Dimensions of clinical nurse specialist work in the UK
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Dimensions of clinical nurse specialist work in the UK

Alison Leary Macmillan senior lecturer, Oncology Department, University College London Hospitals (UCLH) NHS Foundation Trust
Heather Crouch Cancer services manager, UCLH NHS Foundation Trust
Anthony Lezard IT director, North London Cancer Network
Chris Rawcliffe Clinical nurse specialist, UCLH NHS Foundation Trust
Louise Boden Chief nurse, Corporate Nursing, UCLH NHS Foundation Trust
Alison Richardson Professor, Cancer and palliative nursing care, Florence Nightingale School of Nursing and Midwifery, Kings College London

Aim To model the work of clinical nurse specialists (CNSs) in the UK.

Method This article examines data mined as part of a national project. The Pandora™ database was initially collected on a Microsoft™ Office Access database and subsequently, a Structured Query Language database in several iterations from June 2006 to September 2008. Pandora™ recorded CNS activity as a series of events with eight dimensions to each event. Data from this were mined to examine the complexity of CNS work.

Results This study represents the work of 463 CNSs over 2,778 days in England, Scotland and Wales. Clinical work, including physical assessment, referral, symptom control and ‘rescue’ work, accounted for a large part of the CNS’s role. Administration was the second highest workload, with about half of these administrative tasks identified as being suitable for secretarial staff to undertake. Research, education and consultation accounted for less time. A significant proportion of the nurses’ clinical work is undertaken by telephone.

Conclusion CNSs in this study spent much of their time doing complex clinical work Payment by Results (Department of Health 2006) should recognise the work undertaken by CNSs, particularly that done on the telephone. Complex clinical work by CNSs takes place in many different contexts using a wide range of interventions. The role of the CNS is complex and diverse, making comparisons of it difficult. More research needs to be done in relation to quality, safety and efficiency.

Nursing Standard. 23, 15, 40-44. doi: 10.7748/ns2008.



Peer review

This article has been subject to double blind peer review