment (DME) 13. Prescribe diagnostic and laboratory tests 14. Assist patient and family with making decisions regarding palliative care and/or end-of-life care 15. Provide case management and/or coordination of care 16. Perform advanced clinical procedures (e.g., complex wound management, vascular access management) 17. Employ evidence-based clinical practice guidelines to guide prevention, screening, diagnosis and treatment 18. Provide education for patient and/or family with complex learning needs 19. Provide anticipatory guidance and/or health promotion counseling 20. Provide psychosocial support for patient and/or family with complex emotional needs 21. Refer patient and family to other health care professionals and community resources 22. Evaluate the plan of care based on patient and family response 23. Modify the plan of care based on patient and family response 24. Initiate interprofessional care conferences and/or consultations 25. Facilitate integrated care for the patient and family across the continuum 26. Document in accordance with regulatory requirements

II. Consultation 27. Serve as content expert for patient and family advocacy groups 28. Serve as content expert for nursing orientation, nurse residency or internship programs 29. Serve as content expert for professional practice 30. Serve as content expert for legal and/or health policy issues 31. Serve as content expert in the development of population specific documentation systems 32. Provide consultation to develop population-specific educational programs 33. Provide consultation to develop methods to evaluate outcomes of educational interventions 34. Provide consultation in the development of population specific interprofessional guidelines for care 35. Provide consultation in performance improvement/quality initiatives 36. Provide consultation in the analysis of patient acuity levels and safe staffing 37. Disseminate consultation findings to stakeholders

III. Systems A. Leadership 38. Evaluate impact of CNS and nursing practice on systems of care 39. Identify opportunities for practice changes and improvements based on benchmarks 40. Conduct audits to identify gaps in the system that affect patient care delivery 41. Design population specific programs/innovative models of practice across the continuum of care 42. Implement population specific programs/innovative models of practice across the continuum of care 43. Evaluate population specific programs/innovative models of practice across the continuum of care

Appendix A– Work Activities Statements A-2 2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved


44. Promote compliance with regulatory (i.e. local, state, federal), accreditation (e.g. Magnet, The Joint Commission) and

professional standards 45. Promote a supportive and healthy work environment (e.g. team development, conflict resolution, respect, accountability,

civility, Just Culture) 46. Analyze fiscal and budgetary implications of practice and system modifications 47. Analyze programs, processes and technologies based on business and economic principles 48. Analyze the impact of physical environment (e.g., equipment access, room/unit design) and system factors on patient

care delivery 49. Facilitate integration of organizational mission, goals, and systems in patient care practices 50. Perform system level assessments to identify variables that influence nursing practice and outcomes 51. Promote innovative systems thinking among the health care team 52. Analyze the impact of social, political, regulatory and economic forces on the delivery of care 53. Provide input into the design of information systems 54. Provide support for the use of information systems related to the delivery of care across the continuum 55. Evaluate the impact of information systems on the delivery of patient care 56. Use information technologies to enhance patient care 57. Evaluate impact of introduction or withdrawal of products, services, or technologies 58. Assist in the mobilization of organizational resources for local, state, and national emergencies 59. Assist in accreditation and credentialing initiatives 60. Assist in staff recognition initiatives 61. Serve on committees, councils, or administrative teams 62. Promote system-wide policies and protocols 63. Develops and maintains age- and population-specific clinical standards, algorithms, policies, procedures, protocols, and

guidelines

B. Quality and Safety 64. Collect data for submission to appropriate national data bases 65. Facilitate review (e.g., root cause analysis, sentinel event analysis, FMEA) of patient safety issues to identify the need for

a quality improvement initiative 66. Facilitate an interprofessional approach to quality improvement 67. Formulate evidence-based recommendations to improve quality care and practice based on an analysis of quality data. 68. Implement initiatives to address unit, department, system, program, or population quality improvement priorities 69. Disseminate data relative to quality improvement initiatives (e.g., dash board, report card)

C. Outcomes 70. Facilitate the development of outcome measures 71. Identify outcomes with consideration of the associated risks, benefits, and costs for the patient and family 72. Differentiate between outcomes that require care process modification at the individual patient level and those that

require modification at the system level – 73. Integrate organizational science and informatics to make changes in the care environment to improve health outcomes 74. Manage change initiatives to improve outcomes 75. Disseminate outcomes of system-level change internally and externally

IV. Coaching/Education 76. Coach patient and family to navigate the healthcare system 77. Coach colleagues in team building 78. Coach others in creating presentations and generating publications 79. Precept graduate nursing students 80. Precept new clinical nurse specialists to the role 81. Mentor professional colleagues (e.g., nurses, administrators, physicians, therapist)



82. Serve as a role model to colleagues, patients, families, community 83. Provide feedback and evaluation of others 84. Design health information and population–specific education 85. Provide community based education 86. Provide direct education to nurses or other health care professionals 87. Facilitate continuing education and professional development of nurses and other health care professionals 88. Perform a learning needs assessment 89. Mentor professional colleagues through the process of quality improvement 90. Mentor professional colleagues through research utilization and evidence-based practice.

V. Collaboration 91. Establish collaborative relationships within and across roles/providers, departments, organization, networks, and/or

agencies. 92. Establish collaborative relationships with academic partners (e.g., faculty, schools of nursing). 93. Partner with leadership to establish patient care provider competencies and evaluation of practice. 94. Facilitate interprofessional, intra-agency and inter-agency collaborations for transitioning care 95. Evaluate the effectiveness of interprofessional, intra-agency, and inter-agency collaboration 96. Engage in formal self-evaluation seeking feedback regarding own practice, from patients, peers, professional colleagues

and others

VI. Evidence-based Practice and Research 97. Promote scholarly inquiry (e.g., journal club, research grand rounds, and research article review) 98. Identify clinical problems amenable to scholarly inquiry 99. Identify barriers and facilitators in the adoption of evidence-based practices. 100. Incorporate evidence into clinical practice (e.g., clinical decision-making, policies and procedures/protocols, standards,

guidelines, products and technologies) 101. Analyze all sources of evidence for application to nursing practice 102. Conduct a study/investigation to evaluate new products, technologies, and techniques 103. Apply for grants or local/organizational research funding 104. Interact with an institutional review board 105. Serve as a team member on a research or evidenced based practice project (e.g., obtaining consent, collecting data,

literature review, developing proposal, analyzing data) 106. Establish collaborative relationships with nurse scientists 107. Protect the rights of all participants involved in research. 108. Communicate evidence based practice guidelines to the interprofessional team 109. Disseminate evidence-based practice and/or research findings locally, nationally, or internationally

VII. Ethical Decision-making, Moral Agency and Advocacy 110. Advocate for the patient and/or family when there is concern about abuse, neglect or other forms of violence 111. Advocate for patient care issues at the organizational, state or national level 112. Advocate for the moral and legal rights of patients, families, groups and communities 113. Advocate for nurses to practice to the full extent of their education and scope of practice 114. Advocate for the nursing profession to internal and external policy makers and stakeholders 115. Advocate for a process of ongoing ethical inquiry into patient care practices 116. Promote a practice climate conducive to providing ethical care 117. Promote professional accountability in self and others 118. Promote the role and scope of practice of the CNS to legislators, regulators, other health care providers and the public 119. Facilitate patient, family, and healthcare team understanding of the ethical concerns, risks, benefits, and outcomes of

proposed healthcare regimen to promote informed decision making 120. Identify ethical implications of complex care situations, e.g. use of technology and end of life care 121. Identify system-specific ethical and/or moral dilemmas



122. Address patient-specific ethical and/or moral dilemmas 123. Address health care provider-specific ethical and/or moral dilemmas 124. Evaluate the impact of scientific advances, cost, clinical effectiveness, patient/family values and preferences, and other

external influences on patient care delivery


Appendix B Demographic Data Summary


1. Primary Place of Work Adult Health CNS Gerontological CNS

Recruitment Counts

(Percents)

Respondents Counts

(Percents)

Recruitment Counts

(Percents)

Respondents Counts

(Percents) Northeast 71 (12.70) 18 (12.77) 125 (22.36) 32 (21.48) South 201 (35.96) 40 (28.37) 155 (27.73) 38 (25.50) Midwest 227 (40.61) 61 (43.26) 206 (36.85) 62 (41.61) West 58 (10.38) 21 (14.89) 73 (13.06) 17 (11.41) Other 2 (0.36) 1 (0.71) 0 (0.00) 0 (0.00) Total 559 (100.00) 141 (100.00) 559 (100.00) 149 (100.00)

2. What is your gender? Count Percent Female 280 96.89 Male 9 3.11 Total 289 100.00 Missing 1

3. What is your age? Count Percent Under 25 years old 0 0.00 25 - 34 years old 15 5.19 35 - 44 years old 41 14.19 45 - 54 years old 91 31.49 55 - 64 years old 115 39.79 65 and older 27 9.34 Total 289 100.00 Missing 1

Appendix B– Demographic Data Summary B-2 2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved

4. What is your race/ethnic background and Race? Count Percent Hispanic 2 0.71 Non-Hispanic 280 99.29 Total 282 100.00 Missing 8

Count Percent White 268 93.38 Black/African American 12 4.18 American Indian/Alaska Native 1 0.35 Asian or Pacific Islander 5 1.74 Two or More 1 0.35 Other 0 0.00 Total 287 100.00 Missing 3

5. Indicate the highest educational level you have completed: Count Percent Masters in Nursing 261 90.00 Masters in field other than Nursing 21 7.24 Post-Masters Certificate 8 2.76 Doctorate in Nursing Research (e.g., Ph.D., DNS, DSN) 16 5.52 Doctorate in Nursing Practice (DNP) 1 0.34 Doctorate in field other than Nursing 7 2.41 Other 12 4.14

Missing 1 *The percentage is computed using "Total = 290 "; however, the total counts are larger as this question asks the respondents to choose all that apply


6a. How many years of experience do you have as a registered nurse? Number of Years Count Percent 0 to 9 19 6.57 10 to 19 40 13.84 20 to 29 66 22.84 30 to 39 114 39.45 40 to 49 47 16.26 50 to 59 3 1.04 Total 289 100.00 Missing 1 Mean 29.23

6b. How many years of experience do you have practicing as a Clinical Nurse Specialist? Number of Years Count Percent 0 to 9 109 37.72 10 to 19 92 31.83 20 to 29 75 25.95 30 to 39 12 4.15 40 to 49 1 0.35 50 to 59 0 0.00

Total 289 100.00 Missing 1

Mean 13.49


7. Which one best characterizes your current clinical practice location(s)? Count Percent Rural (population less than 2,500) 4 1.39 Town (population between 2,500 - 49,999) 46 15.97 City (population between 50,000 - 249,999) 118 40.97 Metropolitan (population between 250,000 - 999,999) 66 22.92 Greater Metropolitan (population greater than 999,999) 52 18.06 National 2 0.69

Total 288 100.00 Missing 2


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8. Estimate the percentage of time (during an average week) that you provide health care for patients/clients in each of the age groups listed below. Infant Preschool School age Adolescent Adult (birth to 1 years) (2 to 4 years) (5 to 12 years) (13 to 17 years) (18 to 64 years)

Percent of Time Count Percent Count Percent Count Percent Count Percent Count Percent Below 1% 276 95.17 272 93.79 268 92.41 249 85.86 49 16.90 1% to 19% 13 4.48 17 5.86 21 7.24 39 13.45 60 20.69 20% to 39% 1 0.34 1 0.34 1 0.34 2 0.69 98 33.79 40% to 59% 0 0.00 0 0.00 0 0.00 0 0.00 53 18.28 60% to 79% 0 0.00 0 0.00 0 0.00 0 0.00 17 5.86 80% to 100% 0 0.00 0 0.00 0 0.00 0 0.00 13 4.48 Total 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00 Infant Preschool School age Adolescent Adult (birth to 1 years) (2 to 4 years) (5 to 12 years) (13 to 17 years) (18 to 64 years)

Mean percent of time spent with each age group 0.25 0.30 0.46 0.79 26.72

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8. Estimate the percentage of time (during an average week) that you provide health care for patients/clients in each of the age groups listed below. Young-Old Middle-Old Oldest-Old (65 to 74 years) (75 to 84 years) (85 years and older) Percent of Time Count Percent Count Percent Count Percent 0% 15 5.17 3.79 3.79 24 8.28 1% to 19% 39 13.45 22.07 22.07 140 48.28 20% to 39% 177 61.03 55.86 55.86 90 31.03 40% to 59% 52 17.93 15.52 15.52 24 8.28 60% to 79% 7 2.41 2.41 2.41 8 2.76 80% to 100% 0 0.00 0.34 0.34 4 1.38 Total 290 100.00 290 100.00 290 100.00 Young-Old Middle-Old Oldest-Old (65 to 74 years) (75 to 84 years) (85 years and older)

Mean percent of time spent with each age group 27.05 25.80 18.63

9. What is your primary patient/client base? (Select all that apply) Count Percent Well Patients 36 12.41 Maternity Patients 2 0.69 Patients with Acute Conditions 180 62.07 Patients with Chronic Conditions 231 79.66 Terminally Ill Patients 106 36.55 Patients with Behavioral/Emotional/Psychiatric Disorders 86 29.66 Patients with Geriatric Syndromes 153 52.76 Others 34 11.72

10. Which best describes your current primary employment setting? Count Percent Armed Forces 8 2.76 Community/Public Health (city/county/state/federal agency) 10 3.45 Home Health Care 13 4.48 Hospice/Palliative Care 23 7.93 Hospital, Inpatient 145 50.00 Managed Care (HMO, PPO, IPA) 8 2.76 Medical School 7 2.41 Not-for-Profit Clinic 5 1.72 Occupational Health 2 0.69 Outpatient 51 17.59 Owned Practice (group) 45 15.52 Owned Practice (solo) 3 1.03 Private Medical Practice 15 5.17 Rural Health Clinic 6 2.07 Skilled Nurse/Subacute/Long-Term Care 8 2.76 School or College Health 7 2.41 University School or College of Nursing 48 16.55 VA 21 7.24 Other 23 7.93 *The percentage is computed using "Total = 290 "; however, the total counts are larger as this question asks the respondents to choose all that apply

*The percentage is computed using "Total = 290 "; however, the total counts are larger as this question asks the respondents to choose all that apply


11. Do you have prescriptive authority for:

Count Percent a) medications in your current practice 118 40.69 b) controlled substance 94 32.41

c) non-pharmacologic interventions (e.g., wound care, durable medical equipment) 122 42.07

12. Consider the care you provided within the past year. Estimate the percent of patient cases for which you prescribed/managed medications within each of these drug agent categories.

Number/Percent of Respondents Who

Prescribed or Managed Medications within the Drug Agent Category during one or more percent of patient

visits Count Percent Antiinfective agents 125 43.10 Antineoplastic agents 28 9.66 Cardiovascular agents 104 35.86 Endocrine agents 83 28.62 Eye, ear, and skin agents 96 33.10 Gastrointestinal agents 102 35.17 Genitourologic agents 78 26.90 Immunologic agents 46 15.86 Musculoskeletal agents 96 33.10 Neurologic agents 88 30.34 Psychiatric agents 93 32.07 Respiratory agents 86 29.66

13. Are you required to have:

Count Percent a) a physician collaborator/supervisor for your practice 158 54.48

b) a physician collaborator/supervisor for your prescriptive practice only 59 20.34


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14. Approximately what percentage of your average week is spent in each of the following activities?

Quality Improvement and Direct Research/Evidence-based Consultation/ Education/ Risk Assessment Administrative or patient care Practice Collaboration Coaching (Systems Leadership) Supervisory Percent of Time Count Percent Count Percent Count Percent Count Percent Count Percent Count Percent 0% 43 14.83 74 25.52 24 8.28 27 9.31 85 29.31 148 51.03 1% to 19% 91 31.38 177 61.03 155 53.45 135 46.55 146 50.34 100 34.48 20% to 39% 44 15.17 33 11.38 88 30.34 85 29.31 49 16.90 22 7.59 40% to 59% 33 11.38 2 0.69 12 4.14 23 7.93 6 2.07 11 3.79 60% to 79% 41 14.14 3 1.03 2 0.69 17 5.86 2 0.69 7 2.41 80% to 100% 38 13.10 1 0.34 9 3.10 3 1.03 2 0.69 2 0.69 Total 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00

Quality Improvement

and Direct Research/Evidence-based Consultation/ Education/ Risk Assessment Administrative or patient care Practice Collaboration Coaching (Systems Leadership) Supervisory Mean percent of time spent with each activity 33.49 8.92 16.96 15.10 9.89 8.50

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14. Approximately what percentage of your average week is spent in each of the following activities? (Continued)

Other Percent of Time Count Percent 0% 251 86.55 1% to 19% 31 10.69 20% to 39% 4 1.38 40% to 59% 4 1.38 60% to 79% 0 0.00 80% to 100% 0 0.00 Total 290 100.00

Other Mean percent of time spent with each activity 1.80

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15. On average, what percentage of your patient visits are pertaining to conditions related to each of the body systems listed below.

Head, Eyes, Ears Respiratory Cardiovascular Gastrointestinal Genitourinary and Musculoskeletal Nose and Throat System System System Reproductive Systems System

Percent of Time Count Percent Count Percent Count Percent Count Percent Count Percent Count Percent

Below 1% 185 63.79 102 35.17 83 28.62 118 40.69 166 57.24 121 41.72 1% to 19% 95 32.76 107 36.90 72 24.83 130 44.83 107 36.90 115 39.66 20% to 39% 7 2.41 72 24.83 91 31.38 28 9.66 12 4.14 34 11.72 40% to 59% 0 0.00 7 2.41 14 4.83 6 2.07 1 0.34 9 3.10 60% to 79% 0 0.00 0 0.00 7 2.41 1 0.34 2 0.69 2 0.69 80% to 100% 2 0.69 2 0.69 23 7.93 7 2.41 2 0.69 9 3.10

Total 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00

Head, Eyes, Ears Respiratory Cardiovascular Gastrointestinal Genitourinary and Musculoskeletal Nose and Throat System System System Reporductive Systems System

Mean percent of time spent treating conditions within each body system 5.15 12.87 19.10 9.01 6.10 13.50

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13. On average, what percentage of your patient visits are pertaining to conditions related to each of the body systems listed below. (Continued) Endocrine System Neurological (including metabolic Hematopoietic Immune Integumentary System disorders) System System System Percent of Time Count Percent Count Percent Count Percent Count Percent Count Percent 0% 107 36.90 139 47.93 202 69.66 197 67.93 143 49.31 1% to 19% 115 39.66 117 40.34 83 28.62 88 30.34 104 35.86 20% to 39% 28 9.66 23 7.93 5 1.72 2 0.69 19 6.55 40% to 59% 13 4.48 6 2.07 0 0.00 2 0.69 8 2.76 60% to 79% 3 1.03 2 0.69 0 0.00 0 0.00 4 1.38 80% to 100% 24 8.28 3 1.03 0 0.00 1 0.34 12 4.14 Total 290 100.00 290 100.00 290 100.00 290 100.00 290 100.00

Endocrine System Neurological (including metabolic Hematopoietic Immune Integumentary System disorders) System System System Mean percent of time spent treating conditions within each body system 11.79 6.28 1.87 4.94 9.91

16. Are your services billed for reimbursement? Count Percent Yes, they are billed directly 67 23.59 Yes, they are billed under another provider 43 15.14 No, my services are not billed for reimbursement 174 61.27 Total 284 100.00 Missing 6

17. Do you have staff privileges to admit/discharge patients/clients from a facility? Count Percent Yes 39 13.59 No 248 86.41 Total 287 100.00 Missing 3


Appendix C Work Activities Descriptive Statistics


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Adult-Gerontology Clinical Nurse Specialist

Survey Order

Performance Expectation Consequence Frequency Overall Rank

N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev


290 1.87 0.37 2 1.81 0.86 2 3.17 0.81 3 31.79 8.77


290 1.93 0.25 2 1.94 0.84 2 3.30 0.70 3 33.61 7.09


290 1.83 0.38 2 1.46 0.81 2 3.22 0.73 3 29.15 9.08


290 1.87 0.36 2 2.19 0.84 2 3.27 0.78 3 33.66 8.75

5 Formulate differential diagnoses 290 1.65 0.61 2 1.89 0.92 2 2.83 1.10 3 27.97 12.26


290 1.90 0.31 2 1.67 0.79 2 3.36 0.64 3 31.62 7.82

7 Evaluate the impact of health care delivery options on the plan of care and treatment choices

290 1.73 0.45 2 1.52 0.81 2 3.04 0.81 3 27.28 10.36


290 1.92 0.28 2 1.61 0.79 2 3.46 0.68 4 31.83 7.00

9 Design strategies and therapies to meet the multifaceted needs of the complex patient or a population

290 1.52 0.52 2 1.76 0.81 2 3.01 0.79 3 24.34 11.33

10 Prescribe pharmacologic therapies 290 1.02 0.89 1 2.09 1.24 3 1.80 1.53 2 19.36 16.69

11 Prescribe non-pharmacologic therapies (e.g., wound care, behavioral therapies, physical therapies)

290 1.61 0.68 2 1.68 0.89 2 2.57 1.18 3 26.65 12.42

12 Prescribe durable medical equipment (DME) 290 1.19 0.89 2 1.19 0.97 1 1.76 1.40 2 18.32 14.48

13 Prescribe diagnostic and laboratory tests 290 1.18 0.89 2 1.65 1.12 2 2.03 1.50 3 20.50 15.76

14 Assist patient and family with making decisions regarding palliative care and/or end-of-life care

290 1.64 0.55 2 1.62 0.91 2 2.47 0.93 2 25.90 11.29

15 Provide case management and/or coordination of care 290 1.69 0.55 2 1.43 0.85 2 2.77 1.00 3 26.54 11.05

Performance expectation response options: 0 = never, 1 = after first 6 months, 2 = within the first 6 months; Consequences response option: 0 = little or no harm, 1 = mild harm, 2 = moderate harm, 3= severe harm; Frequency response options: 0 = never, 1 = seldom, 2 = occasionally, 3 = often, 4 = frequently

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N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

16 Perform advanced clinical procedures (e.g., complex wound management, vascular access management)

290 1.09 0.74 1 1.94 1.06 2 1.74 1.22 2 18.20 13.42

17 Employ evidence-based clinical practice guidelines to guide prevention, screening, diagnosis and treatment

290 1.84 0.40 2 1.81 0.92 2 3.45 0.75 4 31.41 9.18

18 Provide education for patient and/or family with complex learning needs

290 1.90 0.31 2 1.63 0.84 2 3.23 0.80 3 31.46 7.45

19 Provide anticipatory guidance and/or health promotion counseling 290 1.81 0.45 2 1.28 0.81 1 2.93 0.93 3 28.03 9.25 20 Provide psychosocial support for patient and/or family with complex

emotional needs 290 1.81 0.42 2 1.48 0.82 2 2.99 0.91 3 28.80 9.22

21 Refer patient and family to other health care professionals and community resources

290 1.76 0.50 2 1.28 0.87 1 2.71 0.97 3 26.80 10.22

22 Evaluate the plan of care based on patient and family response 290 1.91 0.29 2 1.52 0.88 2 3.39 0.71 3.5 31.11 7.80

23 Modify the plan of care based on patient and family response 290 1.89 0.32 2 1.59 0.87 2 3.26 0.75 3 30.95 8.30

24 Initiate interprofessional care conferences and/or consultations 290 1.45 0.58 1 1.30 0.84 1 2.40 0.99 2 20.62 11.86

25 Facilitate integrated care for the patient and family across the continuum

290 1.58 0.55 2 1.38 0.84 1 2.76 0.90 3 23.83 11.21

26 Document in accordance with regulatory requirements 290 1.99 0.10 2 2.13 1.01 2 3.84 0.45 4 36.29 5.48

27 Serve as content expert for patient and family advocacy groups 290 1.23 0.53 1 1.28 0.90 1 2.17 1.06 2 16.08 11.17

28 Serve as content expert for nursing orientation, nurse residency or internship programs

290 1.29 0.55 1 1.40 0.91 2 2.44 1.02 2 18.04 11.61

29 Serve as content expert for professional practice 290 1.27 0.49 1 1.60 0.94 2 2.60 1.04 3 18.31 11.37 30 Serve as content expert for legal and/or health policy issues 290 0.99 0.54 1 1.60 1.06 2 1.54 1.08 1 13.55 9.83 31 Serve as content expert in the development of population specific

documentation systems 290 1.08 0.52 1 1.31 0.93 1 1.74 1.05 2 13.48 10.14

32 Provide consultation to develop population-specific educational programs

290 1.26 0.52 1 1.25 0.82 1 2.12 0.92 2 16.25 10.90

33 Provide consultation to develop methods to evaluate outcomes of educational interventions

290 1.26 0.54 1 1.19 0.85 1 2.13 0.96 2 16.05 11.13


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N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

34 Provide consultation in the development of population specific interprofessional guidelines for care

290 1.19 0.51 1 1.34 0.89 1 2.05 0.99 2 15.49 10.56

35 Provide consultation in performance improvement/quality initiatives 290 1.37 0.54 1 1.43 0.84 2 2.57 0.91 3 19.57 11.55 36 Provide consultation in the analysis of patient acuity levels and safe

staffing 290 1.09 0.67 1 1.44 1.02 2 1.71 1.19 2 15.69 12.60

37 Disseminate consultation findings to stakeholders 290 1.28 0.60 1 1.37 0.96 2 2.18 1.16 2 17.92 12.38 38 Evaluate impact of CNS and nursing practice on systems of care 290 1.11 0.52 1 1.29 0.91 1 2.10 1.11 2 14.27 10.17

39 Identify opportunities for practice changes and improvements based on benchmarks

290 1.37 0.54 1 1.43 0.89 2 2.60 0.94 3 19.74 11.79

40 Conduct audits to identify gaps in the system that affect patient care delivery

290 1.28 0.60 1 1.37 0.92 1 2.22 1.05 2 18.07 11.81

41 Design population specific programs/innovative models of practice across the continuum of care

290 1.12 0.52 1 1.29 0.90 1 2.02 0.99 2 14.29 9.79

42 Implement population specific programs/innovative models of practice across the continuum of care

290 1.18 0.52 1 1.35 0.86 1 2.09 0.99 2 15.56 10.45

43 Evaluate population specific programs/innovative models of practice across the continuum of care

290 1.14 0.48 1 1.32 0.85 1 2.12 0.99 2 14.61 9.48

44 Promote compliance with regulatory (i.e. local, state, federal), accreditation (e.g. Magnet, The Joint Commission) and professional standards

290 1.76 0.46 2 2.03 0.97 2 3.35 0.89 4 30.92 11.10

45 Promote a supportive and healthy work environment (e.g. team development, conflict resolution, respect, accountability, civility, Just Culture)

290 1.77 0.47 2 1.74 0.95 2 3.39 0.89 4 29.77 10.67

46 Analyze fiscal and budgetary implications of practice and system modifications

290 1.03 0.59 1 1.27 0.98 1 1.86 1.16 2 13.51 10.63

47 Analyze programs, processes and technologies based on business and economic principles

290 0.95 0.58 1 1.10 0.93 1 1.55 1.12 2 11.48 9.93


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N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

48 Analyze the impact of physical environment (e.g., equipment access, room/unit design) and system factors on patient care delivery

290 1.31 0.63 1 1.31 0.92 1 2.06 1.16 2 18.57 12.86

49 Facilitate integration of organizational mission, goals, and systems in patient care practices

290 1.62 0.53 2 1.38 0.92 2 2.98 1.05 3 24.75 12.08

50 Perform system level assessments to identify variables that influence nursing practice and outcomes

290 1.23 0.56 1 1.35 0.90 1 2.23 1.07 2 16.89 11.31

51 Promote innovative systems thinking among the health care team 290 1.48 0.55 2 1.23 0.86 1 2.72 1.00 3 20.92 11.84

52 Analyze the impact of social, political, regulatory and economic forces on the delivery of care

290 1.20 0.56 1 1.13 0.88 1 2.11 1.10 2 15.24 10.78

53 Provide input into the design of information systems 290 1.21 0.58 1 1.21 0.94 1 1.90 1.03 2 15.60 11.81

54 Provide support for the use of information systems related to the delivery of care across the continuum

290 1.41 0.59 1 1.27 0.89 1 2.34 1.01 2 19.76 12.45

55 Evaluate the impact of information systems on the delivery of patient care

290 1.29 0.58 1 1.28 0.87 1 2.14 1.03 2 17.60 11.81

56 Use information technologies to enhance patient care 290 1.77 0.45 2 1.53 0.88 2 3.14 0.93 3 28.46 10.42

57 Evaluate impact of introduction or withdrawal of products, services, or technologies

290 1.37 0.63 1 1.36 0.87 2 2.24 1.13 2 19.84 12.45

58 Assist in the mobilization of organizational resources for local, state, and national emergencies

290 0.91 0.71 1 1.24 1.09 1 1.19 1.11 1 12.63 11.90

59 Assist in accreditation and credentialing initiatives 290 1.26 0.62 1 1.36 1.04 1 2.04 1.18 2 17.76 13.12

60 Assist in staff recognition initiatives 290 1.47 0.65 2 0.91 0.85 1 2.29 1.10 2 19.81 12.36

61 Serve on committees, councils, or administrative teams 290 1.69 0.50 2 1.22 0.91 1 2.94 0.98 3 25.30 11.29

62 Promote system-wide policies and protocols 290 1.61 0.55 2 1.60 0.94 2 3.01 1.04 3 25.91 12.44


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N Mean Std Dev

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Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

63 Develops and maintains age- and population-specific clinical standards, algorithms, policies, procedures, protocols, and guidelines

290 1.50 0.57 2 1.72 0.98 2 2.94 1.05 3 24.19 12.83

64 Collect data for submission to appropriate national data bases 290 1.29 0.70 1 1.29 0.97 1 2.01 1.22 2 18.64 13.40

65 Facilitate review (e.g., root cause analysis, sentinel event analysis, FMEA) of patient safety issues to identify the need for a quality improvement initiative

290 1.28 0.61 1 1.66 1.00 2 2.06 1.12 2 19.50 12.61

66 Facilitate an interprofessional approach to quality improvement 290 1.60 0.53 2 1.43 0.85 2 2.79 0.99 3 24.31 11.90

67 Formulate evidence-based recommendations to improve quality care and practice based on an analysis of quality data.

290 1.45 0.56 1 1.65 0.87 2 2.74 1.00 3 22.49 11.84

68 Implement initiatives to address unit, department, system, program, or population quality improvement priorities

290 1.43 0.57 1 1.48 0.89 2 2.53 0.97 3 21.26 12.13

69 Disseminate data relative to quality improvement initiatives (e.g., dash board, report card)

290 1.38 0.64 1 1.29 0.91 1 2.39 1.17 3 19.83 12.70

70 Facilitate the development of outcome measures 290 1.33 0.56 1 1.41 0.87 1.5 2.44 1.01 3 18.84 11.96 71 Identify outcomes with consideration of the associated risks,

benefits, and costs for the patient and family 290 1.46 0.56 1 1.58 0.85 2 2.64 1.02 3 22.11 12.46

72 Differentiate between outcomes that require care process modification at the individual patient level and those that require modification at the system level

290 1.27 0.55 1 1.48 0.85 2 2.46 1.05 3 18.12 11.52

73 Integrate organizational science and informatics to make changes in the care environment to improve health outcomes

290 1.16 0.60 1 1.30 0.84 1 2.09 1.15 2 15.58 11.36

74 Manage change initiatives to improve outcomes 290 1.41 0.57 1 1.52 0.85 2 2.64 1.00 3 21.27 12.12 75 Disseminate outcomes of system-level change internally and

externally 290 1.18 0.59 1 1.21 0.83 1 2.12 1.11 2 15.43 11.07

76 Coach patient and family to navigate the healthcare system 290 1.81 0.44 2 1.48 0.90 2 2.95 0.94 3 28.79 10.02

77 Coach colleagues in team building 290 1.49 0.55 2 1.23 0.87 1 2.66 1.00 3 21.04 12.33 78 Coach others in creating presentations and generating publications 290 1.18 0.56 1 0.83 0.78 1 2.04 1.00 2 13.33 10.57


Appendix C

– Work A


C

-7 2012 R


dult-Gerontology C


National Survey R

esults

© C



enter, All R

ights Reserved



N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

79 Precept graduate nursing students 290 1.12 0.44 1 1.37 0.91 1 2.16 0.92 2 14.17 9.39

80 Precept new clinical nurse specialists to the role 290 1.00 0.42 1 1.45 0.94 2 1.93 0.99 2 12.59 7.74

81 Mentor professional colleagues (e.g., nurses, administrators, physicians, therapist)

290 1.15 0.48 1 1.26 0.89 1 2.22 0.94 2 14.43 9.99

82 Serve as a role model to colleagues, patients, families, community 290 1.81 0.39 2 1.62 0.94 2 3.56 0.72 4 29.92 10.26 83 Provide feedback and evaluation of others 290 1.49 0.52 1.5 1.38 0.84 1 2.64 0.95 3 21.53 11.77

84 Design health information and population–specific education 290 1.42 0.57 1 1.36 0.86 1 2.35 0.95 2 20.24 12.01

85 Provide community based education 290 1.34 0.62 1 1.18 0.82 1 1.94 0.97 2 18.05 11.69

86 Provide direct education to nurses or other health care professionals 290 1.64 0.52 2 1.58 0.87 2 2.80 0.85 3 25.80 11.63

87 Facilitate continuing education and professional development of nurses and other health care professionals

290 1.47 0.56 1 1.30 0.86 1 2.61 0.94 3 20.96 11.83

88 Perform a learning needs assessment 290 1.64 0.58 2 1.28 0.90 1 2.43 1.00 2 24.55 11.87 89 Mentor professional colleagues through the process of quality

improvement 290 1.17 0.53 1 1.24 0.86 1 2.22 1.00 2 15.12 10.61

90 Mentor professional colleagues through research utilization and evidence-based practice.

290 1.29 0.54 1 1.35 0.87 1 2.31 0.96 2 17.67 11.56

91 Establish collaborative relationships within and across roles/providers, departments, organization, networks, and/or agencies.

290 1.72 0.46 2 1.62 0.92 2 3.31 0.78 3 27.92 10.95

92 Establish collaborative relationships with academic partners (e.g., faculty, schools of nursing).

290 1.28 0.55 1 1.13 0.84 1 2.34 1.05 2 16.51 11.54

93 Partner with leadership to establish patient care provider competencies and evaluation of practice.

290 1.31 0.58 1 1.45 0.90 2 2.52 1.09 3 19.06 12.24

94 Facilitate interprofessional, intra-agency and inter-agency collaborations for transitioning care

290 1.41 0.55 1 1.42 0.90 1 2.39 1.02 2 20.19 12.62


Appendix C

– Work A


C

-8 2012 R


dult-Gerontology C


National Survey R

esults

© C



enter, All R

ights Reserved



N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

95 Evaluate the effectiveness of interprofessional, intra-agency, and inter-agency collaboration

290 1.14 0.56 1 1.23 0.91 1 2.04 1.11 2 14.78 10.73

96 Engage in formal self-evaluation seeking feedback regarding own practice, from patients, peers, professional colleagues and others

290 1.72 0.48 2 1.57 1.02 2 3.03 0.95 3 27.48 11.97

97 Promote scholarly inquiry (e.g., journal club, research grand rounds, and research article review)

290 1.48 0.60 2 1.08 0.88 1 2.45 1.03 2 20.44 12.59

98 Identify clinical problems amenable to scholarly inquiry 290 1.52 0.58 2 1.12 0.88 1 2.46 0.98 2 21.25 12.49

99 Identify barriers and facilitators in the adoption of evidence-based practices.

290 1.58 0.55 2 1.35 0.90 1 2.62 0.96 3 23.44 12.14

100 Incorporate evidence into clinical practice (e.g., clinical decision-making, policies and procedures/protocols, standards, guidelines, products and technologies)

290 1.79 0.41 2 1.77 0.91 2 3.28 0.81 3 30.05 10.49

101 Analyze all sources of evidence for application to nursing practice 290 1.60 0.54 2 1.52 0.89 2 2.86 0.95 3 24.98 12.02

102 Conduct a study/investigation to evaluate new products, technologies, and techniques

290 1.13 0.56 1 1.27 0.89 1 1.83 0.97 2 14.70 10.87

103 Apply for grants or local/organizational research funding 290 0.87 0.52 1 0.83 0.85 1 1.23 0.92 1 8.67 8.00

104 Interact with an institutional review board 290 1.03 0.61 1 0.96 0.93 1 1.37 0.94 1 11.71 10.76

105 Serve as a team member on a research or evidenced based practice project (e.g., obtaining consent, collecting data, literature review, developing proposal, analyzing data)

290 1.27 0.61 1 1.11 0.90 1 1.85 0.97 2 16.38 12.06

106 Establish collaborative relationships with nurse scientists 290 1.23 0.66 1 0.78 0.82 1 1.76 1.12 2 14.54 11.70

107 Protect the rights of all participants involved in research. 290 1.64 0.60 2 1.98 1.13 2 3.08 1.38 4 28.84 13.11

108 Communicate evidence based practice guidelines to the interprofessional team

290 1.63 0.56 2 1.49 0.91 2 2.80 1.09 3 25.58 12.44

109 Disseminate evidence-based practice and/or research findings locally, nationally, or internationally

290 1.14 0.56 1 1.20 0.94 1 1.81 1.04 2 14.28 10.63


Appendix C

– Work A


C

-9 2012 R


dult-Gerontology C


National Survey R

esults

© C



enter, All R

ights Reserved



N Mean Std Dev

Med-ian Mean

Std Dev

Med- ian Mean

Std Dev

Med- ian Mean

Std Dev

110 Advocate for the patient and/or family when there is concern about abuse, neglect or other forms of violence

290 1.92 0.29 2 2.44 0.89 3 3.08 1.16 4 35.92 7.96

111 Advocate for patient care issues at the organizational, state or national level

290 1.31 0.61 1 1.46 0.97 2 2.10 1.17 2 19.02 13.03

112 Advocate for the moral and legal rights of patients, families, groups and communities

290 1.69 0.52 2 1.74 0.99 2 2.66 1.15 3 27.77 12.18

113 Advocate for nurses to practice to the full extent of their education and scope of practice

290 1.66 0.55 2 1.61 0.94 2 2.82 1.14 3 26.81 11.89

114 Advocate for the nursing profession to internal and external policy makers and stakeholders

290 1.38 0.61 1 1.31 0.96 1 2.19 1.20 2 19.52 12.73

115 Advocate for a process of ongoing ethical inquiry into patient care practices

290 1.58 0.57 2 1.66 0.98 2 2.57 1.21 3 25.22 12.78

116 Promote a practice climate conducive to providing ethical care 290 1.89 0.34 2 2.02 0.99 2 3.52 0.86 4 33.68 9.08

117 Promote professional accountability in self and others 290 1.94 0.26 2 2.10 0.98 2 3.75 0.65 4 35.26 7.82

118 Promote the role and scope of practice of the CNS to legislators, regulators, other health care providers and the public

290 1.36 0.62 1 1.38 0.96 1 2.22 1.21 2 19.63 12.70

119 Facilitate patient, family, and healthcare team understanding of the ethical concerns, risks, benefits, and outcomes of proposed healthcare regimen to promote informed decision making

290 1.68 0.50 2 1.78 0.95 2 2.89 1.03 3 27.75 11.80

120 Identify ethical implications of complex care situations, e.g. use of technology and end of life care

290 1.72 0.46 2 1.93 0.88 2 2.76 1.01 3 29.05 11.34

121 Identify system-specific ethical and/or moral dilemmas 290 1.57 0.53 2 1.83 0.96 2 2.45 1.08 2 25.26 12.34

122 Address patient-specific ethical and/or moral dilemmas 290 1.79 0.43 2 2.00 0.89 2 2.71 1.06 3 30.70 10.67

123 Address health care provider-specific ethical and/or moral dilemmas 290 1.67 0.52 2 1.93 0.93 2 2.47 1.09 2 27.96 11.78

124 Evaluate the impact of scientific advances, cost, clinical effectiveness, patient/family values and preferences, and other external influences on patient care delivery

290 1.34 0.56 1 1.54 0.91 2 2.40 1.06 2 19.68 12.06


Appendix D Work Activities Mean Overall Criticality – Rank Order


Adult-Gerontology Clinical Nurse Specialist Rank Order Overall Rank

N Mean Std Dev 26 Document in accordance with regulatory

requirements 290 36.29 5.48

110 Advocate for the patient and/or family when there is concern about abuse, neglect or other forms of violence

290 35.92 7.96

117 Promote professional accountability in self and others 290 35.26 7.82

116 Promote a practice climate conducive to providing ethical care

290 33.68 9.08


290 33.66 8.75


290 33.61 7.09


290 31.83 7.00


290 31.79 8.77


290 31.62 7.82

18 Provide education for patient and/or family with complex learning needs

290 31.46 7.45

17 Employ evidence-based clinical practice guidelines to guide prevention, screening, diagnosis and treatment

290 31.41 9.18

22 Evaluate the plan of care based on patient and family response

290 31.11 7.80

23 Modify the plan of care based on patient and family response

290 30.95 8.30

44 Promote compliance with regulatory (i.e. local, state, federal), accreditation (e.g. Magnet, The Joint Commission) and professional standards

290 30.92 11.10

122 Address patient-specific ethical and/or moral dilemmas

290 30.70 10.67

100 Incorporate evidence into clinical practice (e.g., clinical decision-making, policies and procedures/protocols, standards, guidelines, products and technologies)

290 30.05 10.49

82 Serve as a role model to colleagues, patients, families, community

290 29.92 10.26

45 Promote a supportive and healthy work environment (e.g. team development, conflict resolution, respect, accountability, civility, Just Culture)

290 29.77 10.67


290 29.15 9.08

120 Identify ethical implications of complex care situations, e.g. use of technology and end of life care

290 29.05 11.34

107 Protect the rights of all participants involved in research.

290 28.84 13.11

Appendix D– Work Activities Mean Overall Criticality – Rank Order D-2 2012 Role Delineation Study: Adult-Gerontology Clinical Nurse Specialist – National Survey Results © Copyright 2013 American Nurses Credentialing Center, All Rights Reserved


N Mean Std Dev 20 Provide psychosocial support for patient and/or family

with complex emotional needs 290 28.80 9.22

76 Coach patient and family to navigate the healthcare system

290 28.79 10.02

56 Use information technologies to enhance patient care 290 28.46 10.42

19 Provide anticipatory guidance and/or health promotion counseling

290 28.03 9.25

5 Formulate differential diagnoses 290 27.97 12.26 123 Address health care provider-specific ethical and/or

moral dilemmas 290 27.96 11.78

91 Establish collaborative relationships within and across roles/providers, departments, organization, networks, and/or agencies.

290 27.92 10.95

112 Advocate for the moral and legal rights of patients, families, groups and communities

290 27.77 12.18

119 Facilitate patient, family, and healthcare team understanding of the ethical concerns, risks, benefits, and outcomes of proposed healthcare regimen to promote informed decision making

290 27.75 11.80

96 Engage in formal self-evaluation seeking feedback regarding own practice, from patients, peers, professional colleagues and others

290 27.48 11.97

7 Evaluate the impact of health care delivery options on the plan of care and treatment choices

290 27.28 10.36

113 Advocate for nurses to practice to the full extent of their education and scope of practice

290 26.81 11.89

21 Refer patient and family to other health care professionals and community resources

290 26.80 10.22

11 Prescribe non-pharmacologic therapies (e.g., wound care, behavioral therapies, physical therapies)

290 26.65 12.42

15 Provide case management and/or coordination of care

290 26.54 11.05

62 Promote system-wide policies and protocols 290 25.91 12.44

14 Assist patient and family with making decisions regarding palliative care and/or end-of-life care

290 25.90 11.29

86 Provide direct education to nurses or other health care professionals

290 25.80 11.63

108 Communicate evidence based practice guidelines to the interprofessional team

290 25.58 12.44

61 Serve on committees, councils, or administrative teams

290 25.30 11.29

121 Identify system-specific ethical and/or moral dilemmas

290 25.26 12.34

115 Advocate for a process of ongoing ethical inquiry into patient care practices

290 25.22 12.78

101 Analyze all sources of evidence for application to nursing practice

290 24.98 12.02


Adult-Gerontology Clinical Nurse Specialist Rank Order

Overall Rank N Mean Std Dev

49 Facilitate integration of organizational mission, goals, and systems in patient care practices

290 24.75 12.08

88 Perform a learning needs assessment 290 24.55 11.87 9 Design strategies and therapies to meet the

multifaceted needs of the complex patient or a population

290 24.34 11.33

66 Facilitate an interprofessional approach to quality improvement

290 24.31 11.90

63 Develops and maintains age- and population-specific clinical standards, algorithms, policies, procedures, protocols, and guidelines

290 24.19 12.83

25 Facilitate integrated care for the patient and family across the continuum

290 23.83 11.21

99 Identify barriers and facilitators in the adoption of evidence-based practices.

290 23.44 12.14

67 Formulate evidence-based recommendations to improve quality care and practice based on an analysis of quality data.

290 22.49 11.84

71 Identify outcomes with consideration of the associated risks, benefits, and costs for the patient and family

290 22.11 12.46

83 Provide feedback and evaluation of others 290 21.53 11.77

74 Manage change initiatives to improve outcomes 290 21.27 12.12

68 Implement initiatives to address unit, department, system, program, or population quality improvement priorities

290 21.26 12.13

98 Identify clinical problems amenable to scholarly inquiry

290 21.25 12.49

77 Coach colleagues in team building 290 21.04 12.33

87 Facilitate continuing education and professional development of nurses and other health care professionals

290 20.96 11.83

51 Promote innovative systems thinking among the health care team

290 20.92 11.84

24 Initiate interprofessional care conferences and/or consultations

290 20.62 11.86

13 Prescribe diagnostic and laboratory tests 290 20.50 15.76

97 Promote scholarly inquiry (e.g., journal club, research grand rounds, and research article review)

290 20.44 12.59

84 Design health information and population–specific education

290 20.24 12.01

94 Facilitate interprofessional, intra-agency and inter-agency collaborations for transitioning care

290 20.19 12.62


Adult-Gerontology Clinical Nurse Specialist Rank Order

Overall Rank N Mean Std Dev

57 Evaluate impact of introduction or withdrawal of products, services, or technologies

290 19.84 12.45

69 Disseminate data relative to quality improvement initiatives (e.g., dash board, report card)

290 19.83 12.70

60 Assist in staff recognition initiatives 290 19.81 12.36

54 Provide support for the use of information systems related to the delivery of care across the continuum

290 19.76 12.45

39 Identify opportunities for practice changes and improvements based on benchmarks

290 19.74 11.79

124 Evaluate the impact of scientific advances, cost, clinical effectiveness, patient/family values and preferences, and other external influences on patient care delivery

290 19.68 12.06

118 Promote the role and scope of practice of the CNS to legislators, regulators, other health care providers and the public

290 19.63 12.70

35 Provide consultation in performance improvement/quality initiatives

290 19.57 11.55

114 Advocate for the nursing profession to internal and external policy makers and stakeholders

290 19.52 12.73

65 Facilitate review (e.g., root cause analysis, sentinel event analysis, FMEA) of patient safety issues to identify the need for a quality improvement initiative

290 19.50 12.61

10 Prescribe pharmacologic therapies 290 19.36 16.69 93 Partner with leadership to establish patient care

provider competencies and evaluation of practice. 290 19.06 12.24

111 Advocate for patient care issues at the organizational, state or national level

290 19.02 13.03

70 Facilitate the development of outcome measures 290 18.84 11.96

64 Collect data for submission to appropriate national data bases

290 18.64 13.40

48 Analyze the impact of physical environment (e.g., equipment access, room/unit design) and system factors on patient care delivery

290 18.57 12.86

12 Prescribe durable medical equipment (DME) 290 18.32 14.48

29 Serve as content expert for professional practice 290 18.31 11.37

16 Perform advanced clinical procedures (e.g., complex wound management, vascular access management)

290 18.20 13.42

72 Differentiate between outcomes that require care process modification at the individual patient level and those that require modification at the system level –

290 18.12 11.52

40 Conduct audits to identify gaps in the system that affect patient care delivery

290 18.07 11.81

85 Provide community based education 290 18.05 11.69



N Mean Std Dev 28 Serve as content expert for nursing orientation, nurse

residency or internship programs 290 18.04 11.61

37 Disseminate consultation findings to stakeholders 290 17.92 12.38

59 Assist in accreditation and credentialing initiatives 290 17.76 13.12 90 Mentor professional colleagues through research

utilization and evidence-based practice. 290 17.67 11.56

55 Evaluate the impact of information systems on the delivery of patient care

290 17.60 11.81

50 Perform system level assessments to identify variables that influence nursing practice and outcomes

290 16.89 11.31

92 Establish collaborative relationships with academic partners (e.g., faculty, schools of nursing).

290 16.51 11.54

105 Serve as a team member on a research or evidenced based practice project (e.g., obtaining consent, collecting data, literature review, developing proposal, analyzing data)

290 16.38 12.06

32 Provide consultation to develop population-specific educational programs

290 16.25 10.90

27 Serve as content expert for patient and family advocacy groups

290 16.08 11.17

33 Provide consultation to develop methods to evaluate outcomes of educational interventions

290 16.05 11.13

36 Provide consultation in the analysis of patient acuity levels and safe staffing

290 15.69 12.60

53 Provide input into the design of information systems 290 15.60 11.81

73 Integrate organizational science and informatics to make changes in the care environment to improve health outcomes

290 15.58 11.36

42 Implement population specific programs/innovative models of practice across the continuum of care

290 15.56 10.45

34 Provide consultation in the development of population specific interprofessional guidelines for care

290 15.49 10.56

75 Disseminate outcomes of system-level change internally and externally

290 15.43 11.07

52 Analyze the impact of social, political, regulatory and economic forces on the delivery of care

290 15.24 10.78

89 Mentor professional colleagues through the process of quality improvement

290 15.12 10.61

95 Evaluate the effectiveness of interprofessional, intra-agency, and inter-agency collaboration

290 14.78 10.73

102 Conduct a study/investigation to evaluate new products, technologies, and techniques

290 14.70 10.87



N Mean Std Dev 43 Evaluate population specific programs/innovative

models of practice across the continuum of care 290 14.61 9.48

106 Establish collaborative relationships with nurse scientists

290 14.54 11.70

81 Mentor professional colleagues (e.g., nurses, administrators, physicians, therapist)

290 14.43 9.99

41 Design population specific programs/innovative models of practice across the continuum of care

290 14.29 9.79

109 Disseminate evidence-based practice and/or research findings locally, nationally, or internationally

290 14.28 10.63

38 Evaluate impact of CNS and nursing practice on systems of care

290 14.27 10.17

79 Precept graduate nursing students 290 14.17 9.39

30 Serve as content expert for legal and/or health policy issues

290 13.55 9.83

46 Analyze fiscal and budgetary implications of practice and system modifications

290 13.51 10.63

31 Serve as content expert in the development of population specific documentation systems

290 13.48 10.14

78 Coach others in creating presentations and generating publications

290 13.33 10.57

58 Assist in the mobilization of organizational resources for local, state, and national emergencies

290 12.63 11.90

80 Precept new clinical nurse specialists to the role 290 12.59 7.74

104 Interact with an institutional review board 290 11.71 10.76

47 Analyze programs, processes and technologies based on business and economic principles

290 11.48 9.93

103 Apply for grants or local/organizational research funding

290 8.67 8.00


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Adult - Gerontology Clinical Nurse Specialist Role