Informing health policy to strengthen the clinical nurse specialist workforce: Insights from Canada
Notice bibliographique
Résumé
Abstract Background The role of advanced practice nurses is unevenly implemented, supported and deployed. In Canada, policy advancement in the regulation, education and funding of nurse practitioners (NPs) have resulted in significant role expansion and health system integration. In contrast, clinical nurse specialists (CNSs) have remained on the fringe of Canadian health care policy development with stagnant growth and consistent under-utilisation. In cardiovascular care, there is a pressing need to address the escalating workforce crisis while achieving improved outcomes and more sustainable health services. CNSs play a pivotal role to meet these objectives. We aimed to provide contemporary evidence to optimise the role of CNSs to support systems transformation and guide nursing practice. Methods We conducted a multi-method study guided by a knowledge mobilization approach and informed by an integrated knowledge translation approach. We aimed to (1) generate evidence to best support, retain and evaluate CNS roles, and (2) co-create stakeholder-informed policy recommendations and actionable strategies to guide a provincial CNS strategy. We conducted a survey of all CNSs in British Columbia (BC) to identify predictors of professional satisfaction and retention, and a qualitative study of the perspectives of senior leaders (e.g., chief nursing officers) on the enablers and facilitators of a fully optimised CNS workforce using an interpretive description approach to conduct the analysis. Results After completing an inventory of all CNS positions across the region, we successfully recruited 96 participants (90% of BC’s CNS workforce), mean age 45.5 years (SD=10.5), 92% women, with 90.5% reporting master’s or PhD academic preparation. Significant (p<0.05) predictors of satisfaction and retention included role clarity, optimisation, and organisational integration, access to orientation and professional development, and established partnerships and networks. We conducted in-depth interviews with 12 senior leaders. We identified the following themes in the analysis: (1) CNSs’ pivotal role to meet the pressing needs of patients and health systems, (2) challenges with role confusion and lack of standardised expectations, and (3) collective interest in collaborative policy to optimise the role. We produced a policy report that was endorsed by the Provincial Nursing and Allied Health Advisory Council with representation of the Ministry of Health Nursing Secretariat, and the CNS Association of BC. Conclusion The development of health policy will contribute to strengthening and sustaining the impact of CNSs in cardiovascular care and championing the role that advanced practice nurses play in meeting the rapidly evolving needs of patients and the current health and human resource crisis experiences across systems.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».