Clinical Nurse Specialist Research Articles

Hospital-Based Credentialing and Privileging: Overview and Implications for the Clinical Nurse Specialist.

The purpose of this article is to provide an overview of hospital-based credentialing and privileging processes for clinical nurse specialists (CNSs), describe barriers to success, and share lessons learned from CNSs who have successfully navigated the credentialing and privileging process. This article shares knowledge, experiences, and lessons learned from an initiative to achieve hospital credentialing and privileging for CNSs at 1 academic medical center. Policies and procedures for credentialing and privileging CNSs are now consistent with other advanced practice providers.

Delirium Position Statement.

Melissa Yager, PhD, RN, CNS, ONC, Director of the Orthopedic Service Line, Department of Orthopedics, Sharp HealthCare, San Diego, CA. Betty R. Clark, MEd, BSN, RN, CRRN, Educational Services, Land O'Lakes, FL. Nichole Gulley, MSN, APRN, AGCNS, CRRN, CMSRN, Spinal Cord Injury/Disorders Clinical Nurse Specialist, VA Northeast Ohio Healthcare System, Louis Stokes VA Medical Center, Cleveland, OH. Dawn L. Denny, PhD, RN, ONC, Associate Professor, College of Nursing & Professional Disciplines, University of North Dakota, Grand Forks, ND. Correspondence: Dawn L. Denny, College of Nursing & Professional Disciplines, University of North Dakota, 430 Oxford Street Stop 9025, Grand Forks, ND 58202 ([email protected]). The authors have disclosed no conflicts of interest.

AB163. SOH23ABS_050. Digital delivery of pain assessment education in the hospital setting—breaking barriers to enhance skills

Background: Audit of nursing documentation found that standards on pain assessment were not being met when measured against national quality care metrics. Face-to-face supportive education was impacting on staff and clinical nurse specialist (CNS) workload. Further education was needed to support nursing staff of the 12 identified units. The aim of the study was to identify the effectiveness of the delivery of supportive pain assessment education utilizing a digital platform in the hospital setting.

Advocating for the Vulnerable: The Clinical Nurse Specialist and Nursing Home Reform.

Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care. Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the "National Imperative to Improve Nursing Home Quality" report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage. There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.

The Influence of a Doctor of Nursing Practice Health Policy Course on Clinical Nurse Specialist Practice and Competencies.

The Influence of a Doctor of Nursing Practice Health Policy Course on Clinical Nurse Specialist Practice and Competencies.

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

We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. 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. 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. Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.

E050 Developing multidisciplinary models of care in rheumatology at University College London Hospital: 18 months of learning from conception to delivery and beyond

Abstract Background/Aims The COVID-19 pandemic has placed unprecedented pressures on NHS departments, with demand rapidly outstripping capacity. The British Society for Rheumatology ‘Rheumatology Workforce: a crisis in numbers (2021)’ highlighted the need to provide innovative ways of delivering rheumatology specialist care. At University College London Hospitals (UCLH) we created a rheumatology multidisciplinary team (MDT) clinic to meet rising demands on our service. The aims of the Rheumatology MDT clinic were to: reduce new appointment/follow-up waiting times, increase clinic capacity, incorporate musculoskeletal (MSK) point of care ultrasound, reduce number of hospital visits and add value to each clinic encounter. Methods We ran a 6-month pilot, supported by our outpatient transformation team, incorporating a Rheumatology Advanced Practice Physiotherapist (APP), Clinical Nurse Specialist (CNS) and MSK ultrasound within a Consultant clinic. The success of the pilot helped secure funding for a further 12 months. Over 18 months we have implemented: APP/Consultant enhanced triage - up to 40% of referrals were appropriate for APP assessment, including regional MSK problems and back pain. This increased capacity for consultant-led appointments. Standardisation of time-lapse between CNS and consultant follow-up appointments to ensure appropriate spacing between patient encounters. Facilitated overbooking of urgent cases afforded by additional capacity provided by the APP. MSK ultrasound embedded in the clinic template. ‘Zoom’ patient education webinars facilitated by MDT members and wider disciplines e.g. dietetics, to empower self-management and reduce the administrative burden of patient emails/phone calls occurring outside the clinic. Patient participation sessions and feedback to help shape the service. Results During the 6-month pilot we reduced our waiting time for follow-up appointments from 9 months to 2. We now have capacity to book 1-2 urgent cases each week. Pre-MDT the average wait from consultant referral to physiotherapist appointment was 55 days. The MDT allows for same day assessment (reducing 2-3 patient journeys a clinic) and where suitable, facilitates discharge or onwards referral to the appropriate service. A dedicated MDT CNS has shortened treatment times, reduced email traffic between CNS and consultant and allows for same day, joint decision-making resulting in fewer appointments. Zoom webinar feedback has been positive. Patients value the broad expertise of allied health professionals which supports self-management. Embedding ultrasound allows for same day diagnostics, decreased referrals to radiology and reduced hospital visits. Conclusion Our MDT model has reduced waiting lists, decreased treatment delays and cut hospital attendances. Point of care ultrasound allows for same day decision making and abolishes the cost and diagnostic delay associated with referrals to radiology or outsourced providers. Shared decision-making adds value to outpatient attendances, which is reflected in patients’ positive feedback. The MDT model maximises the existing workforce skill set by enhancing the APP and CNS role, allowing patients immediate access to their expertise. Disclosure F. Higgs: None. D. Ludwig: None. N. Allotey: None. S. Begum: None. J. Burton: None.

Zero Harm: Clinical Nurse Specialist and Informatics Nurse Specialist Synergy

The clinical nurse specialist brings unique skills and knowledge to the effort in health care organizations to achieve zero harm to patients. The informatics nurse specialist supports the effort with special talents and knowledge. When an informatics nurse specialist joined the clinical nurse specialist team, the synergy of their collaboration proved to yield unanticipated benefits in our quality and safety journey to zero harm.

Evaluation of the Clinical Nurse Specialists Training Program in Pediatric Intensive Care Units in China: Quantitative Results from Participants’ Perspectives

Background: This study aimed to systematically evaluate the effectiveness of a clinical nurse specialists training program in Zhejiang Province, China, from participants’ perspectives. Methods: This cross-sectional study was conducted with 209 PICU nurse specialists who participated in the training program from 2016 to 2021. All participants completed an online questionnaire two years after graduation. We collected their demographic characteristics and their development status after the training (e.g., continuous improvement of core competence, research skills, and promotion). Chi-squared test was applied to assess the differences in effectiveness across subgroups. Results: In total, 209 (87.8%) out of 238 nurses responded to the survey among whom 73.7% launched new projects in their hospital after training and 75% published research articles in peer-reviewed journals. Also, 32.4% received promotions, and 67% participated in ICU-related continuing education programs. Based on multivariate regression analysis, the execution of new projects was closely related to the nurse’s position and the level of their working hospitals. The job title and position were associated with publication, research performance, promotion, and continuing education. Conclusions: The nurse specialists of the PICU carried out a set of new projects implanting new skills that they had learned from the training program. Their core competence was improved, including theoretical knowledge and operation skills, teaching capacities, and scientific research abilities. Many trainees published papers, applied for research grants, got promotions, and had further opportunities for continuing education.

Personalized Palliative and Survivorship Care for Patients With Metastatic Cancer Treated With Radiation Therapy.

While the benefits of early palliative care for patients with metastatic cancer are well established, cancer survivorship remains inadequately integrated into the care of patients with distant metastases. Moreover, the optimal model of care delivery is poorly defined. A prognostic model previously developed and validated at Good Samaritan University Hospital identified four groups of patients with metastatic solid tumor malignancy having very favorable, favorable, standard or unfavorable prognoses with median survival of 31, 14, 4 and 1 month, respectively. This framework holds promise for the personalized delivery of supportive, palliative and survivorship care services in the context of radiation therapy. We review the published literature providing the rationale for a novel multidisciplinary care model where the radiation oncology Clinical Nurse Specialist identifies and coordinates interventions to address unmet physical and emotional issues faced by survivors with metastatic cancer with the goal of improving quality of life and overall survival.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. This study used a quantitative exploratory descriptive approach using survey data. A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.

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

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. 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. 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. 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.

Clinical Nurse Specialist and Clinical Nurse Leader Collaboration During the COVID-19 Pandemic.

The aim of this study was to describe an innovative strategy to maintain healthcare worker safety and optimal patient outcomes that was implemented by a healthcare system in the Southeastern United States during the COVID-19 pandemic. During the surges of the COVID-19 pandemic, healthcare systems have struggled with healthcare worker burnout, high staff turnover rates, and redeployment of staff to unfamiliar areas and the uncertainty regarding COVID-19 personal protection and patient care. Clinical nurse specialist/clinical nurse leader teams were created to help ensure healthcare worker safety and optimize patient care outcomes. Healthcare worker safety and desired patient outcomes were maintained. Throughput was expedited for emergency department patients, and there was timely implementation of therapeutic modalities for critically ill patients. Clinical nurse specialist/clinical nurse leader team collaboratively cross-trained staff to ensure their safety and delivery of quality patient care. The team was pivotal in helping safeguard staff from harm while optimizing patient outcomes. Lessons learned will help us in future disasters as well as our daily operations.

March of Dimes Report on Access to Maternity Care in the United States.

Dr. Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist in St. Louis, MO, and the Editor-in-Chief of MCN. Dr. Simpson can be reached via email at [email protected] The author declares no conflicts of interest.

Men’s s Health in Nursing Practice: A Survey of Senior Nurses

Background: Australian men are likelier to die younger than women, often from preventable diseases or conditions. Gendered health promotion has improved men’s engagement with health services, with nurses playing a central role in information and healthcare design. The primary aim of this research was to survey senior clinical and executive nurses on their understanding and perception of men’s health. Methods: A cross-sectional quantitative online survey was attended by senior nurses within a single hospital setting in metropolitan Sydney between June 2022 and July 2022. Sampling selection was conducted of nurses who currently hold senior clinical or management roles within the health district (Nurse Manager, Nurse Unit Manager, Director of Nursing, Nurse Practitioner, Transitional Nurse Practitioner, Clinical Nurse Consultant, Clinical Nurse Specialist, Nurse Educator, Clinical Nurse Educator) with descriptive analysis applied to interpret the data sets. Results: A total of 84 responses were received, representing a 33% survey participation rate. A key finding was that 89.1% of senior nurses believed that traditional masculine traits affected health-seeking behaviour. However, 60.2% had not discussed men’s-specific agencies with male patients, and 33.7% of senior nurses believed that gender was not a determinant of health. There was strong endorsement (74.6%) for a men’s health education program to be developed specifically for nurses. Conclusion: The results of this single-site online survey of senior nurses illustrate that while foundational understandings of gender as a determinant of health were divided, there remained strong endorsement for targeted men’s health promotion to patients and the development of men’s health educational programs to support nurses in providing holistic care for their male patients.

N29 Audit of Inflammatory Bowel Disease Telephone Advice Line

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic unpredictable condition of the gastrointestinal tract and advice lines for chronic disease are well established. Advice lines are a fundamental part of the Inflammatory Bowel Disease services. They offer advice and support for patients and have been shown that early intervention via an advice line can have a major impact in avoiding hospitalisation due to a flare up. Inflammatory Bowel Disease advice lines provide for multiple queries in relation to IBD and increasing demands were observed. The introduction and increased use of biologic medication (subcutaneous and oral) requires a repeat Hi Tech prescription and this has increased the workload through the IBD advice line. The aim was establish if aspects of the IBD advice line was in accordance with IBD Standards UK and to highlight any deficiencies that would require corrective action Methods Data was collected on all telephone calls received by the ANP IBD advice line during the data period 17/01/2022 to 11/02/2022 (n=80). The average number of monthly calls to the service is 146. Prospective data was collected by ANP IBD and analysed by the Clinical Audit Facilitator using IBM SPSS Statistics v 24. Criteria used to measure against: Rapid access to specialist advice should be available to patients to guide early flare intervention, including access to a telephone/email advice line with response by the end of the next working day ( IBD Standards UK) Results The highest number of calls to the advice line was 23/80 (29%) for a Hi Tech prescription. Flare up calls consisted of 21.2% of the calls and results investigations was equal to this. Administration queries and medication queries consisted of 7.5% of the calls. Clinical related queries were almost 9% of the calls. 59% of calls were returned within 36 hours. Mean interval of time call was returned was 34.7 hours and a median interval of 28 hours. Conclusion The audit indicates the highest number of calls are for repeat Hi tech prescriptions for medications. A Quality Improvement Plan includes the establishment of a dedicated Hi Tech Prescription Telephone/Virtual Clinic. This will also ensure an improved quality and a safer standard of care for patients. . The audit further identifies the number of calls and the effectiveness of the Inflammatory Bowel Disease advice line e.g. the number of calls (17/80) that dealt with a flare up that would have possibly attended the Emergency Department. It also highlights the time intervals for return of calls (33/80) calls were returned &amp;gt; 36 hours. A new Clinical Nurse Specialist Inflammatory Bowel Disease would improve service outcomes.

A global perspective of advanced practice nursing research: A review of systematic reviews protocol.

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A clearer understanding of the roles that are in place across the globe, and how they are being used will support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform. To identify current gaps in advanced practice nursing research globally. This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We will include reviews that examine APNs, NPs or CNSs using recognized role definitions. We will search the CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, Joanna Briggs Institute, and Web of Science electronic databases for reviews published from January 2011 onwards, with no restrictions on jurisdiction or language. We will search the grey literature and hand search the reference lists of all relevant reviews to identify additional studies. We will extract country, patient, provider, health system, educational, and policy/scope of practice data. We will assess the quality of each included review using the CASP criteria, and summarize their findings. This review of systematic reviews protocol was developed following the PRISMA-P recommendations. CRD42021278532.

Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes.

Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days ( P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.

Addressing Gender-Related Inequality in Continence Care

Addressing Gender-Related Inequality in Continence Care

Successful Clinical Nurse Specialist Recruitment: Creating a Talent Pipeline.

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. 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 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. 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.