A description of the roles, activities, and skills of clinical nurse specialists in the United States. 
Clinical nurse specialists (CNSs) frequently adapt to meet the challenging and changing needs of patients, families, nurses, physicians, and institutions, thus creating an advance practice role that is problematic in definition and description.  The two dilemmas associated with CNSs have been role confusion and ambiguity, and the inability to explicate CNSs' value in economic terms.  The purpose of this study was to describe the roles, activities, skills, and the cost-saving and revenue-generating activities of Master's-prepared nurses who function in traditional CNS roles in the United States.  A descriptive research design was employed, using Role Theory as a framework to guide the study.  The tool used to measure CNS practice included a 68-item instrument.  It was pretested and used in two pilot studies.  Content validity was supported by three experienced CNSs who were, at the time, in a doctoral nursing program.  Instrument reliability was 0.89.  Surveys were mailed to all individuals who subscribed (n = 2379) to the Clinical Nurse Specialist Journal.  From the convenience sample, 724 CNSs participated, providing a margin of error of +/- 4 percentage points with a 99% confidence level.  Regarding the five role components, CNSs reported (listed from most frequently to least frequently) spending time in the role of expert practitioner, educator, consultant, administrator, and researcher.  Most of the activities listed in each of the roles were typical of CNS practice.  Of the advanced practice roles, the two with the most surprising results were the expert practitioner and administrator roles.  The results indicated a trend toward performing advanced skills that have been in the past considered solely medical practice and toward increasing administrative responsibilities.  A small number of CNSs were able to identify cost-saving and revenue-generating activities, including the monetary value of the activity.