Nursing skill mix and nursing time: The roles of registered nurses and clinical nurse specialists

Objective: The roles of clinical nurse specialists (CNS) and registered nurses, while similar, should also be quite different, with the CNS functioning as an advanced practice nurse. Differences in roles can be partially explained and understood by examining the use of their time. Adjustments to skill mix usually involve using more plentiful but less-skilled workers, and there is a growing body of overseas research in this field. In contrast, little research has examined and compared the use of nursing time for the RN and CNS role, particularly in an Australian context. Comparing work activities enables employers to begin to answer the question: Are skilled nursing personnel being used effectively and efficiently? Design: A work-sampling study conducted over eight weeks. Data were analysed descriptively using SPSS, v.9. Setting: Six wards in a large private not-for-profit hospital. Main outcome measure: To determine whether there is a differentiation in the roles of CNS and RN by examining the percentage of time spent in 25 specific activities. Results: In some activities it is not possible to distinguish differences in the amount of time spent by RNs and CNSs. In other activities such as clerical, meetings and administration, CNSs are spending more time than anticipated. Consideration needs to be given to employing clerical staff to relieve the CNS of these non-clinical aspects. Conclusion: The study extends the understanding of the roles of registered nurses and clinical nurse specialists and provides a basis on which to begin to understand similarities and differences in their roles.