• advanced nursing practice;
  • advanced practice nursing;
  • clinical nurse specialist;
  • consultant nurse;
  • hospital setting;
  • nurse practitioner;
  • role;
  • scope of practice

Aim.  Evaluate the usefulness of the role of clinical nurse specialists and the content of their work by mapping their activities.

Background.  The clinical work of advanced practice nursing differs in different countries, and a clear picture is lacking on what exactly advanced practice nurses do.

Design.  Prospective exploratory study.

Method.  The setting of the study was the largest hospital in Iceland where over half of the country’s active nursing workforce are employed, including the only clinical nurse specialists. Of 19 clinical nurse specialists working at the hospital, 15 participated. Data were collected over seven days with a structured activity diary that lists 65 activities, classified into six roles and three domains. In 17 instances, the ‘role activities’ and ‘domain activities’ overlap and form 17 categories of practice. The clinical nurse specialists coded their activities at 15-minutes interval and could code up to four activities simultaneously. Daily, the clinical nurse specialists evaluated their clinical nurse specialist background.

Results.  The roles that occupied the greatest proportion of the clinical nurse specialists’ time were education, expert practice and ‘other’ activities, while the smallest proportions were in counselling, research and practice development. The domain they worked in most was the institutional domain, followed by the client/family domain and the clinical outcome management domain. All of the clinical nurse specialists reported working on two activities simultaneously, 11 of them on three activities and six on four activities. They self-assessed their background as clinical nurse specialists as being very useful.

Conclusion.  The activity diary is a useful tool for assessing the content of practice. Clinical nurse specialists spend too much time on activities related to the institution. Nurse managers are advised to provide clinical nurse specialists with ample time to develop the direct practice role in the client/family domain.

Relevance to clinical practice.  The development of advanced nursing practice requires that clinical nurse specialists take an active and visible part in direct patient care.