The Bright Future for Clinical Nurse Specialist Practice

Implementing a Transition-to-Practice Program for Novice Clinical Nurse Specialists: A Pilot Project

PURPOSE

The aim of this study was to determine the impact of a transition-to-practice program on job satisfaction among novice clinical nurse specialists (CNSs) in the US Air Force.

PROGRAM DESCRIPTION

A needs assessment was conducted among currently practicing Air Force CNSs (n = 30) to establish the necessity for a transition-to-practice program. Newly graduated CNSs (n = 8) were paired with experienced CNS mentors and met every 2 weeks for 2 months to discuss progress on the CNS core competencies. Before beginning the program, mentees self-reported perceptions related to the core competencies. Mentors focused on areas of self-reported low competency. The Nursing Context Index was administered preintervention and postintervention to assess the program's impact on job satisfaction.

OUTCOMES

Overall job satisfaction among novice CNSs improved from 5.01 to 5.57 (scale, 1-7) after completing the program. Personal satisfaction (4.30-5.63) and satisfaction with professional support (5.28-6.00) showed the greatest improvement out of the 4 elements of job satisfaction evaluated.

CONCLUSIONS

Transition-to-practice programs can be beneficial for novice CNSs in establishing their practice. Future studies with larger sample sizes over longer periods of time are necessary to determine the true impact of similar programs.

Association between advanced practice nursing and 30-day mortality in mechanically ventilated critically ill patients: A retrospective cohort study

PURPOSE

Little is known about the association between advanced practice nursing and mortality. The aim of this study was to evaluate whether the presence of advanced practice nurses (APN), that is, certified nurse (CN) and certified nurse specialist (CNS) in intensive care, is associated with 30-day mortality for mechanically ventilated critically ill patients.

MATERIALS AND METHODS

Using a Japanese national in-patient database, we identified 45,620 patients who were admitted to an intensive care unit (ICU) and received mechanical ventilation within 2 days of hospital admission between 1 April 2014 and 31 March 2015. We assessed the association between the number of CN/CNSs per 10 adult ICU beds and 30-day mortality.

RESULTS

We examined 8955 patients in 134 hospitals without CN/CNSs and 36,665 in 284 hospitals with CN/CNSs. Overall, the number of CN/CNSs per 10 adult ICU beds ranged from 0 to 7.5. In the multivariable analysis, the number of CN/CNSs per 10 adult ICU beds was significantly associated with a reduction in 30-day mortality (adjusted odds ratio 0.97; 95% confidence interval, 0.94-1.00; P=0.023).

CONCLUSIONS

Our findings show that APNs may play an important role in improving patient outcome in the adult ICU.

The Advanced Practice Clinical Nurse Specialist

The clinical nurse specialist (CNS), one of the 4 advanced practice registered nurse (APRN) categories, has a unique role to play in contributing to high-quality patient care and system-level change across multiple health care settings. CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge. The purpose of this article was to describe the role of the CNS, explain the background of the CNS role as it relates to APRN practice, provide current CNS workforce statistics, and share opportunities for hospitals and health systems to strategically use CNSs to advance patient and organizational goals.

Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland

AIMS AND OBJECTIVES

To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland.

BACKGROUND

While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy.

DESIGN

A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31).

METHODS

Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland.

RESULTS

The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies.

CONCLUSIONS

Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies.

RELEVANCE TO CLINICAL PRACTICE

Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses.

Clinical nurse specialists: then, now, and the future of the profession

PURPOSE

The role of the clinical nurse specialist (CNS) has evolved significantly over time and will continue to do so. Future students, faculty, and practicing CNSs should be aware of their roots, current status, and what the future may entail.

RATIONALE

An accurate understanding and reflection of the past, present, and future of this specific advanced practice nursing specialty could ensure its continued success as a predominate force in health restoration and the promotion of the health and well-being of people.

DESCRIPTION

A review of the literature yielded a lack of cohesive information about the evolution of the CNS role, prompting an investigation into the historical, current, and future aspects of the CNS.

OUTCOME

This article compiles information related to the evolution of the CNS role and what the future may entail.

CONCLUSION

An understanding of how the CNS role evolved, where it stands currently, and future considerations may help clarify the role, improve utilization of the CNS in a variety of settings, improve standards for CNS education and certifications, and advance this nursing practice specialty.