Clinical Nurse Specialist Competencies Research Articles

A Crosswalk Analysis Between Magnet® Standards and Clinical Nurse Specialist Practice Competencies.

The purpose of this study was to determine the alignment between the American Nurses Credentialing Center's Magnet Recognition Program® standards and clinical nurse specialist (CNS) practice competencies. Despite documentation of CNS contributions to achieving and sustaining Magnet Recognition®, there is a lack of evidence clearly aligning Magnet® standards and CNS practice competencies. Using a crosswalk method, an expert panel of CNSs and chief nursing executives analyzed alignment of the 50 Magnet standards with the 44 National Association of Clinical Nurse Specialists core practice competencies. CNS practice competencies are aligned closely with Magnet standards: 86% of the 50 Magnet standards aligned with at least 1 CNS competency and 81.8% of CNS competencies aligned with at least 1 Magnet® standard. The alignment between Magnet standards and CNS competencies supports evidence of CNS contributions to organizational achievement of Magnet Recognition and will assist nurse executives in identifying a full scope of opportunities for CNSs to contribute to nursing excellence.

Advanced Practice Nursing in Chile and the Role of the Registered Nurse

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.

Core competencies of clinical nurse specialists: A comparison across three Nordic countries.

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland. Clinical nurse specialist roles were first developed more than 60years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries. A descriptive correlational study. An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline. A total sample of 184clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate=72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p=.000) and in organisational competency (p<.05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency. A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries. The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.

Using Clinical Nurse Specialist Competencies for Advanced Practice Registered Nurse Designation

Geddie, Patricia I. PhD, APRN-CNS, AOCNS, FCNSEditor(s): Minarik, Pamela PhD, APRN, BC, FAAN, Column Editor: Author Information

Establishing the Clinical Nurse Specialist Identity by Transforming Structures, Processes, and Outcomes.

The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes. The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected. Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities. The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.

The Long Road Home: Neonatal Long-term Care

The Long Road Home: Neonatal Long-term Care

Therapeutic hypothermia post-cardiac arrest: a clinical nurse specialist initiative in Pakistan.

The purpose of this project was to assess the feasibility of an evidence-based therapeutic hypothermia protocol in adult post-cardiac arrest (CA) patients in a university hospital in Pakistan. Cardiac arrest has a deleterious effect on neurological function, and survival is associated with significant morbidity. The International Liaison Committee of Cardiopulmonary Resuscitation and the American Heart Association recommend the use of mild hypothermia in post-CA victims to mitigate brain injury caused by anoxia. In Pakistan, the survival rate in CA victims is poor. At present, there are no hospitals in the country that use the evidence-based hypothermia intervention in adult post-CA victims. This pilot project of therapeutic hypothermia in adult post-CA patients was implemented in a university hospital in Pakistan by a clinical nurse specialist in collaboration with the cardiopulmonary resuscitation committee and the nursing leadership of the hospital. Various clinical nurse specialist competencies and roles were used to address the 3 spheres of influence: patient, nurses, and system, while executing an evidence-based hypothermia protocol. Process and outcome indicators were monitored to evaluate the effectiveness and feasibility of hypothermia intervention in this setting. The hypothermia protocol was successfully implemented in 3 adult post-CA patients using cost-effective measures. All 3 patients were extubated within 72 hours after CA, and 2 patients were discharged home with good neurological outcome. Adoption of an evidence-based hypothermia protocol for adult CA patients is feasible in the intensive care setting of a university hospital in Pakistan. The process used in the project can serve as a road map to other hospitals in resource-limited countries such as Pakistan that are motivated to improve post-CA outcomes. This experience reveals that advanced practice nurses can be instrumental in translation of evidence into practice in a healthcare system in Pakistan.

National Validation of the NACNS Clinical Nurse Specialist Core Competencies

To validate the 75 core National Association of Clinical Nurse Specialists' (NACNS) clinical nurse specialist (CNS) competencies among practicing CNSs. Specific aims were to (a) determine the extent to which 75 core CNS competencies were used in current CNS practice, (b) determine the importance of those competencies to practicing CNSs, and (c) identify gaps between CNS core competencies and role expectations in current practice. A survey design was used with both paper-and-pencil and online instruments. The survey included 150 items and three open-ended questions. A convenience sampling method was used, which targeted practicing CNSs. Respondents (N=505) were practicing CNSs who entered the field as RNs between 1956 and 2006. The survey had a high degree of internal consistency reliability (0.967%) between the subscales. The 75 NACNS core competencies were found to be useful and important for CNSs. A few gaps were identified between CNS core competencies and CNS role expectations in current practice. No one method for validating competencies will be satisfactory for all situations; however, the processes and methods used in this study were well suited to accomplish the goal of validating CNS core competencies. The process described here may be instructive to leaders of other national and international professional organizations interested in developing and evaluating competencies. Core competencies are useful and important to currently practicing CNSs. The CNS role is growing internationally. Core CNS competencies can be a framework for CNS role development, education, and practice. As described here, a competency validation survey is one way to assure that CNSs are meeting healthcare needs.

Developing an Empirical Base for Clinical Nurse Specialist Education

This article reports on the design of a clinical nurse specialist (CNS) education program using National Association of Clinical Nurse Specialists (NACNS) CNS competencies to guide CNS program clinical competency expectations and curriculum outcomes. The purpose is to contribute to the development of an empirical base for education and credentialing of CNSs. The NACNS CNS core competencies and practice competencies in all 3 spheres of influence guided the creation of clinical competency grids for this university's practicum courses. This project describes the development, testing, and application of these clinical competency grids that link the program's CNS clinical courses with the NACNS CNS competencies. These documents guide identification, tracking, measurement, and evaluation of the competencies throughout the clinical practice portion of the CNS program. This ongoing project will continue to provide data necessary to the benchmarking of CNS practice competencies, which is needed to evaluate the effectiveness of direct practice performance and the currency of graduate nursing education.

Tool Development for Evaluation of Clinical Nurse Specialist Competencies in Graduate Students

The purpose of this study was psychometric testing of the tool, Self Evaluation of CNS Competency Development. The tool was developed using the NACNS competencies, with some concepts added to reflect graduate program objectives. The student sample was 33 students who provided informed consent and completed the tool. The preceptor sample was 6 preceptors who clinically supervised 6 students. As expected, independent samples t tests with matched pairs of 6 students and preceptors showed that there were no mean differences in 9 of the 12 categories within the 3 spheres of influence. Using the contrasted groups approach, discriminant function analysis showed that 91.7% of beginning and ending students were correctly classified. Cronbach alpha was estimated as .96. Results show partial support for criterion-related validity and construct validity. Tool reliability is satisfactory. Further testing with larger samples of students and clinical nurse specialists is recommended.

Infusing gerontological nursing content into advanced practice nursing education

The inclusion of gerontology content in the nursing curriculum is paramount as our population of older adults grows. As one of 10 recipients of the John A. Hartford Foundation/AACN awards for Enhancing Gerontological and Geriatric Nursing Education for Advanced Practice Nursing Programs, we successfully integrated gerontological/ geriatric content throughout core courses for all concentrations taught at the master's level. The Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care were used as a guide to integrate gerontological nursing content across the core courses. We present examples of content, strategies, and evaluation methods that demonstrate infusion of gerontology in a nursing theory course, research course, and healthcare law and policy course. Twenty-two of the competencies are addressed in these core courses and provide a foundation for further development in the support and specialty courses for the nurse practitioner, clinical nurse specialist, nursing administrator, nurse educator, and nurse anesthetist. We also present helpful Web-based resources for older adult care.

Achieving Clinical Nurse Specialist Competencies and Outcomes Through Interdisciplinary Education

Without formal education, many healthcare professionals fail to develop interdisciplinary team skills; however, when students are socialized to interdisciplinary practice through academic clinical learning experiences, effective collaboration skills can be developed. Increasingly, educational environments are challenged to include clinical experiences for students that teach and model interdisciplinary collaboration. The purpose of this quality improvement initiative was to create an interdisciplinary educational experience for clinical nurse specialist (CNS) students and postgraduate physicians. The interdisciplinary learning experience, supported by an educational grant, provided an interdisciplinary cohort of learners an opportunity to engage in a clinically focused learning experience. The interdisciplinary cohort consisted of CNS students and physicians in various stages of postgraduate training. The clinical experience selected was a quality improvement initiative in which the students were introduced to the concepts and tools of quality improvement. During this 1-month clinical experience, students applied the new skills by implementing a quality improvement project focusing on medication reconciliation in the outpatient setting. The CNS core competencies and outcomes were used to shape the experience for the CNS students. The CNS students exhibited 5 of the 7 essential characteristics of the CNS (leadership, collaboration, consultation skills, ethical conduct, and professional attributes) while demonstrating competencies and fulfilling performance expectations. During this learning experience, the CNS students focused on competencies and outcomes in the organizational sphere of influence. Multiple facilitating factors and barriers were identified. This interdisciplinary clinical experience in a quality improvement initiative provided valuable opportunities for CNS students to develop essential CNS characteristics and to explore practice competencies in the area of systems. Interdisciplinary clinical experiences offer students opportunities to develop needed collaboration and communication skills. Educators should create interdisciplinary educational experiences for students to better prepare them for their roles in a clinical setting.

Integrating Gerontology Competencies Into Graduate Nursing Programs

Current demographic and health care utilization trends strongly indicate a rapidly increasing demand for nurses who are well qualified to care for older adults. Advanced practice nurses are positioned to assume leadership roles in geriatric nursing care; however, they must first acquire adequate preparatory education. This article describes two graduate nursing schools' curricular innovations that were funded by The John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing (AACN), through the Geriatric Nursing Education Project: Enhancing Gerontological/Geriatric Nursing for Advanced Practice Nursing. These programs at University of North Carolina at Greensboro and Pennsylvania State University incorporated techniques to translate the Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care [American Association of Colleges of Nursing. (2004). Nurse practitioner and clinical nurse specialist competencies for older adult care. Washington, DC: AACN] into an advanced practice curriculum and developed strategies to sustain curricular innovations. Finally, lessons learned from these two projects are discussed and recommendations are made for integrating geriatric nursing competencies into graduate programs.

A Necessity Not a Luxury: Preparing Advanced Practice Nurses to Care for Older Adults

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population. Relying solely on certified geriatric APNs to care for older adults is not a viable solution. Educating all APNs with grounding in gerontological nursing care may well be the answer to expanding our nation's capacity to competently care for our rapidly aging population. As part of the 4-year Enhancing Geriatric Nursing Education in Baccalaureate and Advanced Practice Nursing Grant, the American Association of Colleges of Nursing developed a set of core gerontological competencies for graduate APN programs. These competencies, entitled Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care, delineate guidelines for APNs who are not specialists in gerontology but provide care to older adults. This article describes the competency development process, provides an overview of broad categories and examples of competency statements, and highlights model case studies for integrating gerontological content throughout APN curricula to ensure that graduates are equipped to provide competent care to older adults.

Spheres of Clinical Nurse Specialist Practice Influence Evidence-based Care for Patients With Atrial Fibrillation

The purpose of this article is to review atrial fibrillation (AF) and its consequences, to present sources of published evidence-based guidelines for management of AF, and to highlight multifaceted clinical nurse specialist (CNS) interventions that promote positive outcomes for patients with AF. The number of people with AF is expected to increase from 2.3 million to more than 5 million in the next 50 years. AF is associated with increased mortality, morbidity, healthcare expenditures, and decreased quality of life. Recognition of the growing number of AF cases and adverse consequences of AF led to development of evidence-based guidelines for AF management. Although nurses in diverse settings are accountable for providing evidence-based care for patients with AF, the guidelines have not been widely disseminated to nurses. This discussion includes a review of the adverse consequences of AF and a summary of management of recently detected AF with a focus on recommendations for nursing activities/interventions that are supported by evidence-based guidelines. Multifaceted strategies directed toward nurses and nursing practice, patients/clients, and organizations/systems that are linked to published CNS competencies and outcomes are highlighted. CNS influence in all 3 spheres of CNS practice promotes positive outcomes that include improved patient/client functioning and self-management, reduced complications of treatment, decreased fragmentation of care, advancement of professional nursing practice, adherence to regulatory standards, and development of patient care processes that are supported by published guidelines. With the use of the strategies discussed, clinical nurse specialists, whose spheres of influence include nursing and nursing practice, patients/clients, and organizations/systems, promote improved patient outcomes through implementation of evidence-based guidelines for AF management.

A transcultural core course in the clinical nurse specialist curriculum.

For the nursing profession, the delivery of culturally congruent care must become a priority. Clinical nurse specialists are in a key position to promote change; however, formal preparation in transcultural care is urgently needed. Nurse educators are challenged to prepare clinical nurse specialists who are equipped to provide quality care to culturally diverse individuals and to collaborate with a multicultural workforce. The purpose of this article is to describe a transcultural core course in the clinical nurse specialist adult health curriculum. The course explores current issues in pluralism, diversity, and healthcare in relationship to clinical nurse specialist competencies. The article addresses the course components, including objectives, topics, teaching strategies, assignments, bibliography, class Web page, and course evaluation. A unique component is the evaluation of students' self-efficacy perceptions (confidence) concerning culture care of diverse individuals as measured by a psychometrically valid instrument, the Transcultural Self-Efficacy Tool. The article concludes with future implications for clinical nurse specialist education.

Nurse Practitioners and Clinical Nurse Specialists

Although the origins of clinical nurse specialists (CNSs) and nurse practitioners (NPs) are different, some nurse educators believe that the roles of these advanced specialists should merge, while others believe that, from a philosophical point of view the roles are distinct, and should be kept separate. In order to throw light on this controversy, CNS and NP alumnae from a Master of Science program in upper New York State were surveyed. Graduates of the past 10 years were asked about their current role functioning, satisfaction with their work and career choice, and opinions about a number of professional issues, including the merging of NP and CNS preparation. The most impressive finding was the overlapping functions and opinions of the graduates actually involved in the clinical role. Although differences in traditional areas associated with the two groups were noted, they were not nearly as large as the literature suggest. The majority of the graduates supported the merging of the two roles. Such a merger has advantages for both types of specialists, nursing school curriculums, the health care system, and ultimatley the consumer.

Caring—The Work of the Clinical Nurse Specialist

The purpose of Clinical Nurse Specialist™: The International Journal for Advanced Nursing Practice is to disseminate outcomes of clinical nurse specialist practice, to foster continued development o fthe clinical nurse specialist role, and to highlight clinical nurse specialist contributions to advancing nursing practice and health policy globally. Objectives of the journal are: 1. Disseminate knowledge about clinical nurse specialist competencies and the education and regulation of practice; 2. Communicate outcomes of clinical nurse specialist practice on quality, safety, and cost of nursing and health services across the continuum of care; 3. Promote evidence-based practice and innovation in the transformation of nursing and health policy for the betterment of the public welfare; 4. Foster intra-professional and interdisciplinary dialogue addressing nursing and health services for specialty populations in diverse care settings adn cultures. Clinical Nurse Specialist is the official journal of the National Association of Clinical Nurse Specialists.

Nutrition Support Nursing: A Specialty Practice

The purpose of Clinical Nurse Specialist™: The International Journal for Advanced Nursing Practice is to disseminate outcomes of clinical nurse specialist practice, to foster continued development o fthe clinical nurse specialist role, and to highlight clinical nurse specialist contributions to advancing nursing practice and health policy globally. Objectives of the journal are: 1. Disseminate knowledge about clinical nurse specialist competencies and the education and regulation of practice; 2. Communicate outcomes of clinical nurse specialist practice on quality, safety, and cost of nursing and health services across the continuum of care; 3. Promote evidence-based practice and innovation in the transformation of nursing and health policy for the betterment of the public welfare; 4. Foster intra-professional and interdisciplinary dialogue addressing nursing and health services for specialty populations in diverse care settings adn cultures. Clinical Nurse Specialist is the official journal of the National Association of Clinical Nurse Specialists.

Planning Clinical Nursing Research with a Geriatric Population

The purpose of Clinical Nurse Specialist™: The International Journal for Advanced Nursing Practice is to disseminate outcomes of clinical nurse specialist practice, to foster continued development o fthe clinical nurse specialist role, and to highlight clinical nurse specialist contributions to advancing nursing practice and health policy globally. Objectives of the journal are: 1. Disseminate knowledge about clinical nurse specialist competencies and the education and regulation of practice; 2. Communicate outcomes of clinical nurse specialist practice on quality, safety, and cost of nursing and health services across the continuum of care; 3. Promote evidence-based practice and innovation in the transformation of nursing and health policy for the betterment of the public welfare; 4. Foster intra-professional and interdisciplinary dialogue addressing nursing and health services for specialty populations in diverse care settings adn cultures. Clinical Nurse Specialist is the official journal of the National Association of Clinical Nurse Specialists.