CLINICAL PRACTICE ACTIVITIES OF CLINICAL NURSE SPECIALISTS' CONFLICTS IN PROFESSIONALISM AND BUREAUCRACY.

Description

This study is designed to investigate conflict in the clinical practice of clinical nurse specialists (CNSs). Conflict in attitudes, control and structure of clinical practice, and conflict in the use of professional time is studied. Conflicting orientations to bureaucracy and professionalism was explored for explanations of existing phenomena in nursing practice. I obtained data from 448 CNSs who are members of the American Nurses Association. Three settings for practice were used to draw the random sample; these settings parallel Hall's criteria for settings reflecting varying amounts of bureaucracy. One setting was further grouped into faculty CNSs providing direct patient care and those not providing direct patient care. Selected other variables such as whether they received master's degrees before 1975 or after 1975, specialty area, and years in selected settings provided the basis for additional group analysis. Descriptive characteristics of this sample showed characteristics representative of the population. The instrument is a combination of two previously-used instruments, Hall's Occupational Inventory and Gordon's Work Environment Preference Schedule. In addition, I developed items to determine control of practice and structural arrangements for clinical practice, satisfaction with control of clinical practice, beliefs about faculty practice scales, and one item that measured actual and preferred time allotments for clinical practice. All scales developed exhibited high alpha coefficients. I analyzed data to determine conflict in clinical practice and attitudes regarding beliefs about faculty practice. Analysis of conflicting orientations of bureaucracy and professionalism demonstrated differences in groups of CNSs' attitudes. Conflict in control and structure as well as use of time for professional activities was also demonstrated. I proposed suggestions and guidelines for nurse educators in higher education and employers of CNSs.

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