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

2. Transforming Roles

The Transforming Roles Clinical Nurse Specialist SLWG was established in summer 2018. The review followed the established Transforming Roles Methodology (see Annex A).

The Clinical Nurse Specialist SLWG was tasked:

• to provide strategic direction to the development and transformation of Clinical Nurse Specialist/Specialist Nurse Practitioner roles to meet the current and future needs of Scotland's health and care system;
• to provide an overarching forum to coalesce informal nursing role developments emerging from either policy or service imperatives to ensure nationally consistent, sustainable and progressive nursing roles and career pathways;
• to review the current Information Services Division (ISD) reporting categories to enable more consistent and accurate reporting of nurse specialist roles.

Clinical Nurse Specialists in Scotland mainly work across Levels 6 and 7 of the NHS Education for Scotland (2021) NMaHP Development Framework (see Figure 1 below). In light of this, the SLWG agreed to consider the role definition, competencies and scope of practice at Level 6 (Senior Practitioner) and Level 7 (Advanced Practitioner). The CNS SLWG worked in partnership with the Transforming Roles Advanced Nursing Practice Phase II SLWG to co-develop this report. A full list of contributors can be found at Annex M.

Figure 1: Clinical Nurse Specialists and Specialist Nurse Practitioner Roles Aligned to NES NMAHP Development Framework^[9]

Level 7 – Advanced Practitioner

• Advanced Practice (Nurses)
  • Advanced Clinical Nurse Specialist
  • Advanced Nurse Practitioner

Level 6 – Senior Practitioner

• Specialist Nurses
  • Clinical Nurse Specialist
  • Specialist Nurse Practitioner

Level 5 – Practitioner

• Practitioner
  • Staff Nurse

For Advanced Clinical Nurse Specialist Level 7, this document should be read in conjunction with the Transforming Nursing Roles Advanced Nursing Practice Phase I^[10] and Phase II publications.^[11] From the Advanced Nursing Practice work, a 'triangle of capability' has been developed to act as a high-level framework for supporting the transformation of these roles, and has therefore also been applied in the transformation of the CNS roles (see Figure 2).

Summary of key findings

• The CNS role has evolved over time and CNSs now work at a range of levels of practice of the NES NMaHP Development Framework, most commonly at Levels 6 and 7.
• At Level 6, Clinical Nurse Specialist and Nurse Practitioner roles could both be considered as 'specialist'. However, Nurse Practitioners tend to have a broader scope of practice relative to Clinical Nurse Specialists, who would be expected to have a deeper knowledge of their specialty.
• Clinical Nurse Specialists and Nurse Practitioners working at Advanced Practice level are collectively referred to as Advanced Practice (Nurses).
• The Advanced Clinical Nurse Specialist title should be specifically used to denote a Clinical Nurse Specialist role at Level 7, and to differentiate them from Level 7 Advanced Nurse Practitioners who are generalist (see Annex L).