The development of the clinical nurse specialist in the United Kingdom.

Abstract

The phenomenon of the Clinical Specialist has been known in the USA since the 1960s. Interest in involving nurses with advanced (university) training in patient care has also developed in Europe. This is partially the result of the evolution that nursing has undergone in Europe. Specialisation in nursing has been expanding in many different ways in the United Kingdom. Some of these nurses have been criticised for following the medical model, where as others have been developing their nursing role and expertise. Much confusion and controversy still arises as to what should be the correct criteria for a Clinical Nurse Specialist and in which direction the role should progress. This article describes the situation in the United Kingdom. The changes that have taken place in recent years in British nursing are presented and the role of pressure groups and the reform attempts in specialist hospitals are sketched. Finally the author puts forward eleven key factors that have been identified as crucial to the development of Clinical Nurse Specialists. At present not many nurses in the United Kingdom meet all of these criteria and many lack the educational qualifications, and advanced training required to develop their role. Proposed new legislation and the continuing growth of university and higher education for nurses in the United Kingdom are seen as possible ways forward for improving the specialist nursing skills and care given by these experienced nurses.