The Role of the Clinical Nurse Specialist as Clinician and Advocate in a Primary Health Care Clinic

Reflections on Ambulatory Care Nursing and the Impact of the Clinical Nurse Specialist

OBJECTIVE

The aims of this study were to identify and discuss reflections of ambulatory care nursing and the integral role of the clinical nurse specialist (CNS) in defining nursing practice in the ambulatory care setting.

DESCRIPTION OF PROJECT

Three CNSs and a CNS student, all assigned to the ambulatory care setting, discussed their experiences supporting nursing practice in the ambulatory care setting. Major reflections were identified, organized, and then expounded from personal experiences and published studies to highlight the impacts of the CNS in ambulatory care nursing.

OUTCOMES

Four major reflections were identified: ambulatory nursing is complex, ambulatory care nursing is in its infancy, ambulatory care nursing adds value, and opportunities exist for measuring the impact of ambulatory care nursing. Progress is being made in determining the role of the nurse in the ambulatory care setting, but more work is required. The CNS is prepared to define nursing practice in the ambulatory care setting and develop nursing-specific resources that support nurses in practicing to the full extent of their licensure.

CONCLUSION

The ambulatory care setting is expected to support the majority of the healthcare needs of the future. Ambulatory care nurses are well suited to meaningfully contribute to patient care. Evidence-based nursing practice in this setting is vital to ensure safe, quality patient care.

The effect of a gerontology nurse specialist for high needs older people in the community on healthcare utilisation: a controlled before-after study

BACKGROUND

Nurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care.

METHODS

This was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts.

RESULTS

A total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group.

CONCLUSIONS

This specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design.

TRIAL REGISTRATION

Retrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314.

Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives

AIMS AND OBJECTIVES

To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals.

BACKGROUND

Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary.

DESIGN

A qualitative descriptive general inductive design was used.

METHODS

Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes.

RESULTS

Data analysis revealed two central themes from the older people perspective: "holistic expertise" and "communication." Two main themes were identified from the health professional perspective: "competency" and "service delivery." Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial.

CONCLUSIONS

The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at-risk older people in the community.

RELEVANCE TO CLINICAL PRACTICE

The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist.

From Hospital to Ambulatory Care: Realigning the Practice of Clinical Nurse Specialists

PURPOSE/OBJECTIVES

This article describes how a large healthcare organization expanded the practice of clinical nurse specialists from the hospital to the ambulatory setting.

BACKGROUND

Clinical nurse specialist practice traditionally focused on actualizing the 3 spheres of influence (patient, nurse, and organization) in the hospital setting.

RATIONALE

Changes in the healthcare system shifting patient care to the ambulatory setting created opportunities for clinical nurse specialists to improve patient outcomes in this setting.

DESCRIPTION

An innovation framework from the Mayo Clinic Center for Innovation based on inspiration, generation of ideas, experimenting, and diffusion was used to assess and prioritize the work of clinical nurse specialists in the ambulatory setting.

OUTCOMES

Clinical nurse specialists became integral members of hospital and ambulatory nursing leadership. In the ambulatory setting, they are partnering to standardize patient care, providing tools for nurses to practice to full scope, and identifying and providing solutions for patient safety issues.

CONCLUSION

Aligning clinical nurse specialists in the hospital and ambulatory care settings allows partnership with multidisciplinary teams to ensure that evidence-based practices and standardized care are infused across the continuum of care.

IMPLICATIONS

Evidence-based practices and standardized care encourage nurses to practice to full scope and focus on improved patient outcomes.

[Differences and similarities between the competencies of a nursing supervisor and an advanced clinical nurse specialist]

INTRODUCTION

With the aim of contributing to the development of a more specific professional regulation, the present study was to identify differences and similarities between the competencies of the nursing supervisor and clinical nurse specialist in an intensive care unit.

MATERIAL AND METHODS

A critical analysis of the literature published between 2003 and 2013 was conducted, identified through systematic searches in electronic databases, health management and practitioner journals and reference lists of the 17 items included.

RESULTS

«Management and administration» and «direct clinical practice» were identified as specific competencies of nursing supervisor and clinical nurse specialist respectively. «Collaboration», «leadership» and «research» emerged as competencies shared by both profiles, but with different a operationalization way of conducting it.

CONCLUSIONS

These findings imply that regulation, education and implementation of these profiles must address their specific skills as the distinctive approach taken in operationalizing shared.