Aim To assess the activities of clinical nurse specialists (CNSs), examining work patterns, job plans and team structures, especially the balance of patient-facing and non-patient-facing activity.

Method A quantitative evaluation was conducted using diary cards at Imperial College Healthcare NHS Trust. CNSs were asked to record their activity for each ten-minute period of the working day over two weeks.

Results Data were received from 236 of 261 (90.4%) possible respondents and more than one million minutes of data were submitted. On average, CNSs spent 41% of their time in direct patient-facing activities and an additional 21.5% in patient-related activities. However, there was wide variation in how time was spent between individuals and teams, and across divisions within the trust. CNSs estimated that 16.4% of their clinical activity may have prevented an adverse event or patient attendance at hospital.

Conclusion Data generated from this evaluation will be used to develop coherent job plans for individuals and teams of CNSs and to identify which nurse-led activities are being reimbursed by commissioners of services.