Clinical nurse specialists' role in selecting & using knowledge to improve practice & develop practice-based policies designed to promote optimum patient outcomes

There are almost 270,000 registered nurses working in Canada (Canadian Nurses Association, 2005); the largest number of health care providers working with patients and their families in the health care system. Logic dictates that incremental positive change aimed at this group will have significant impact on the health care system and ultimately, patient outcomes. Advanced practice nurses such as the clinical nurse specialist (CNS), whose roles include activities as intermediaries, champions and change agents, are important facilitators of such change (Ahrens, 2005; DeBourgh, 2001; Milner, Estabrooks, & Humphrey, 2005). In terms of evidence-based nursing practice where the major desired change is increasing the use of research evidence by frontline nurses, CNSs are poised to make significant impact. Current thinking suggests that passive diffusion of research knowledge is not sufficient to ensure its adoption in practice (Grol & Grimshaw, 2003; Lomas, 1991). The CNS group is a largely untapped and potentially cost-effective force in efforts to create positive change in evidence-based nursing practice. As credible and trusted sources of knowledge, CNSs fulfill an intermediary function as facilitator, essential for successful implementation of research into nursing practice (Harvey et al., 2002).