Clinical Nurse Specialist Practice Research Articles

Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Oncology Clinical Nurse Specialists Practice in the Outpatient Setting.

With rapidly evolving oncology care, the role of the outpatient clinical nurse specialist is most valuable and essential. The purpose of this article is to describe the role of the clinical nurse specialist in the ambulatory oncology settings and highlight the clinical nurse specialists' unique influence across the spheres of impact. This article shares several contributions of an outpatient clinical nurse specialist, which include ways this role impacts nursing practice, patient care, and standardizing organizational guidelines. A method of recording the clinical nurse specialists' encounters or indirect consults was also utilized to provide a process to log consultation received in the day-to-day practice. Work exemplars were included to further demonstrate the impact of this role in this setting. Outpatient clinical nurse specialist need is rising especially in the oncology setting where the majority of cancer care and treatment is delivered. It is important to continue to disseminate and highlight the value it brings to the organization.

Credentialed and Privileged Clinical Nurse Specialists.

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. 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. The exemplars illustrate CNS practice as an independent provider within a health system. 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.

Exploring Clinical Nurse Specialist Impact in Primary Health Care: Exemplars From a Student's Clinical Practice.

Primary healthcare (PHC) is a clinical frontier full of opportunities for clinical nurse specialists (CNSs) to improve population outcomes, facilitate smooth care transitions, and overcome challenges through a unique lens. Clinical nurse specialist practice in primary care is exceedingly rare, and there is a paucity of literature on the topic. This article provides exemplary projects implemented by a CNS student in a primary care clinic. Primary healthcare has been described as the "front door" of the health system. It has increasingly relied on nursing to deliver health services, yet PHC and nursing practice in this setting remain poorly defined. Clinical nurse specialists are well-positioned to define these concepts, standardize processes used to deliver services, and impact patient outcomes in PHC. The CNS student successfully supported a primary care clinic in these activities. Reviewing the impact of the CNS student's experience offers a better understanding of CNS practice in PHC. Gaps exist in the literature regarding best practices and care delivery in PHC. Clinical nurse specialists are educationally prepared to address these gaps and improve patient outcomes at the health system's "front door." Utilizing a CNS's unique skill set achieves cost-effective and efficient healthcare delivery in a new way that bolsters the strategy of utilizing nurse practitioners to meet the challenge of provider shortages.

Interface of Clinical Nurse Specialist Practice and Healthcare Technology.

This article demonstrates the leadership role of the clinical nurse specialist in developing and implementing healthcare technology across the continuum of care. Three virtual nursing practices-facilitated self-care, remote patient monitoring, and virtual acute care nursing-illustrate how the clinical nurse specialist is well suited to transform traditional practice models to ones that use healthcare technology effectively. These 3 practices use interactive healthcare technology to gather patient data and allow communication and coordination with the healthcare team to meet patient-specific needs. Use of healthcare technology in virtual nursing practices led to early care team intervention, optimized care team processes, proactive patient outreach, timely access to care, and reduction in healthcare-associated errors and near-miss events. Clinical nurse specialists are well positioned to develop innovative, effective, accessible, and high-quality virtual nursing practices. Integrating healthcare technology with nursing practice augments care for various patients, ranging from those with low illness severity in the outpatient setting to acutely ill patients in the inpatient hospital environment.

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.

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.

Nurses' Perceptions of the Clinical Nurse Specialist Role Implemented in a Highly Specialized University Hospital in Spain: A Qualitative Study.

To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain. Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.

Clinical Nurse Specialist Practice: Impact on Improving Sedation Practice in Critical Care.

Prolonged mechanical ventilation results from deeper levels of sedation. This may lead to impaired respiratory muscle functioning that develops into pneumonia, increases antibiotic use, increases delirium risk, and increases length of hospitalization. A trauma and surgical intensive care unit interdisciplinary team conducted a quality improvement project to lighten sedation levels and shorten mechanical ventilation time. The project included multimodal elements to improve sedation practice. Standardizing the spontaneous awakening trial algorithm, creation of electronic health record tools, integration of sedation practices into daily rounds, and focused education for nursing were implemented in April 2021 through October 2021. A reduction of median hours spent on mechanical ventilation was achieved. Mechanical ventilation hours decreased from 77 to 70. Richmond Agitation Sedation Scale levels improved from a median of -2 to -1, and daily spontaneous awakening trials increased from 10% to 27% completed. The quality improvement project demonstrated that, with increased daily spontaneous awakening trials and lighter sedation levels, the time patients spent on mechanical ventilation was shortened. There was no increase to self-extubation with lighter sedations levels. Shorter time on mechanical ventilation can reduce patient harm risks.

The pediatric clinical nurse specialist: A children's hospital journey

The role of the pediatric clinical nurse specialist (CNS) is grounded in the core curriculum and competencies outlined by the National Association of Clinical Nurse Specialists Statement on CNS Practice and Education and the certifying body (National Association of Clinical Nurse Specialists, 2019). As of 2019, there were over 70,000 practicing CNSs across the United States (National Association of Clinical Nurse Specialists, 2019). The NACNS program directory outlines 12 CNS pediatric programs in eight states and over 60 adult programs across the country (National Association of Clinical Nurse Specialists, 2020).

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.

Developing New Clinical Nurse Specialist Educational Opportunities in Ambulatory Care Settings

Purpose The purpose of this project was to develop an ambulatory clinical practicum for clinical nurse specialist (CNS) students in rural and underserved Eastern North Carolina. Description of the Program A 14-week clinical practicum was designed for CNS students who participated in a Health Resources and Services Administration Advanced Nursing Education Workforce grant–sponsored program entitled “Advanced Practice Registered Nurse RURAL Scholars Program.” The objectives of the clinical practicum were to increase student competence in ambulatory care, identify critical knowledge and competencies in CNS ambulatory care, and determine potential opportunities for CNS practice in ambulatory settings. Outcome Students demonstrated increased awareness and interest in specific health challenges faced by rural and underserved communities and became aware of services available for individuals with complex healthcare needs. Deficiencies in the CNS curricula regarding ambulatory care were identified by students. Although the value of the CNS in ambulatory practice was appreciated by students, staff, and preceptors alike, opportunities for employment in ambulatory settings in rural and underserved communities continue to remain a challenge. Conclusion Student experiences in an ambulatory care CNS clinical practicum support the need for the development of knowledge and competencies in ambulatory care that will allow for the expansion of CNS practice in rural and underserved communities.

Informing and Supporting the New Clinical Nurse Specialist Prescriber.

Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.

Clinical Nurse Specialist Practice: Impact on Emergency Department Blood Culture Contamination.

Blood culture collection is a common procedure performed in emergency departments. Rate of blood culture contamination is a metric that is tracked by organizations to ensure appropriate treatment for patients suspected of having bacteremia and ensure appropriate use of hospital resources. A team of nurses and technicians undertook a quality improvement project to decrease blood culture contamination rates in a suburban emergency department. The project included use of standardized blood culture collection kits, creation of a dedicated collection team, and implementation of a new blood culture collection device. Through this work, blood culture contamination rates decreased from greater than 3.0% to less than 1.5% consistently for nearly 24 months. Providing feedback and continued monitoring has made this quality improvement initiative a success for the department and the organization and has resulted in cost savings of nearly 2 million dollars.

Direct-to-Consumer Online Prescribing: Opportunities and Risks for Clinical Nurse Specialist Practice.

Direct-to-Consumer Online Prescribing: Opportunities and Risks for Clinical Nurse Specialist Practice.

Direct to Consumer Online Prescribing - Opportunities & Risks for Clinical Nurse Specialist Practice.

Direct to Consumer Online Prescribing - Opportunities & Risks for Clinical Nurse Specialist Practice.

Adapting Clinical Nurse Specialist Practice Priorities During the COVID-19 Pandemic.

Adapting Clinical Nurse Specialist Practice Priorities During the COVID-19 Pandemic.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease.

Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis.

To conduct a construct validity test on a clinical nurse specialist core competency scale. Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research-driven efforts to develop and validate clinical nurse specialist core competencies. A descriptive study, using an online self-report questionnaire, was conducted from May to September 2019 in three Nordic countries. An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50-item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study. One hundred and eighty-four responses were obtained (Finland n=52, Denmark n=95, Iceland n=37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale. Based on the analysis and subjective interpretation, we suggest a 47-item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study. The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate-level programme curricula and inform future competency research.

Emergency Use Authorization for Bamlanivimab in Mild to Moderate COVID-19: Implications for Clinical Nurse Specialist Practice.

Emergency Use Authorization for Bamlanivimab in Mild to Moderate COVID-19: Implications for Clinical Nurse Specialist Practice.