Changes in Clinical Practice and Role Perceptions of Clinical Nurse Specialists Following the Expanded Nursing Practice Pilot Project in Korea

Background: A nationwide resident physician strike in Korea led to a pilot project expanding nursing practice. During this period, clinical nurse specialists (CNSs) assumed expanded clinical support roles. However, evidence describing changes in CNS practice is limited. Purpose: This study examined changes in task performance and role perceptions among CNSs following implementation of the expanded nursing practice pilot project. Methods: A cross-sectional descriptive survey was conducted with 103 CNSs at a tertiary hospital. Participants were categorized as 82 existing CNSs practicing before the pilot project and 21 newly appointed CNSs afterward. Data were collected using a structured self-administered questionnaire assessing task performance rates, task distribution, and role perceptions. Results: Performance of delegated prescription-related activities and clinical support tasks increased significantly, while core CNS functions—including patient assessment, interdisciplinary communication, education, and research—were maintained. Direct nursing care accounted for the largest proportion of work. Participants perceived role expansion as meaningful but reported increased workload, unclear role boundaries, and insufficient legal and compensation support. Conclusions: CNS played a critical role in maintaining care continuity and supporting clinical decision-making. Sustainable expansion of CNS roles requires clear legal authority, accountability, appropriate compensation, and protected time for education and research.