This review shows that developing CNS expertise from novice to expert requires education, clinical experience, and continuous professional support, while further research on support strategies and competencies is needed.
Abstract
ABSTRACT Aims and Objectives The mixed‐method review aimed to synthesize research on how clinical nurse specialists' expertise develops from novice to expert and how this progression can be supported. Methodological Design and Justification The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and was registered on PROSPERO. A mixed‐methods approach was used to combine qualitative and quantitative data and enhance the robustness of the findings. Research Methods Literature search was conducted in CINAHL, PubMed and Scopus in September 2024. The selection and quality assessment of the studies were performed using JBI critical appraisal tools. The synthesis was based on qualitative and quantitative studies, using Benner's ‘From Novice to Expert’ model as a framework. Ethical Issues and Approval Ethical approval was not required for this study. Outcome Measures The main outcomes were stages of expertise development and factors supporting progression. Results Eleven articles were included for review. Becoming a clinical nurse specialist requires a basic nursing degree, clinical experience and a higher education degree. According to the results, expertise was seen to develop through three stages: novice, competent and expert, with the support of organizations, mentors, colleagues and multi‐professional collaboration. Pursuing continuing education while gaining experience is essential to carry on the journey towards expertise. Study Limitations The study screening process may have introduced selection bias, potentially leading to the omission of relevant articles. Additionally, selected articles on other interventions, such as service development, were excluded. However, they could have provided further insights into development. Conclusions This review shows that developing CNS expertise from novice to expert requires education, clinical experience, and continuous professional support. Strengthening structures and collaboration enhances patient care, while further research on support strategies and competencies is needed.
Background and Objectives: Advanced practice nurses (APNs) play an increasingly important role in improving healthcare quality and outcomes. This systematic review synthesized evidence on APN roles and healthcare outcomes in Thailand. Methods: The review protocol was prospectively registered in PROSPERO (CRD420261331793). Four databases (PubMed, CINAHL, Scopus, and Thai Journals Online) were searched from inception to January 2026. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the Mixed Methods Appraisal Tool (MMAT, 2018) for mixed-methods studies and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental, analytical cross-sectional, and qualitative studies. A narrative synthesis was undertaken because of methodological heterogeneity. Results: Twenty studies were included, comprising eight quasi-experimental studies, six cross-sectional studies, four mixed-methods studies, one retrospective study, and one qualitative descriptive study. APNs performed diverse roles, including direct clinical care, care coordination, consultation, patient education, mentoring, and implementation of evidence-based practice. APN-led models of care were associated with favorable clinical outcomes, enhanced self-care and quality of life, increased patient and caregiver satisfaction, and reduced hospital length of stay and healthcare costs. Conclusions: The available evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand. However, these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated.
Understanding patients' lived experiences of advanced practice nursing can help nurses and healthcare organizations strengthen patient-centred care and highlight the importance of protecting time for listening, supporting clear and individualized communication, building trustful partnerships, encouraging patient participation, and recognizing APNs' role in coordinating care across complex healthcare systems.
Qin Hu, Wei-Yan Tan, Shanshan Liu et al.· Journal of Nursing Scholarsh...· 0 citations
Abstract Objectives To map existing literature on nurses’ contributions to medical decision-making in hospital care, the factors influencing their involvement and how both nurses and physicians perceive this contribution. Design A scoping review was conducted following Arksey & O'Malley’s framework and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-Systematic Review and Meta-Analyses extension for Scoping Reviews (ScR) checklist Data sources A broad literature search was conducted in PubMed, CINAHL and the Cochrane Library. The initial search was performed in October–November 2023 and updated in December 2025, with no time or language restrictions. Eligibility criteria Empirical studies were screened by two independent researchers and included if they reported on nurses’ involvement in or attempts to contribute to decision-making regarding medical treatments for adult patients in the hospital. Data extraction and synthesis Data were charted using a predefined extraction form. Extracted data were coded, grouped and examined inductively to identify recurring patterns, which were discussed and refined by the two reviewers. Results A total of 111 studies were included, encompassing a wide range of study designs and clinical settings. Studies have reported that nurses often contribute to decision-making in subtle ways during ward rounds, multidisciplinary meetings and informal interactions, drawing on their observations and advocating for patients’ interests. Nurses reported moderate involvement, while physicians acknowledged nurses’ expertise but did not consistently recognise their input. We developed a model that illustrates how the interplay between personal, organisational and cultural factors determines whether nurses’ clinically relevant observations are acknowledged and integrated into medical treatment decisions. Conclusion Nurses contribute to medical treatment decision-making in various but often subtle, ways. Unfortunately, their contributions are not consistently recognised within decision-making processes.
V. W, Stoffels M, Kusurkar R. A. et al.· BMJ Open· 0 citations
Qualitative evidence suggests that registered nurses perceive GAI as a potentially supportive tool for improving efficiency, assisting clinical and research decision-making, and promoting professional development.
Yan Deng, Yidan Zhu, Jiaqi Li et al.· Frontiers in Public Health· 0 citations
Aim To synthesize evidence on strategies and contextual factors that influence confidence development among newly graduated nurses in acute care settings and to propose an integrated conceptual framework to guide practice, policy, and research. Design Integrative literature review. Methods This integrative review followed Whittemore and Knafl’s framework and PRISMA 2020 reporting guidance. Two reviewers screened studies, extracted data, and applied design‐specific JBI critical appraisal tools. Disagreements were resolved by consensus and consultation with a third reviewer. Data were synthesized through constant comparison and coded by outcome tier (direct confidence/self‐efficacy, related capacity, and proxy transition outcomes). Data Sources Five databases (Academic Search Complete, PubMed/Medline, CINAHL Complete, and PsycINFO) were searched from inception through June 30, 2024, with an updated search in May 2025. Results Forty studies met the inclusion criteria, representing qualitative, quantitative, and mixed methods designs. Five mechanism‐based domains were identified: support, skill development, reflection, integration, and organizational culture. Organizational culture functions as a conditioning context that can strengthen or constrain mentorship, skill development, reflection, and integration. These findings informed a conceptual framework illustrating the cyclical and dynamic relationships between individual strategies and organizational conditions. Conclusion Confidence‐building is a multifaceted and ongoing process influenced by mentorship, targeted training, reflection, team integration, and organizational culture. A comprehensive approach is necessary to help newly graduated nurses transition successfully into acute care practice. Implications for Nursing Management Nurse managers play a central role in shaping the conditions that allow newly graduated nurses to develop professional confidence during transition to practice. The findings from this review suggest that confidence‐building strategies are most effective when supported by psychologically safe unit cultures, protected preceptor time, constructive feedback, manageable workloads, and structured opportunities for reflection and team integration. Rather than treating confidence as an individual trait, nursing management should approach it as a workforce outcome influenced by staffing, leadership practices, mentorship infrastructure, and organizational socialization. Strengthening these conditions may improve transition experiences, support retention, and contribute to safer, more stable acute care environments.
Justin Fontenot, Fu-Qin Liu, J. Immanuel· Journal of Nursing Managemen...· 0 citations
Introduction Programmatic assessment (PA) is widely endorsed as a way to organize assessment around competency development in postgraduate medical education (PGME), yet no systematic review has synthesized the empirical evidence in this setting. We therefore synthesized the evidence on its contribution to competency development in PGME and on the factors that shape its implementation. Methods A systematic review was conducted following PRISMA 2020 guidelines (PROSPERO: CRD420261349850). We searched MEDLINE, Embase, Scopus, Web of Science, and EBSCOhost from January 2005 onward. Each included study was mapped against four operational features of PA derived from van der Vleuten et al. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and findings were synthesized using a narrative approach. Results Twenty studies met inclusion criteria. Four reported competency-related outcomes, all with observational designs. Two evaluated purposefully designed PA systems, and two analyzed milestone-based data generated within regulated competency-based training without an explicitly designed PA system. These studies reported increases in competency ratings and improved examination outcomes over training, though none could establish a causal link to the assessment system. The remaining 16 studies focused on implementation processes, stakeholder perceptions, and measurement properties. Challenges including feedback documentation barriers, misalignment between intended and perceived assessment stakes, and variable stakeholder engagement were reported consistently across settings. Methodological quality was uneven across the included studies (nine rated High, six Moderate, and five Low on a descriptive MMAT-based quality index). Discussion The empirical evidence for PA in PGME remains limited relative to its theoretical foundations. Most evidence reflects how stakeholders experience the system or whether assessment tools produce reliable data, rather than whether the system improves competency or patient care. Future research should extend outcome measurement beyond system-internal metrics and account for the contextual specificity of PA across diverse educational and regulatory environments.
İbrahim Ulaş Özturan, Pinar Daylan, Cansu Alyeşil Özturan et al.· Frontiers in Medicine· 0 citations
