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The words clinical nurse specialist have been part of the nursing vocabulary for some time, but are these nurses specialized practitioners like many of us, or is there a larger role for them to play? This paper is a piece of reflective writing and is intended to further the debate concerning clinical nurse specialists The paper examines clinical nurse specialists from an intensive care unit perspective It looks at the intensive care unit and the wealth of under-utilized experience these environments contain The paper examines the existing and envisaged roles of clinical nurse specialists, their education and utilization, and also the difficulties that they are likely to face in their evolution, both from within the nursing profession and from outside it