Barriers and Opportunities in the Implementation of Clinical Nurse Specialist Roles in Iran's Healthcare System: A Qualitative Exploration

Background The Iranian healthcare system will encounter significant challenges in the future, such as evolving disease patterns and rising healthcare expenses. Although clinical nurse specialists play a crucial role in decreasing hospital readmissions, enhancing quality of life, and alleviating the financial strain on the healthcare system, integrating their role into the Iranian healthcare system presents both a challenge and an opportunity. The aim of this study, using a qualitative approach, was to explore the barriers and challenges associated with implementing Clinical Nurse Specialist (CNS) roles in the Iranian healthcare system. Methods This qualitative study was conducted using the directed content analysis approach. A purposeful sampling method with maximum variation was performed among the nurses holding a master's degree or higher. Data were collected using 19 in-depth semi-structured interviews and analysis process was conducted using the Graneheim and Lundman method, utilizing MAXQDA software version 10. Results The analysis revealed three main categories in the structural dimension, two main categories in the process dimension, and one main category in the outcome dimension. In the structural dimension, the main categories identified were human resources, organizational structure, and facilities. In the process dimension, the main categories included the interactive processes involved in the implementation of care and treatment, as well as diagnosis and treatment. In the outcome dimension, the primary category was health status Conclusions The successful integration of CNS roles into Iran’s healthcare system requires addressing the multifaceted barriers identified in this study. By drawing on international experiences and tailoring strategies to the unique socio-cultural and organizational context of Iran, policymakers and healthcare leaders can unlock the potential of CNSs to improve healthcare quality, reduce costs, and enhance patient satisfaction. The findings of this study serve as a foundation for developing evidence-based policies and practices that support the optimal utilization of highly qualified nursing professionals in Iran.