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State nursing practice acts granting legal authority to advanced practice nurses vary widely, with many states not recognizing clinical nurse specialists (CNSs). This survey identified characteristics of registered nurses claiming the CNS title in California. A literature-based survey tool was designed, piloted, and distributed to 209,846 nurses in California, with instructions to return the survey if the recipient self-identified as a CNS. Among the 1061 respondents, 65% were prepared with a Master's in Nursing. Most CNSs practiced in hospitals, and patients were the most frequently listed clients. CNSs overwhelmingly identified their primary role as clinical expert. Major barriers to practice included lack of public recognition and legal recognition in nursing practice acts. Significant differences were found in most characteristics between graduate-prepared and nongraduate-prepared CNSs. Variability in practice and educational preparation is not only potentially confusing to other healthcare providers and the public, but it may not serve the best interests of CNS clients.

In 1993, California mandated a study of the practice characteristics of Clinical Nurse Specialists (CNSs) in the state. This report describes, compares and contrasts the demographic, practice and educational characteristics of a subsample of cardiovascular CNSs with the rest of the CNS sample. Cardiovascular CNSs tended to have characteristics more indicative of a hospital-based specialty and the role appeared to be more consistently established than the general CNS sample. In addition, cardiovascular CNSs had a significantly higher percentage of graduate-prepared nurses. They had significantly fewer interactions in outpatient, community, and home settings than the rest of the CNS group. While cardiovascular CNSs play a vital role in the high technology-based hospital setting, they do not appear to be moving out of that setting as are other CNSs. This is an interesting finding since cardiovascular disease is chronic and well suited to outpatient management within the CNS charter. These findings may aid in establishing future opportunities for cardiovascular CNSs in the new health care environment, as well as serve as a benchmark for educators of CNSs.