Clinical Nurse Specialist

1. Clinical Nurse Specialist Linda D Urden, DNSc, RN, CNS, NE-BC, FAAN Professor and Director Master’s and International Nursing Programs Hahn School of Nursing and Health Science University of San Diego

2. What is a Clinical Nurse Specialist ? • There are four types of advanced practice nurses: • Clinical Nurse Specialist (CNS) • Nurse Midwife • Nurse Practitioner • Nurse Anesthetist • CNSs are licensed registered nurses who have graduate preparation at the master’s and doctoral levels • CNSs have additional certifications or licenses as a CNS

3. Where Do CNSs Practice? • CNSs are expert clinicians who work in a variety of clinical practice settings • Population: pediatrics, geriatrics, women’s health • Setting: critical care, emergency room • Disease or medical subspecialty: diabetes, oncology • Type of Care: rehabilitation, home health, mental health, palliative care • Type of Problem: pain, stress, wounds • CNSs are independent practitioners and may form their own practice

4. Spheres of CNS Practice • Patient • May coordinate the care of a certain specialty population, e.g., HF, transplant • May manage clinics for specialty • May be consulted to provide teaching, support for a newly diagnosed condition • Staff • Mentor, role model for staff • Teach, rounds, consultant for complex cases • Organization • Lead system wide initiatives, multidisciplinary teams • Instrumental in managing change of practice (EBP)

5. Where Do CNSs Work ? • CNSs practice in a variety of health care settings • Per 2010 survey, 70% practice in some type of inpatient care setting • Remainder indicated home health care, long term care, public health centers, ambulatory care, correctional facilities, and private industry • CNSs teach in schools of nursing….increasing numbers with full time CNS practice while teaching courses in the schools

6. CNSs Are… • Leaders of teams in organizations to improves quality and safety of care • Developers of programs to prevent avoidable complications • Coaches of those with chronic diseases to prevent hospital readmissions • Consumers of evidence-based practice to ensure best care and services (MSN, DNP) • Researchers to create new knowledge to improves outcomes of care (PhD).

7. CNSs: Meeting the New Demands of a Reformed Health Care System • CNSs are uniquely positioned due to their expertise and skills to be leaders as we move forward with new models of care • Improving the quality and safety of care • Eliminating unnecessary care • Improving the care for those with chronic illnesses • Reducing the costs of care

8. How CNSs Can Meet Needs… • Increase effectiveness of transitioning care from hospital to home and prevent readmissions (create a Medicare benefit that would support providing transitional care) • Improve the quality and safety of care and reduce health care costs (leading EB system-wide changes: med errors, HACs, etc.) • Educate, train, increase the nursing workforce needed for improved health care system (EB orientation programs, mentor new and tenured staff)

9. How CNSs Can Meet Needs… • Increase access to community-based care through the expansion of Nurse Managed Health Care Centers (slow down progression of chronic disease • Increase the availability of effective care for those with chronic disease (promote self care and manage symptoms) • Improve access to wellness and preventive care (wellness company owned/managed by CNSs reduce costs)

10. Typical CNS Day • Make rounds on high risk cases • Coordinate/attend multidisciplinary care conference • Consult with staff on complex cases (anywhere in the organization) • Discuss cases with MDs, other care team members • Teach a specialty class • Meet with nurse residency program participants

11. Typical CNS Day • Attend leadership meeting • Meet with pharmacist on join EBP project • Meet with Director regarding new orientees • Consult with another CNS • Conference call with professional organization committee meeting • Intervene with new equipment that appeared with a patient from the OR- that staff had never seen before • Meet with staff who is presenting an inservice for the first time

12. Typical CNS Day • Work on revising one of the many procedures that need updated • Discuss with faculty the CNS student who you will be precepting next semester • Prepare for the system-wide EBP team meeting that you will lead tomorrow • Did anyone say lunch ?????

13. CNS Summary • Clinical experts in diagnosis and treatment of illness in specialties across the continuum of care • Provide evidence-based care in a variety of settings • Direct providers of Medicare services • Prescribers of medications (38 states) • Coordinators of care across settings • Leaders and facilitators of change among large groups and organizations • Researchers in identifying effective interventions with proven outcomes

14. www.NACNS.org Urden@sandiego.edu