Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland

1. Clinical Nurse Specialists: Key Issues

Clinical Nurse Specialists (CNSs) are an integral part of the workforce of NHS Scotland and the wider health and social care landscape across the public, independent and third sectors. The role involves delivering services and supporting people and families who require specialist care across hospital and community settings.^[1]

Clinical Nurse Specialists make a valuable contribution to health and social care in a range of ways, including:

• delivering services close to home;
• developing innovative service delivery frameworks;
• promoting seamless care across sectors;
• developing and implementing care plans;
• monitoring, reviewing and amending treatment plans of care for people with long-term conditions to prevent unrequired hospital admissions;
• helping other staff to develop new skills by providing education and training.^[2]

Within the NHS, a diverse array of job titles have emerged across the nursing workforce. Some of these lack clear demarcation from other roles and are not always aligned with education pathways or provision.^[3] This has been found to cause confusion to the public, employers and commissioners of services. A recent study reported 595 job titles in use from a review of 17,960 nurse specialist posts in the UK.^[4]

The most commonly used titles were identified as Clinical Nurse Specialist (CNS), Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. The study demonstrated that job titles tend to cluster at particular pay bands.

The Royal College of Nursing (RCN) has suggested that the rich diversity of clinical nurse specialist roles has emerged for a variety of reasons, including: growing nursing expertise linked to extended and expanded nursing roles; clinical developments leading to new opportunities; and changing service needs.^[5]

Within Scotland the roles of Clinical Nurse Specialist and Nurse Practitioner are well established in some specific areas. For the purpose of this paper we will refer to Nurse Practitioners as Specialist Nurse Practitioner, denoting Level 6 on the NHS Education for Scotland (NES) NMaHP Development Framework.^[6] In the last decade we have also seen development of the Advanced Nurse Practitioner role.^[7] An international overview of the development of specialist and advanced practice nursing may be found within guidelines published by the International Council of Nursing.^[8]

To improve national consistency within Scotland for Clinical Nurse Specialist and Specialist Practitioner Roles, the Chief Nursing Officer (CNO) commissioned a Short Life Working Group (SLWG) to review the role of the Clinical Nurse Specialist as part of the Transforming Roles Programme.