The spectrum of operation includes dealing directly with patients, nursing personnel and the wider organizational structure of management concerned with issues of policy formulation and research implementation. The clinical nurse specialists may thus participate in the direct care of patients or engage in indirect care processes, which affect the care of a wider part of the patient population. Therefore, a clinical nurse specialist could take part in patient evaluation in one instance and in the next instance be part of a team building or overhauling a unit of healthcare professionals by making policies and recommendations on new evidence-based incorporations. The role of the clinical nurse specialist pervades the whole healthcare continuum, which includes interaction with the three important elements of the care system including the patient, nurse and system. These spheres overlap in the care continuum, and the roles of the CNS reaches all these spheres in an effort to improve nursing care and patient outcomes (Newhouse et al., 2011). The only difference in the operational set up is that the roles of the clinical nurse specialist vary subtly as s/he moves from one sphere to another in particular practice instances (Canam, 2005).
The greatest and perhaps most significant role and purpose of a clinical nurse specialist as an advance practice nurse entails the integration of care along the healthcare continuum. The clinical nurse specialists have a direct impact on patient care, handling of professional practitioners in the business of care delivery as well as the direct interaction with the system as a whole. The pervasive nature of these roles cannot be handled by any other nursing practitioner because they lack a wider scope of education (LaSala, 2007). Apart from clinical knowledge, the clinical nursing specialists also have education and experience in administration, teaching,