A Three-Dimensional Framework of Guidance-Motivation-Governance: Investigating Clinical Nurse Specialists' Management Perceptions

Abstract Objective The aim of this study is to analyze the current status and influential factors pertaining to the management mechanisms of Clinical Nurse Specialists through the lens of a three-dimensional Guidance-Motivation-Governance framework, in accordance with China's 14th Five-Year Plan aimed at enhancing clinical specialty capacities.. Methods A cross-sectional survey was conducted among 646 Clinical Nurse Specialists using convenience sampling during December 2025-May 2026. Participants completed the self-developed 25-item Guidance-Motivation-Governance Assessment Scale, which was validated through Delphi expert consultation (Cronbach's α = 0.949). Data analysis employed SPSS 24.0 for non-parametric tests and multivariate linear regression. Results With non-normally distributed data, the GMGAS score was reported as a median of 84.45 (IQR, 16.04) on a 100-point scale, indicating generally acceptable performance despite the governance dimension scoring critically low at 25.71 (IQR, 4.29). Univariate analysis identified five significant predictors of management efficacy: management position, hospital tier, specialty area, department size of Clinical Nurse Specialists, and dedicated position availability (all P < 0.05).Multivariate regression modeling (adjusted R²=0.085, P < 0.001) further confirmed four core determinants: managerial position ( β = 1.881), hospital tier ( β = 3.178), specialty area ( β = 0.480), and dedicated positions ( β =-5.255). Notably, the severe shortage of dedicated positions (available in only 17.03% of departments) demonstrated the strongest detrimental effect on management efficacy. Conclusion This study shows that establishing dedicated positions, empowering managers, and utilizing tertiary hospital resources are key to optimizing specialty nurse management efficacy. By empirically validating how dedicated position absence and non-managerial roles undermine governance mechanisms, we provide the first evidence-based framework to resolve China's chronic "training-management imbalance" dilemma.