Informing health policy to strengthen the clinical nurse specialist workforce: Insights from Canada
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.027 | 0.009 |
| Scholarly communication | 0.009 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".