Work

From policy to practice: Rolling out the clinical nurse specialist role in Portugal

Year: 2025

Type: article

Abstract: • Demonstrates the significant positive impact of Clinical Nurse Specialists (CNS) on healthcare outcomes. • Provides an international comparison of regulations and educational requirements of CNS roles. • Proposes a policy framework to guide the implementation of CNS roles. • Illustrates the actual application of the framework to an European country. The specialization of Health Human Resources (HHR) is increasingly recognized as essential for addressing evolving healthcare demands. This paper presents a comprehensive policy framework for assisting with the implementation of Clinical Nurse Specialist (CNS) roles at the national or regional level, integrating key dimensions including barriers and enablers, regulation and governance, education and training requirements, career development, workforce planning, and economic analysis. The framework was applied to the implementation of CNS roles in Portugal, resulting in the issuance of a decree-law by the government. Our findings demonstrate that the economic analysis step was critical in addressing concerns from government authorities and health system funders regarding the potential budgetary impact of CNS implementation. By providing evidence-based projections of costs and benefits, the economic analysis facilitated smoother negotiations and consensus-building among stakeholders, including nursing unions. Furthermore, the integration of workforce planning ensured the alignment of educational capacity with workforce needs, thus avoiding potential implementation bottlenecks. The application of the framework also revealed important feedback relationships between its dimensions, highlighting the interdependent nature of the implementation process. This dynamic approach, which adapts to real-time feedback and stakeholder input, underscores the necessity of a holistic and iterative strategy for successful CNS role integration. The insights gained from the Portuguese case underscore the utility of this policy framework in guiding the implementation of advanced nursing roles in diverse healthcare contexts.

Source: Health Policy

DOI: 10.1016/j.healthpol.2025.105308

Authors: Mário Amorim-Lopes, Sofia Cruz-Gomes, Elisa Doldi, Bernardo Almada-Lobo

Institutions: Universidade do Porto, INESC TEC, University of Bergamo

Language: English

Topic: Nursing Roles and Practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Decent work and economic growth

Open Access status: hybrid

Estimated APC paid: $4,220