Clinical Nurse Specialists’ Role in Selecting & Using Knowledge to Improve Practice & Develop Practice-based Policies Designed to Promote Optimum Patient Outcomes

Full Report (PDF, 269 KB)

Dr. Joanne Profetto-McGrath (Principal Investigator)
Faculty of Nursing, University of Alberta

Dr. Anna Ehrenberg
Faculty of Nursing, University of Alberta

Susan Young
Capital Health Authority, Edmonton, Alberta

Wendy Hill
Capital Health Authority, Edmonton, Alberta

Main Messages


Clinical Nurse Specialists (CNSs) are advanced practice nurses with expert knowledge and skills in a specific area of practice (Canadian Nurses Association, 2003). The role of the CNS in the field of evidence-based practice has largely been ignored, in spite of the fact that it is pivotal to the facilitation of research into practice in the clinical setting. The published literature is limited in terms of how CNSs access and transfer research knowledge in making clinical decisions. Therefore, the purpose of this study was to identify and develop a preliminary understanding of the approaches utilized by CNSs to select and use research knowledge in their daily practice, with the long-term aim of developing concrete strategies for this group beyond obtaining and disseminating evidence.

The study comprised four phases over a two-year period, with final data synthesis ongoing. In Phase One, a telephone survey was developed and piloted based on the findings from our CNS pilot study (Profetto-McGrath, PI) conducted in 2004, and expert panel review. The developed survey tool included Likert-type questions (a scale of 1-5, ‘never’ to ‘very often’, in response to frequency of evidence use) as well as open-ended questions. Appendix A records the survey and Appendix B records the academic paper derived from the pilot study.

In Phase Two, the survey was completed by a telephone sample of 94 (75% response rate) CNSs across Alberta. This was the first known Canadian provincial survey to specifically target CNSs and their use of evidence. Our findings indicate that literature tailored to specialties and personal experiences are the most frequently accessed sources of evidence by CNSs. This evidence is then used most often to facilitate improvements in patient care. The most common reported facilitator for use and dissemination of research was communication skills, while the most common barrier reported was dealing with multiple roles. Implications for nursing practice include the need for further development of CNSs’ ability to retrieve, use and transfer knowledge to increase the uptake of research findings in nursing practice and ultimately improve patient care. Balancing multiple roles was reported to be the greatest challenge in using and disseminating research and so the role of the CNS needs to be more specific and well known to all health care professionals to maximize their potential, and minimize unnecessary demands placed on them.

While the naturalistic observations and related interviews with five CNSs in Phase Three have been completed, the results are still being reviewed and synthesized. Preliminary findings suggest that CNSs consistently use research to inform practice, something the healthcare system expects and needs from this role, especially in terms of developing EBP guidelines. CNSs appear to be well positioned to assist QI/QA departments in terms of clinical/patient needs, and are able to use this research to better inform practice/policy. We anticipate adding to our findings (and an addendum to this report) by the end of 2008.