A Compendium of Clinical Nurse Specialist Roles in a Canadian Health Authority.

Interior Health in British Columbia advocates for and supports advanced practice nurses, inclusive of regional clinical nurse specialists (CNSs). CNSs develop evidence-informed programs, education, policies and practice standards. The article uses an advanced practice nursing framework to anchor two case studies: (1) the operationalization and implementation of a regional CNS role in primary care and (2) the use of a knowledge translation strategy to build clinical capacity in serious illness conversations. These case studies embody the CNS role and provide a voice for CNSs to communicate the ways in which their advanced practice nursing role is pivotal in healthcare system transformation and for providing quality patient care.

National Association of Clinical Nurse Specialists Affiliate Support for Professional Growth of Clinical Nurse Specialist Students.

PURPOSE/OBJECTIVES: The purpose of this article was to describe how a National Association of Clinical Nurse Specialists affiliate partnered with a local university to engage clinical nurse specialist (CNS) students, enhance its mission and activities, and create succession planning opportunities, while providing mentorship and professional growth opportunities. DESCRIPTION OF THE PROJECT: Academic preparation of CNS students endeavors to instill professionalism. A 3-pronged partnership incorporating the inclusion of a student liaison on the board, presentation of student clinical work at the affiliate's annual conference, and development of a student scholarship was implemented. OUTCOMES: Membership in professional nursing organizations for a CNS student provides exposure and access to professional development resources, socialization to the role, rewarding networking opportunities with peers and colleagues, and leadership development. Anecdotal feedback demonstrated a better understanding of the CNS role, increased confidence, and enhanced knowledge on topics such as legislative advocacy as well as experiences of sharing clinical challenges with CNS colleagues. CONCLUSION: Partnership with the local university allowed the affiliate to maintain the influx of new CNSs, which sustains membership, nurtures the growth of new CNSs, and ensures the influx of new ideas. Furthermore, membership in professional nursing organizations is imperative to address the opportunities that exist in healthcare.

Differentiating Specialized and Advanced Nursing Roles: The Pathway to Role Optimization.

Aim: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Method: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. Results: Respondents (n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs (p < 0.001) and SNs (p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership (p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement. Conclusion: Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.

Credentialed and Privileged Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to illustrate, using exemplars, the practice of clinical nurse specialists (CNSs) in Michigan who are credentialed and privileged as providers by hospital/healthcare agencies to practice in acute inpatient and ambulatory settings. DESCRIPTION: The CNS provides expert specialty direct patient care to improve patient outcomes. They hold a graduate degree as a CNS, are professionally certified as a CNS in a specialty practice population, and are licensed or otherwise recognized to practice as an advanced practice nurse by the state nursing practice regulatory agency. OUTCOME: The exemplars illustrate CNS practice as an independent provider within a health system. CONCLUSION: Hospital-based credentialing and privileging facilitates CNS practice within the full scope of practice authority that consists of education, certification, and licensure and is a valuable contribution to cost-effective, high-quality clinical care for specialty populations.

Demonstrating the Value of the Clinical Nurse Specialist: A "How-to" Guide.

PURPOSE/OBJECTIVES: The purpose of this article is to provide a guide to identifying measurements of value and how to calculate different types of return on investment (ROI). Exemplars of clinical nurse specialist (CNS) work efforts with ROI will be presented. DESCRIPTION OF THE PROJECT/PROBLEM: The CNS is the oldest advanced practice role; however, the role can be vague, making it difficult to articulate the value of the CNS in the organization. Functioning in 3 spheres of impact, the CNS can easily impact practice; however, demonstrating the value of this work is not always on top of mind and is rarely taught in academic programs. OUTCOME: This article describes the difference between revenue generation, cost savings, and cost avoidance, as well as various structural, process, and outcome measures that can be used to calculate ROI. Resources available for performing ROI calculations will be described and shared. CONCLUSION: Distributing work across the 3 spheres creates various opportunities for the CNS to demonstrate value; however, the CNS must be able to articulate that value to the organization. Developing the skill set to consistently identify metrics can be challenging; however, it is critical to the ongoing success and future of the CNS role. Utilizing these metrics to demonstrate the value and then disseminating the outcomes of these contributions will continue to promote the value of the CNS in the future.

Successful Clinical Nurse Specialist Recruitment: Creating a Talent Pipeline.

BACKGROUND: The future of the clinical nurse specialist (CNS) role depends on nurses enrolling in CNS programs and having access to clinical experiences. At 1 institution, challenges with CNS recruitment and variations in how students were precepted were noted. This article describes a successful CNS student program and its value in creating a talent pipeline. PROJECT: A revision to student placements was initiated to create a formalized program including enhanced academic partnerships, standardized expectations and goals, assigned clinical projects and end-of-semester presentations, appointment of a student coordinator, and structured preceptor preparation. OUTCOMES: Outcomes included 100 placements for 50 different students; the primary source of recruitment for the organization is now prior students, with 17 being hired since program inception. A 325% increase was also noted in qualified preceptors. Student productivity increased, and 11 students were accepted for national presentations. Academic sites have reported increased satisfaction. CONCLUSION: Organizations looking to increase CNS recruitment should consider the revision of their student program. A centralized CNS responsible for student experiences can ensure standardization and provide preceptor support. The CNSs have an essential role in securing their future nationally and can do so through growing new talent and aiding in preparation for practice.

Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study.

Background and Objectives: Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives. Methods: An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10th Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year. Results: Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice. Conclusions and Practice/Policy Relevance: APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

Advanced Practice Nursing in Chile and the Role of the Registered Nurse: Integrating 2 Realities Through Continuous Education.

PURPOSE/AIMS: The aim of this study was to explore the perceptions that experienced and highly specialized nurses have of the clinical nurse specialist (CNS) role through description of the registered nurses' (RNs') experiences. DESIGN: This study used a qualitative descriptive design. METHODS: Interviews were conducted with 6 RNs (2 managers, 1 chief nursing officer, 2 educators, and 1 clinician) and 32 RNs who participated in 5 focus groups. Participants were purposively sampled from intensive care units and emergency departments from 4 public and private hospitals. The analysis of the narratives and field notes used thematic content analysis. RESULTS: Common aspects of the CNS competencies and the experienced RN were recognized. These included direct patient care, assessment, and mentoring, with important differences in management, research, and coaching competencies. CONCLUSION: The findings could facilitate the development of a master's program for the CNS in Chile. Formally recognizing the skills and clinical experiences of expert RNs may motivate nurses to pursue a master's degree that prepares them for advanced practice.

Clinical Nurse Specialist: A Critical Member of the ICU Team.

OBJECTIVES: To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided. DATA SOURCES: Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Not applicable. CONCLUSIONS: The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.

Can You Escape Sepsis? Using a Healthcare Escape Room as an Innovative Approach to Nursing Education.

PURPOSE/OBJECTIVES: The purpose of this article is to provide the clinical nurse specialist with an interactive, creative, and fun approach using an escape room to increase the retention and application of knowledge about caring for patients with sepsis and improve patient care outcomes. DESCRIPTION OF THE PROJECT: This project involved the design of a healthcare-based escape room, where clinical nurses and interprofessional learners engaged in a series of puzzles and problem-solving experiences to apply clinical judgment and critical thinking about patient care. THEORY AND FRAMEWORKS: Knowles' theory of adult learning guided the development of this gamified learning. OUTCOME: The clinical nurse specialist was critical to the success of the escape room. The escape room created an innovative learning environment, expanding opportunities to engage staff and promote high-quality care for best patient outcomes. CONCLUSION: The benefits of incorporating adult learning principles with gamification-based education as a teaching strategy are evident in the feedback and overwhelmingly positive responses received from participants. The successes of the sepsis escape room have presented opportunities to continue supporting progressive, fun, and evidence-based learning environments and positively impact both nursing education and patient care outcomes.

COVID-19 Pandemic 101: An Epidemiology and Public Health Primer for Oncology Nurses.

BACKGROUND: Understanding basic epidemiology and public health concepts is essential to the provision of safe care during a pandemic. These basic concepts and terms include containment, mitigation, predictive modeling, latent period, incubation period, reproduction number, case fatality rate, and test sensitivity and specificity. OBJECTIVES: Public health concepts and terms are defined, described in the context of the COVID-19 pandemic, and specific implications for oncology nursing practice are discussed. METHODS: A review of public health literature and reputable websites with a focus on COVID-19 data. This article defines epidemiologic and public health concepts and uses examples from the pandemic to illustrate oncology nursing implications. FINDINGS: The COVID-19 pandemic is changing oncology nursing care delivery. Oncology nurses need to understand these concepts to anticipate and advocate for optimal oncology care.

A COVID-19 screening tool for oncology telephone triage.

PURPOSE: Symptoms associated with COVID-19 infection have made the assessment and triage of cancer patients extremely complicated. The purpose of this paper is to describe the development and implementation of a COVID-19 screening tool for oncology telephone triage. METHODS: An Ambulatory Oncology Clinical Nurse Educator and three faculty members worked on the development of an oncology specific triage tool based on the challenges that oncology nurses were having with the generic COVID triage tool. A thorough search of the published literature, as well as pertinent websites, verified that no screening tool for oncology patients was available. RESULTS: The screening tool met a number of essential criteria: (1) simple and easy to use, (2) included the most common signs and symptoms as knowledge of COVID-19 infection changed, (3) was congruent with the overall screening procedures of the medical center, (4) included questions about risk factors for and environmental exposures related to COVID-19, and (5) assessed patient's current cancer history and treatment status. Over a period of 3 weeks, the content and specific questions on the tool were modified based on information obtained from a variety of sources and feedback from the triage nurses. CONCLUSION: Within 1 month, the tool was developed and implemented in clinical practice. Oncology clinicians can modify this tool to triage patients as well as to screen patients in a variety of outpatient settings (e.g., chemotherapy infusion units, radiation therapy departments). The tool will require updates and modifications based on available resources and individual health care organizations' policies and procedures.

Nursing Salons Take to Hospital Education Days.

Salon gatherings featuring conversations about current themes in a profession are evolving with time and practice to meet the needs of modern nurses and their clinical partners. Nursing clinical educators at a Midwestern pediatric hospital system offered a nursing salon experience as a new component of education days to provide an opportunity for clinical staff to engage in content and conversations about practice in a setting away from direct patient care. The objective of the nursing salons was to engage in professional reflection. Staff members of a professional development center and a department of quality and safety collaborated to provide this experience for over 500 nurses, clinical support associates, and leaders, to enhance clinical education days.

Building Evidence-Based Practice Competency Through Interactive Workshops.

BACKGROUND: Consistent implementation of evidence-based practice (EBP) leads to high-quality care, improved patient outcomes, and reduced costs. Increased job satisfaction, decreased turnover, and increased autonomy are reported when nurses use evidence for practice decisions. It is essential that clinical nurse specialists have strong EBP skills and enculturate these skills into bedside staff. PROJECT DESIGN AND IMPLEMENTATION: Interactive 90-minute workshops were developed to review the steps of EBP. The participants were nurses at the bedside and were encouraged to cultivate a spirit of inquiry. OUTCOME EVALUATION: Twenty-three workshops were held with 349 participants. Pre and post surveys were used to assess changes in knowledge and self-perceived confidence. A moderate to large effect size was noted in all areas measured. The largest change in knowledge was in correct identification of use of Boolean operators, which showed a 71% improvement. Overall mean knowledge improved by 29%, which was statistically significant (P < .0001). IMPLICATIONS FOR PRACTICE: Clinical nurse specialists can enact culture change by understanding the needs of their stakeholders and applying concepts to find creative ways to bring change to staff. This workshop successfully taught EBP concepts and implemented culture change in a way that was low cost and easy to replicate.

Borders in clinical teacher professional development: A concept analysis.

Background: A career in nursing academia offers clinicians a new challenge. Academic nursing and clinical nursing are two separate worlds with different social and cultural borders, foci and ways of working. It is possible to imagine this space as a kind of borderland, a new frontier that is simultaneously exciting and perilous. Aim: A concept analysis explored the borders as a site of meaning for professional development. Method: This study employed a four step concept analysis. Results: The analysis revealed four attributes of borders that are useful for clinical teachers to understand; liminality, border crossing, border work, and inhabiting a new world. Conclusion: As a liminal space, clinical teaching can be a site where uncertainty and ambiguity arises. This can create anxiety but also opportunities to think about both worlds differently, so that clinical teachers may discover new insights and applications for their work.

Strategies to Promote Nurses' Engagement in Clinical Research: Description of Two Nurse Scholar Programs.

Innovative programs are needed to build a pipeline of future nurse scientists necessary to generate practice-based evidence for optimal healthcare and to address the serious shortage of PhD-prepared nurses. This paper describes two nurse scholar programs based in one large, Magnet® designated healthcare institution that aim to provide clinical registered nurses (RNs) with mentored research opportunities in order to ultimately build an internal pipeline of practice-based nurse scientists. The Clinical Nurse Scholar Program provides clinical RNs the opportunity to conduct a research study under the mentorship of a senior nurse scientist. The Nursing Research Scholar Program provides a clinical RN enrolled in a PhD program or who recently completed a PhD program with an opportunity to gain enhanced research training and acquire new research skills. These two scholar models have the potential to be replicated in other institutions to enhance the development of future nurse scientists and to address a critical national shortage of PhD-prepared nurse scientists.

Market competition and demand for skills in a credence goods market: Evidence from face-to-face and web-based non-physician clinician training in rural China.

BACKGROUND: Non-physician clinicians (NPCs) providing services in functionally private markets account for a large share of the workforce in the primary care system in many low-income and middle-income countries. Although regular in-service training is believed to be crucial to updating NPCs' professional knowledge, skills, and practices, participation rates are often low. Low participation may result from the "credence good" nature of the market for primary care: if patients are unable to observe quality improvements from training, NPCs have weaker incentives to participate. Empirical evidence is limited on the relationship between market competition and NPC participation in-service training as well as how participation varies with the type of training available. METHODS: The study uses a dataset of 301 NPCs from three prefectures in Yunnan, a province in southwest China, collected in July 2017. Logistic regression is used to estimate the relationship between competition and NPC's participation in in-service training. We assess the relationship between participation and both the quantity of competition (number of competitors in the same village and surrounding villages) and the quality of competition (proxied using characteristics of competing clinicians). RESULTS: In 2016, nearly two thirds of NPCs participated in face-to-face or web-based in-service trainings at least once. Specifically, 58 percent of NPCs participated in face-to-face in-service trainings, and 24 percent of NPCs participated in web-based in-service trainings. The quantity of competitors is unrelated to participation in in-service training. The quality of competition is not related to face-to-face training but has a significant positive relationship with participation in web-based training. CONCLUSIONS: Web-based trainings may be a better approach to increase NPC skills in developing country primary care markets.

Implementing a Transition-to-Practice Program for Novice Clinical Nurse Specialists: A Pilot Project.

PURPOSE: The aim of this study was to determine the impact of a transition-to-practice program on job satisfaction among novice clinical nurse specialists (CNSs) in the US Air Force. PROGRAM DESCRIPTION: A needs assessment was conducted among currently practicing Air Force CNSs (n = 30) to establish the necessity for a transition-to-practice program. Newly graduated CNSs (n = 8) were paired with experienced CNS mentors and met every 2 weeks for 2 months to discuss progress on the CNS core competencies. Before beginning the program, mentees self-reported perceptions related to the core competencies. Mentors focused on areas of self-reported low competency. The Nursing Context Index was administered preintervention and postintervention to assess the program's impact on job satisfaction. OUTCOMES: Overall job satisfaction among novice CNSs improved from 5.01 to 5.57 (scale, 1-7) after completing the program. Personal satisfaction (4.30-5.63) and satisfaction with professional support (5.28-6.00) showed the greatest improvement out of the 4 elements of job satisfaction evaluated. CONCLUSIONS: Transition-to-practice programs can be beneficial for novice CNSs in establishing their practice. Future studies with larger sample sizes over longer periods of time are necessary to determine the true impact of similar programs.