From shadow to change agent: Revitalization of the clinical nurse specialist role.

In 2017, A Magnet designated 528-bed tertiary care community hospital underwent significant leadership change. With that, came the opportunity to redefine the Clinical Nurse Specialist (CNS) role within the largest of five hospitals in a two-billion-dollar health care system. Through evidence-based practice, effective leadership, and the vision of a change agent, this is the story of the revitalization of the CNS role.

The nursing profession in Tunisia.

The Tunisian health care system is experiencing a significant period of change and needs reforms so as to adapt. The nursing profession, which is the main actor of this system, in terms of number and function, is barely known or utterly unknown. The present paper's authors, who are paramedical teachers, aim to shed light on the specificity of the nursing and the nursing profession based on data collecting, and rare articles and legislation texts. In four sections, the paper will discuss the following issues: the nursing population demography, providing several indicators, their training throughout the reforms period, their training which has been "hooked" to university studies, their job profile and career plan. This presentation will also address the situation in Algeria and Morocco, based on data available on the Web. The acquisition of "core" skills and skills "shared with other caregivers" represents the roadmap for the drafters of the training benchmarks currently under drafting. The higher institutes of nursing are looking of ways to secure the required trainers and resources needed to the opening of departments, prior to the launch of a 'doctoral school', which represents the only incubator of future teachers and researchers. Private training institutions representing a new investment sector are to be assessed in terms of overall employability. Perspectives, in 12 points, should be planned for a pedagogically accredited, professionally performing and socially responsible profession.

Perfil acadêmico, crenças e autoeficácia em pesquisa de enfermeiros clínicos: implicações para o Programa de Pesquisa de Enfermagem de um Hospital na Jornada Magnet® / Academic profile, beliefs, and self-efficacy in research of clinical nurses: implications for the Nursing Research Program in a Magnet Journey™ hospital

OBJETIVO: Descrever o perfil acadêmico, a experiência em pesquisa, as crenças e a autoeficácia em pesquisa dos enfermeiros clínicos de um hospital em Jornada Magnet®. MÉTODOS: Estudo descritivo, tipo survey, para avaliar perfil acadêmico, experiência em pesquisa, crenças e habilidades de pesquisa dos enfermeiros clínicos. A análise foi dividida em características demográficas; perfil acadêmico/científico (titulação acadêmica, participação em grupos de pesquisa, envolvimento em publicações, atividades de ensino, conferências científicas e apresentação de posteres); crenças relacionadas à Pesquisa em Enfermagem (habilidades, benefícios para a carreira, reputação da instituição, para o cuidado do paciente, satisfação no trabalho); e autoeficácia em pesquisa (conduzir revisão de literatura, avaliar a qualidade dos estudos, usar teoria; compreender as evidências e escrita científica: facilidade para colocar as ideias no papel, reconhecer e adaptar o texto para o leitor, escrever obedecendo os padrões requeridos pela ciência, escrever com objetividade, clareza e precisão; inserir as referências apropriadamente, usar corretamente a ortografia e gramática; escrever textos em inglês). RESULTADOS: A maioria dos enfermeiros clínicos tinha pouca experiência em pesquisa, todavia, demonstraram crenças positivas e percepção de habilidades de pesquisa bem desenvolvidas. CONCLUSÃO: Nossos achados devem contribuir para a elaboração de programas de pesquisa que objetivem facilitar o engajamento dos enfermeiros clínicos no desenvolvimento de projetos científicos.

OBJECTIVE: To describe the academic profile, research experience, beliefs, and self-efficacy in research of clinical nurses in a Magnet Journey™ hospital. METHODS: Quantitative descriptive designed to assess research experience of clinical nurses. The survey was divided into demographics characteristics; scientific/academic profile (Nursing degree; membership in academic research groups, involvement in papers, teaching activities, scientific conferences, and posters presented); beliefs related to nursing research (about skills, benefits to career, reputation of institution, patient care; job satisfaction level); and Research Self-Efficacy (conducting literature review; evaluating quality of studies; using theory; understanding evidence; and scientific writing: putting ideas on paper easily; recognize and adapt the text to the reader; write to the standards required by science; write with objectivity, logical sequence, coherence, simplicity, clarity, and precision; insert the references in the text correctly; write the references appropriately; use correct spelling and grammar; write texts in English). RESULTS: Most clinical nurses had low research experience, yet had positive beliefs in and perception of well-developed research skills. CONCLUSION: Our findings should contribute to the preparation of research programs aimed at facilitating the engagement of clinical nurses in the development of scientific projects.

Academic profile, beliefs, and self-efficacy in research of clinical nurses: implications for the Nursing Research Program in a Magnet Journey™ hospital.

OBJECTIVE: To describe the academic profile, research experience, beliefs, and self-efficacy in research of clinical nurses in a Magnet Journey™ hospital. METHODS: Quantitative descriptive designed to assess research experience of clinical nurses. The survey was divided into demographics characteristics; scientific/academic profile (Nursing degree; membership in academic research groups, involvement in papers, teaching activities, scientific conferences, and posters presented); beliefs related to nursing research (about skills, benefits to career, reputation of institution, patient care; job satisfaction level); and Research Self-Efficacy (conducting literature review; evaluating quality of studies; using theory; understanding evidence; and scientific writing: putting ideas on paper easily; recognize and adapt the text to the reader; write to the standards required by science; write with objectivity, logical sequence, coherence, simplicity, clarity, and precision; insert the references in the text correctly; write the references appropriately; use correct spelling and grammar; write texts in English). RESULTS: Most clinical nurses had low research experience, yet had positive beliefs in and perception of well-developed research skills. CONCLUSION: Our findings should contribute to the preparation of research programs aimed at facilitating the engagement of clinical nurses in the development of scientific projects.

Supplemental nurses are just as educated, slightly less experienced, and more diverse compared to permanent nurses.

In the past three decades, the shortage of nurses willing to work in hospitals has been a persistent challenge in the United States. Hiring supplemental registered nurses-nurses on short-term contracts obtained through an external staffing agency-has been common to fill gaps in nurse staffing. But there has been insufficient evidence about supplemental nurse workforce trends to inform workforce policy. To address this concern, we compared qualifications and characteristics of supplemental nurses with those of permanent nurses during 1984-2008. The two groups shared similar education levels in terms of possessing a baccalaureate or higher degree. Supplemental nurses were somewhat less experienced than permanent nurses, averaging fifteen years of experience in 2008 compared to eighteen years for permanent nurses. The supplemental nurse workforce was more diverse racially and ethnically and more likely to be male than the permanent nurse workforce. These data show that employing supplemental nurses could help meet the challenges of an aging nursing workforce, the projected future shortage of nurses, and an increasingly diverse US population.

Articulating the role of the clinical nurse specialist in New Brunswick.

The clinical nurse specialist (CNS) role is often misunderstood and underutilized. Through partnership with the CNS Advisory Committee in the Horizon Health Network and the Masters of Nursing Program at the University of New Brunswick, the authors developed a clear articulation and visual representation of the CNS role in New Brunswick. This paper synthesizes information gleaned from interviews with the clinical nurse specialists working within Horizon Health Network and integrates this information with the published literature and the position statement of the Canadian Nurses Association (CNA). Vision, voice and value emerged as key considerations, as did barriers to, and successes of, the CNS role. This paper contributes to the acquisition of knowledge regarding the role of the CNS according to the CNA and current published literature. It further promotes an understanding of the important role of the CNS in the healthcare system in New Brunswick, and introduces strategies that can be utilized by clinical nurse specialists to demonstrate value and support the continuation of the role.

Advanced practice nursing in Canada: overview of a decision support synthesis.

The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

A framework for description and evaluation of the nurse specialist role in South Australia.

Professionalising forces in nursing, burgeoning costs and increasing crises in medical care in rural and remote areas have led to the development of specialty nursing. However, description and evaluation of the role of the Nurse Specialist in the Australian context has not been well documented. This interpretive study was designed to explore the major components of Nurse Specialist roles in South Australia and to develop a framework for description and evaluation of these roles. A total of 30 Nurse Specialists from two major metropolitan teaching hospitals participated in focus groups to explore their roles. Role components were used to develop tools and a framework for describing and evaluating these roles. Participants identified clinical, educational, professional development, management and research as key components of the Nurse Specialist role. The results highlighted the diversity within the role for each Nurse Specialist and the need for a comprehensive range of evaluation tools. Recommendations arising from the research suggest that evaluation strategies need to be accompanied by appropriate staff education and be sensitive to the social, political and economic context of practice.

Reaching for the stars: career advancement and the registered nurse.

Clinical nursing has long struggled to secure the place of primacy it deserves in the profession's hierarchy of importance and worth. It is ironic that, even at the beginning of the 21st century, a clinical nurse is generally not as well-recognized, rewarded or remunerated as a colleague working in nursing management, education or research. Until the profession recognizes and takes serious action to remedy this situation, the crisis of recruitment and retention in nursing currently ravaging the globe is likely to continue. In this paper, I present a discursive account of an exciting initiative by a leading private, acute-care hospital which addresses this very problem. A new ladder for clinical nurse specialists (CNSs) introduces a rigorous and systematic approach to the appointment of three classifications of CNS, each requiring evidence of successively higher levels of competency, and which are accompanied by fiscal reward and stronger peer recognition.

Classifying specialist student practice: debates and dilemmas.

At present, the practice elements of the Specialist Community Practitioner Awards within the BSc (Hons) in the Community Health degree course at Manchester Metropolitan University do not directly contribute to degree classification. Student evaluation and external examiner concerns about the heavy assessment load motivated the course team to consider classifying practice at 20 Level III credits which would replace 20 theory credits. The process of developing a credible assessment tool for specialist practice was long and hard but the course team is now in a position to undertake an exploratory study of the assessment and classification of practice. This paper provides an overview of the discussion and debates that took place in the years before the study began. A future paper will provide detail of the study and will include practice educators, students and managers views on the structure, process and outcomes of marking specialist student practice in community settings.

A unique perspective on advanced practice nursing.

This article presents a working definition of the advanced practice registered nurse (APRN). The types of nurses that could be included in this definition and the benefits of broadening the category are discussed, as well as possible reasons for the less inclusive, previous definition of this category. Strategies are proposed for resolving concerns about broadening the category.