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Document Type

Thesis - University Access Only

Award Date


Degree Name

Master of Science (MS)


Graduate Nursing

First Advisor

Phyllis Gaspar


midwestern nurse practitioners


A study was done to explore the role of the Clinical Nurse Specialist (CNS) practicing in three Midwestern states. Components of the role, role responsibilities, barriers and advantages to the role and rural/urban differences among these factors were examined. Questionnaires were mailed to all CNS's holding a license in South Dakota and Iowa. A response rate of 46.24% was obtained. Of those returned, 26 fit the criteria of being a CNS with a Masters degree practicing in the Midwest.
Statistical analysis demonstrated that the Midwestern CNS's role consists of the four traditional CNS roles of clinician, educator, consultant, and researcher with a greater frequency of case management described by rural CNS's and a slightly less frequent researcher role by urban CNS's. Population characteristics of CNS clients were examined. The 51-70 year old age group and middle and lower-middle socioeconomic classes were the groups most frequently served. Clients were described by the complexity and high risk nature of their disease process with rural CNS's having a wider variety of client's problems requiring a more "generalist" perspective. Decreased resources and workload were seen as barriers to practice with lack of knowledge about the role found as the most significant barrier. Safety and caring people were found to be the most significant advantages. No significant rural/urban CNS differences were found when comparing professional support available, job satisfaction, age groups served, socioeconomic groups served, population characteristic influencing practice most and barriers to practice. Significantly fewer rural CNS's (37.0%) felt they had college courses available to maintain their expertise than urban CNS's (77.8%). "Close to family" was perceived to be a significantly greater advantage to rural CNS's than urban.

Library of Congress Subject Headings

Nurse practitioners -- Middle West



Number of Pages



South Dakota State University


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