Advanced practice nurses execute many different functions in many different roles. Perhaps the most ambiguous of these roles is that of the clinical nurse specialist. This article describes how one hospital developed the clinical nurse specialist into an acute care nurse practitioner position in the cardiac surgery arena. How the role started and was implemented is discussed from a personal perspective. Evaluation of the position was performed quantitatively, by cost data, and qualitatively, by patient, family, nurse, and physician satisfaction

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