Observing the Work of the Clinical Nurse Specialist

Developing a core competency framework for advanced practice nursing in mainland China: a sequential exploratory study

BACKGROUND

Advanced Practice Nursing (APN) have been highly valued and an integral part of the health care system. Development and establishment of new APN roles is a complex process that has resulted from a wide variety of reasons, key component is a lack of a competency map delineation and role evaluation. Currently, however, competence framework has not been compared at an international level. In mainland China, APN have been introduced in some organizations but their competency domains have not yet been clearly defined, this study aimed to identify the core competencies for advanced practice nursing.

METHODS

This study was performed in two phases: first, in-depth and semi-structured individual interviews with 46 participants from key stakeholders were carried out followed by a qualitative content analysis, then an item pool of core competencies was constructed by extracting data from the first phase and the results from previous studies, scales and documents; second, a Delphi technique was conducted with the participation of 28 experts from 7 areas of China to form the final core competency framework for advanced practice nursing.

RESULTS

Through the qualitative phase, the core competency framework with six domains and 70 items emerged and then entered into the Delphi phase. Twenty-eight of 30 experts finished 2 rounds of Delphi approaches. The final core competencies for advanced practice nursing consisted of six domains with 61 items, including direct clinical nursing practice, research and evidence-based nursing practice, professional development, organization and management, mentoring and consultation, and ethical/legal practice.

CONCLUSION

This core competency framework consisted of six domains with 61 items can be used in competency-based education to cultivate advanced practice nurses as well as competency level assessment.

Time use of advanced practice nurses in hospitals: A cross-sectional study

AIMS

To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.

DESIGN

A cross-sectional, observational study.

METHODS

Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.

RESULTS

Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.

CONCLUSION

Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.

IMPACT

Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.

Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey

BACKGROUND

Clinical nurse specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for clinical nurse specialists. Previous studies have found that clinical nurse specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of clinical nurse specialists.

OBJECTIVE

To identify the practice patterns of clinical nurse specialists in Canada.

DESIGN

A descriptive cross-sectional survey.

PARTICIPANTS

Self-identified clinical nurse specialists in Canada.

METHODS

A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified clinical nurse specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis.

RESULTS

The actual number of clinical nurse specialists in Canada remains unknown. The response rate using the number of registry-identified clinical nurse specialists was 33% (804/2431). Of this number, 608 reported working as a clinical nurse specialist. The response rate for graduate-prepared clinical nurse specialists was 60% (471/782). The practice patterns of clinical nurse specialists varied across clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support clinical nurse specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a clinical nurse specialist and consequently made it difficult to determine the number of clinical nurse specialists in Canada.

CONCLUSIONS

This is the first national survey of clinical nurse specialists in Canada. A clearer understanding of these roles provides stakeholders with much needed information about clinical nurse specialist practice patterns. Such information can inform decisions about policies, education and organizational supports to effectively utilize this role in healthcare systems. This study emphasizes the need to develop standardized educational requirements, consistent role titles and credentialing mechanisms to facilitate the identification and comparison of clinical nurse specialist roles and role outcomes internationally.

Advanced nursing roles: a systematic review

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.

Reporting relationships of clinical nurse specialists in acute care

Reporting relationships between clinical nurse specialists (CNSs) and administrators (ADMs) can facilitate or constrain CNS practice and affect patient outcomes. Limited information is available comparing reporting relationships and perspectives of CNSs and ADMs.

PURPOSE

The purpose of the present study was to describe CNS and ADM reporting relationships and compare their perspectives about the activities and outcomes of CNS practice in acute care settings.

DESIGN

The present study uses a descriptive survey.

SETTING

Four healthcare organizations in the midwestern United States.

SAMPLE

Clinical nurse specialist participants (n = 30) were master's degree prepared and employed in an acute care setting. Administrator participants (n = 7) were responsible for supervision and evaluation of CNSs in their organization.

METHODS

Questionnaires were developed from literature and content review by experts. The CNS and ADM questionnaires contained separate sections for CNS and organization information with parallel construction of questions about CNS activities and outcomes.

FINDINGS

There was variability across organizations related to reporting relationships and structure of CNS work. No significant differences were found when comparing CNS and ADM perspectives of work activity proportions and the importance of 10 activities and 7 outcomes. The most important CNS activities included developing clinical protocols and guidelines, quality improvement, and coordination of care. The most important outcomes included evidence-based nursing care and skilled and competent nursing staff.

CONCLUSION

Comparing perspectives of work activity time, priority activities, and outcomes provides a basis for collaboration between CNSs and ADMs in reporting relationships.

IMPLICATIONS

Clinical nurse specialists should develop positive interactions and shared understanding with ADMs to improve effectiveness and enhance patient outcomes.

Clinical nurse specialist education: actualizing the systems leadership competency

PURPOSE

The purpose of this article was to show how sequenced educational strategies aid in the acquisition of systems leadership and change agent skills, as well as other essential skills for professional clinical nurse specialist (CNS) practice.

BACKGROUND

Clinical nurse specialist education offers the graduate student both didactic and clinical experiences to help the student transition into the CNS role. Clinical nurse specialist faculty have a responsibility to prepare students for the realities of advanced practice. Systems leadership is an integral competency of CNS practice.

IMPLICATIONS

The contemporary CNS is to be a leader in the translation of evidence into practice. To assist students to acquire this competency, all CNS students are expected to use research and other sources of evidence to identify, design, implement, and evaluate a specific practice change. Anecdotal comments from students completing the projects are offered. Student projects have been focused in acute and critical care, palliative care, and adult/gerontologic health clinical settings; community outreach has been the focus of a few change projects. Examples of student projects related to the systems leadership competency and correlated to the spheres of influence impacted are presented.

A modern African perspective on the role of the clinical nurse specialist

In Africa, there is an overwhelming and increasing prevalence of illnesses such as HIV and AIDS, tuberculosis, and malaria. This constitutes a "burden of disease" facing Africa. Nursing must evolve accordingly to the changing needs of clients, many of whom have chronic illnesses. In achieving desirable outcomes, it is essential to adopt and adapt the clinical nurse specialist (CNS) role so that expert and specialist practice is available to clients in a cost-effective manner. The role of the CNS singles out clinical responsibilities in a hospital setting so that nurse administrators can concentrate on the provision of resources. A CNS position in the hospital structure would offer a clinical career pathway for advanced practice nurses who wish to remain "by-the-bedside." Regional initiatives are already beginning to show a need for master's-prepared, advanced practice nurses in the clinical areas so as to reduce maternal mortality.

Strategies used by clinical nurse specialists in "difficult" clinician-patient situations

The purpose of this study was to describe strategies used by clinical nurse specialists when caring for patients involved in "difficult" clinician-patient situations. Clinical nurse specialist members of the National Association of Clinical Nurse Specialists were surveyed to identify frequently used and high-priority strategies. Subjects (N = 234) identified strategies from a wide spectrum of activities, with agreement found between highest and lowest frequently used and priority approaches. Respect for the patient and ability to focus on the issue at hand emerged in the highest reported strategies.

Centres of Excellence for the care of people with progressive ataxias

This article provides a description of the progressive ataxias and how such a diagnosis impacts on a person's life. The nurse's role in helping these patients, who can face numerous difficulties in everyday life, is highlighted. Moreover, the authors discuss the development of Ataxia Specialist Centres of Excellence for the diagnosis and management of people with ataxia, and the benefits believe these centres will bring to the care of these patients.