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					                                                               ISD(M)50                                  Specialty
                                                                                                         Description
                                                           IN CONFIDENCE
                                                                                                         NHS Board
                                                            Revised 09/2006                              Division


                                                Information Services (ISD)

          Clinical Nurse Specialist Data Collection at 30 September 2006

Definition of a Clinical Nurse Specialist:
A clinical nurse specialist is a registered nursing professional who has acquired additional knowledge, skills and
experience, together with a professionally and/or academically accredited post-registration qualification (if available) in
a clinical specialty. They practice at an advanced level and may have sole responsibility for a care episode or defined
client/group.

Nurse Practitioners should be included in the collection.

The following nurses should not be included: Practice Nurses, Consultant Nurses / Midwives, Health Visitors, District
Nurses, Public Health Nurses/Midwives, Community Psychiatric Nurses, Community Learning Disabilities Nurses and
Community Paediatric Nurses.


Please note that all forms for your board/division should be returned to ISD in one batch by 27th October.
Please return this completed form to your co-ordinator prior to this date.

If any of your details have changed please amend accordingly.

Guidance notes for completion of this form can be found on the Scottish Health Statistics website under
Workforce Statistics, at www.isdscotland.org/workforce and then click on links.

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Part A: KEY DATA                     Complete All Fields

National Insurance Number (1)


NMC Registration Number (2)

Note: in the absence of a unique staff identifier within NHSScotland, national insurance number is used for this
purpose on all workforce data held by ISD. The Data Protection Act regulates how ISD handles personal information
- please see the note on the next page for details.
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Part B: PERSONAL DETAILS                            Complete All Fields

Surname (3)


Forename (4)


Date of Birth (5)                                                             Sex (6)




Professional Group (7)                      Grade / Band (8)




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Part C: ABOUT YOUR CLINICAL NURSE SPECIALIST POST                                                       Complete All Fields

What is your job title? (9)




                                                                Page 1 of 2
                                                     ISD(M)50
                                                 IN CONFIDENCE
                                                  Revised 09/2006

Post Registration Qualifications (if applicable)

Using the list of codes provided, indicate which Specialist Practitioner Qualification(s) you hold that are relevant
to your current role (10)




Indicate which academic / professional qualifications you hold that are relevant to your role (tick all that apply)
(11)

     PhD                               Degree                                  Professional Studies


     Masters                           Certificate / Diploma                   ENB


     Other (please specify)



NHS Board (12)                                       Division(s) if applicable (13)




Which one of the following do you mainly work in? (14)

 Wholly acute setting

 Wholly primary care setting

 Mixture of both



Contracted hours per week for this post (15)            Year Started in Clinical Nurse Specialist Post (16)




 Specialty (17)                                                      Description
 (Please enter appropriate code from list)


 If the specialty in which you work is not listed, please specify below




 Target Age Group (18)                                          Child              Adolescent            Adult
 (Tick all that apply)



Signature of Clinical Nurse Specialist

Data Protection Act
The information covered by the Clinical Nurse Specialist Data Collection will be handled by the Information Services
(ISD) of the NHS National Services Scotland. The Data Protection Act 1998 regulates how ISD handles personal
information, and in compliance with the Act, ISD’s processing of personal data has been notified to the Office of the
Information Commissioner. A copy of this notification is available on-line at the Information Commissioner’s website
at <http://www.informationcommissioner.gov.uk> under NHS National Services Scotland. ISD also complies with the
Data Protection Principles set out in the Act in its storing, processing and disclosure of personal information. The
information you provide will be used by ISD for workforce planning, analytical and statistical purposes, and will only be
used and disclosed in connection with these purposes.




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