The role of the clinical nurse specialist in stoma care: A modified Delphi consensus.

INTRODUCTION: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day-to-day working role. AIMS: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?' DESIGN: Delphi consensus. METHODS: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub-categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session. RESULTS: All 13 statement and most (150/193) statement sub-categories reached consensus, with 20 sub-categories added during voting session one. CONCLUSIONS: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously. IMPLICATIONS FOR PRACTICE: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient-centred. PATIENT OR PUBLIC CONTRIBUTION: No patients or public were involved in any aspect of this paper-in hindsight this might have been useful.

Improving the care and health of populations through optimal use of clinical nurse specialists.

Patients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CNSs) are uniquely qualified to care for patients with complex illnesses as well as having the skills to optimize care for entire populations with complex needs. The absence of consistent legislative advanced practice registered nurse recognition of CNSs prevents health care systems from optimal use of this advanced practice registered nurse role to improve and provide safe and quality care for these patients. Additional barriers in optimal utilization of CNSs include lack of consistency: in title protection and licensing from state to state; ensuring patient access through identification and tracking of CNS numbers across the United States in order to determine workforce and educational program requirements; and ensuring appropriate reimbursement for care provided by CNSs. Therefore, it is the position of the American Academy of Nursing that addressing public and private sector regulatory, legislative, and policy concerns related to CNSs is essential to achieving optimal population health outcomes across the nation.

How Specialty Certification Influences Professional Practice.

Certified Nurses Day (March 19) honors nurses worldwide who contribute to better patient outcomes through board certification in their specialty. In this month's Magnet® Perspectives column, Sharon Vanairsdale, MS, APRN, ACNS-BC, NP-C, CEN, program director for Emory University Hospital's Serious Communicable Diseases Unit, discusses the value of certification, what it means to her professional practice, and how it helps to champion her work. Ms Vanairsdale is triple certified as a certified emergency nurse, an adult clinical nurse specialist, and an adult nurse practitioner. She is also an adult clinical nurse content expert for the American Nurses Credentialing Center®. She received the 2016 National Magnet Nurse of the Year® Award in the Exemplary Professional Practice category for her development of Ebola treatment and preparedness protocols, as well as significant contributions to the education and training of American healthcare workers around Ebola and other emerging infectious disease threats.

What does the Development of the European Core Curriculum for Cardiovascular Nurses Mean for Australia?

A core curriculum for the continuing professional development of nurses has recently been published by the Council on Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. This core curriculum was envisaged to bridge the educational gap between qualification as a nurse and an advance practice role. In addition, the shared elements and international consensus on core themes creates a strong pathway for nursing career development that is directly relevant to Australia. Education programs for nurses in Australia must meet the mandatory standards of the Australian Nursing and Midwifery Accreditation Council (ANMAC), but without a national core curriculum, there can be considerable variation in the content of such courses. The core curriculum is developed to be adapted locally, allowing the addition of nationally relevant competencies, for example, culturally appropriate care of Aboriginal and Torres Strait Islander individuals. Two existing specialist resources could be utilised to deliver a tailored cardiovascular core curriculum; the Heart Education Assessment and Rehabilitation Toolkit (HEART) online (www.heartonline.org.au) and HeartOne (www.heartone.com.au). Both resources could be further enhanced by incorporating the core curriculum. The release of the European core curriculum should be viewed as a call to action for Australia to develop a core curriculum for cardiovascular nurses.

Education for the advanced practice of clinical nurse specialists.

The results of an ethnographic study of the expert practice of clinical nurse specialists (CNSs) can be used to develop a curriculum based on the actual clinical competencies and skilled performance of successful CNSs. Benner's seven domains of expert clinical nurse practice formed the conceptual framework for an investigation that confirmed that expert CNSs demonstrate those domains as well as additional clinical, educational, and consultative competencies specific to the role. Several examples from the practice of oncology CNSs are included. Incorporating these findings into graduate education learning experiences would ensure that new graduates of CNS programs have a grasp of the realistic as well as the theoretical aspects of the role.

Issues in the assessment of expert nurses: purposes, standards and methods.

It is generally agreed that experts seek and use different information, and that the solutions they propose and implement are also different in kind and quality from those of non-experts. This makes assessment of experts a challenging problem. The difficulty of establishing standards and criteria by which the expert can be assessed should not necessarily prevent such assessment from being undertaken. However, the purpose of assessing experts should be clearly articulated before engaging in such practices, since different purposes may legislate different assessment methods. This paper canvasses concerns relating to the assessment of expert nurses, including: the definition of expertise; establishing standards of expert nursing performance; the training of appropriate assessors; and the choice of assessment method. Care needs to be exercised at all times to avoid obscuring the issues by concentration on assessing isolated expert behaviours to the exclusion of consideration of the underlying political purposes and the economic consequences of assessing expertise.

Higher level practice in nursing: a prerequisite for nurse consultants?

The Prime Minister has stated that he wishes nurse consultant posts to be introduced in the NHS. The UKCC is currently consulting on a framework for recognizing nurses who are working at a higher level of practice, and this work could form the professional standards infrastructure for those seeking a nurse consultant post.

Gerontological nursing practice standards: achievement and importance.

The 1987 ANA Standards of Gerontological Nursing Practice is compared with the 1976 Standards and found to be a new document, not simply a revision. These 1987 standards are assessed using five queries: progression, timeliness, adequacy of scope, substance, and form. Eighteen nurses practicing at a long term care facility in the midwest rated both the achievement and importance of these new standards. Descriptive data analysis demonstrated unmet expectations for all but 1 of the 11 standards. One appropriate function of the gerontological clinical nurse specialist is ongoing evaluation of these nursing practice standards which will continue to describe and prescribe professional nursing practice.

Perspectives on developing, marketing, and implementing a new clinical specialist position.

The purpose of this article is to provide guidelines for the clinical nurse specialist (CNS) who is involved in setting up a new position. The article describes the use of marketing strategies as a means of introducing the role to a prospective employer. Three guidelines are proposed as a framework for successful development of a new position. They are: (1) clearly defined purposes, goals, and role responsibilities, (2) mutual agreement of role expectations, and (3) self-confidence of clinical knowledge and ability. The article discusses the issues of unrealistic expectations, credibility, and role competition as potential difficulties in implementing a new position and offers suggestions to assist the CNS to realize success in implementing a new position. The key to success in setting up a new position is to develop the function that makes the CNS most valuable to the employer.

Job sharing: a viable option for the clinical nurse specialist.

NUMEROUS WORK TIME options have been developed to attract, retain and meet the various needs of nurses. Job sharing, a work option little known to nurses, can be a successful alternative for balancing professional and personal lifestyle. The business literature supports job sharing and other innovative work options as successful mechanisms in retaining quality employees in their respective professions. After exploring the literature in this area, a proposal for job sharing the oncology clinical nurse specialist (CNS) position was presented to the Personnel Director and Vice President of Nursing at our institution. The proposal addressed the advantages and disadvantages of the concept. These included: (1) scheduling flexibility, (2) reduced absenteeism and turnover, (3) increased productivity, (4) handling fringe benefits, and (5) job satisfaction. The proposal was accepted, and the job sharing position has been successfully implemented for more than 2 years now. This paper describes issues relevant to designing and implementing job sharing in a CNS position.

Costs and benefits of clinical nurse specialists.

The emphasis on cost containment during the 1980s has given way to a renewed interest in the quality of health care services that can be delivered at a reasonable cost. In this climate, clinical nurse specialists (CNSs) have an excellent opportunity to demonstrate the cost-effectiveness of their work. In order to do so, costs and benefits of CNS services must be measured and compared.

Operationalizing advanced practice registered nurse legislation: perspectives from a clinical nurse specialist task force.

Many state boards of nursing are currently examining advanced nursing practice and determining a process to recognize and regulate it appropriately. In 1999, Minnesota state law was altered to define and provide title protection for advanced practice registered nurses. After passage of the new law, the Minnesota Board of Nursing convened 4 task forces, representing each of 4 advanced practice nursing groups, to develop recommendations regarding issues of certification, criteria for determining acceptable certifying organizations, procedures in the event of examination failure, and a process for communicating this information to the nursing community. This article provides an overview of the legislation and describes the process used to obtain and operationalize the new law. The process undertaken in the clinical nurse specialist task force is also described, including the key issues that emerged and lessons that were learned.

Ethics of case management: implications for advanced practice nursing.

The healthcare system is under pressure to provide quality care with less money for a growing and aging populace, and the resulting changes in the system could pose ethical problems for advanced practice nurses. Expanding healthcare needs, the increased use of technology, and dwindling resources all place burdens on advanced practice nurses, who have taken on the role of case manager in an attempt to reduce costs, meet patient outcomes, and provide improved, personalized, high-quality care. This paper explores the ethical concerns that can arise from managed care delivery systems and discusses the role of advanced practice nurses as case managers and the possible implications for nursing practice and research.