Evidence for their effectiveness is limited

General practice p 706

The number and the roles of clinical nurse specialists continue to increase in many areas of health care, despite limited evidence about their use. Some see the role as a threat to generalist nurses1 or even to primary care physicians. Nevertheless, nurses now lead services, admit and discharge patients, make autonomous clinical decisions, and organise programmes of care.2 What do we know about the use of such nurses and about their effectiveness?

The largest group of specialist nurse roles, in both hospital and community settings, are Macmillan nurses, who provide palliative care, followed by specialist nurses in diabetes, asthma, stoma wound care, infection control, and HIV/AIDS.3 One more recent trend has been for clinical nurse specialists based in hospital to serve as liaison nurses to the community, providing care across organisational boundaries, particularly in chronic disease management. A database maintained at the University of Sheffield …