Role of the Clinical Nurse Specialist as an Advanced Practice Nurse - Research Paper Example

? Clinical Nurse Specialist      The Role of the Clinical Nurse Specialist as an Advance Practice Nurse Clinical Nurse Specialists (CNS) are certified Registered Nurses (RNs) who practice as ‘Advanced Practice Registered Nurses’ (APRNs). Clinical nurse specialists offer expert clinical practice in their areas of specialty as well as act as researchers, consultants, educators, collaborators and clinical leaders within the service of a specific population of patients. Clinical nurse specialists should have undergone masters’ or doctorate programs of nursing under their areas of specialty (LaSala, 2007). The operational scope of clinical nurse specialists is wide, and this offers them a wide scope of coverage in their service delivery. The spectrum of operation includes dealing directly with patients, nursing personnel and the wider organizational structure of management concerned with issues of policy formulation and research implementation. The clinical nurse specialists may thus participate in the direct care of patients or engage in indirect care processes, which affect the care of a wider part of the patient population. Therefore, a clinical nurse specialist could take part in patient evaluation in one instance and in the next instance be part of a team building or overhauling a unit of healthcare professionals by making policies and recommendations on new evidence-based incorporations. The role of the clinical nurse specialist pervades the whole healthcare continuum, which includes interaction with the three important elements of the care system including the patient, nurse and system. These spheres overlap in the care continuum, and the roles of the CNS reaches all these spheres in an effort to improve nursing care and patient outcomes (Newhouse et al., 2011). The only difference in the operational set up is that the roles of the clinical nurse specialist vary subtly as s/he moves from one sphere to another in particular practice instances (Canam, 2005). Purpose of the Clinical Nurse Specialist as an Advance Practice Nurse The greatest and perhaps most significant role and purpose of a clinical nurse specialist as an advance practice nurse entails the integration of care along the healthcare continuum. The clinical nurse specialists have a direct impact on patient care, handling of professional practitioners in the business of care delivery as well as the direct interaction with the system as a whole. The pervasive nature of these roles cannot be handled by any other nursing practitioner because they lack a wider scope of education (LaSala, 2007). Apart from clinical knowledge, the clinical nursing specialists also have education and experience in administration, teaching, public health and research. As such, they can offer a good multi-tasking force whose services can go beyond patient care. Their wider spectrum of knowledge allows them to conceptually visualize the whole healthcare system. This ability makes clinical nurse specialist the best force towards improving healthcare. Therefore, they play a significant role of integrating the whole care system and being able to identify deficient areas and probable remedies (Canam, 2005). Clinical nursing specialists also play the role of introducing and implementing evidence-based practice through research and educational efforts. Their ability to comprehend the nursing system from the patient care view to the managerial and educational view allows them to not only conduct research, but also make objective decisions on policy formulation and implementation in the building of an evidence-based model of care. Clinical specialists gather significant amounts of data in the research and educational roles. The analysis of this information gives insight on better ways to possibly improve care, and as the change agents and educators, the clinical nurse specialists can teach the rest of the personnel on the implementation (LaSala, 2007). Objectives of the Clinical Nurse Specialist as an Advance Practice Nurse The objectives of the clinical nursing specialist fall into various categories that define the roles of the CNS. The first objective of a CNS is to offer direct clinical care in the normal clinical practice, which includes implementing nursing care, performing advanced assessment and evaluation of outcomes of care. The second objective entails delivering expert coaching under their educational role (LaSala, 2007). Under this objective, clinical nurse specialists offer guidance in the development of clinical expertise and at the same time helping the nursing force in integrating evidence-based practice into actual care. The educational role also extends to teaching patients and family on healthcare as well as the general public in the public healthcare context. The third objective entails the formation of collaborative relations in practice through the formation of multidisciplinary sharing. The collaboration with other personnel also entails offering consultative assistance in the review of alternative approaches to the implementation of planned changes (Newhouse et al., 2011). This also encompasses the education role where the clinical nurse specialist offers advice and mentorship to other professionals in placement or under his or her leadership mantle. The development of evidence-based practice is also another objective of the CNS. Research is an important objective for clinical nursing specialists, and this involves data collection and constant evaluation and analysis of care indicators. Clinical nurse specialists should evaluate practice and collaborate in research so as to develop a body of knowledge that will foster evidence-based practice upon the interpretation and application of the findings (LaSala, 2007). Fostering professional leadership and ethical decision-making is also an important objective for clinical nurse specialists. The objective of the CNS as a leader is to offer quality leadership in the allocation of resources, making of policies and decisions as well as in directing the healthcare delivery process. All this should be conducted objectively and innovatively so as to facilitate continuous improvement in care. The Background of Clinical Nurse Specialists The development of the practice and concept of advanced nursing has been a long and slow process. The initiation of specialization in this regard can be traced back to the Gold Mark Committee from 1923 (LaSala, 2007). The committee identified a need for the inclusion of public health roles as well as administrative and teaching roles in the nursing profession and curriculum. This identification made a significant role towards the expansion of the nursing curriculum and scope of roles under the nursing umbrella. The new curriculum based on the recommendations of the committee endeavored to increase theoretical learning on aspects, such a public health and administration, so as to widen the expertise of the specialists. This new approach de-emphasized clinical leadership but still held it as an integral part of the development of whole-rounded specialists. The onset of the 1950s showed an increased demand for nurses with specialized skills and knowledge. This call had three significant conceptualizations. The first was the creation of clinical competence that would foster understanding of a wide range of functions and develop in depth knowledge on practice. The second was the development of clinical expertise around the responsibility and coordination of care throughout the care continuum (LaSala, 2007). The third concept entailed the development of professional collaboration in the implementation of practice, which was meant to foster professional sharing of knowledge. The implementation of these concepts created the base upon which current nursing would be differentiated. In the early 1960s the shortage of primary care givers led to a recommendation by the Surgeon General for nursing practitioners to be trained in primary care so as to acquire a bigger force to support primary care delivery. The addition of this role was later to persist in the development of nursing expertise. The inclusion of specialist training also opened way to the development of graduate level specialized content for the profession (Brunnell & Byers, 1998). The development of this curriculum changes and new content coupled with increasing baccalaureate prepared nurse professionals led to a permanent entrenchment of the clinical specialization in the nursing profession (LaSala, 2007). In the 70s and 80s a transformative force emanating from discussions on roles and scope of practice between the nurse practitioners and clinical nursing specialists led to the merging of the two. The development of the advanced nurse practice was concluded by the final merging of the Council of Primary Nurse Practitioners and the clinical nurse specialists. This led to a conclusive formation of the body of nurses in advanced practice. Currently, the CNS force plays a significant role in carrying out activities that are often carried out by physicians in areas that may not be reached by physicians. Their specialization has enabled them to extensively participate in the care continuum from primary care delivery under the public health to direct clinical care of patients and finally to the system development end. For example, in less restrictive states clinical nursing specialists can make prescriptions, which were traditionally a reserve for the physicians. The increase of CNS participation has been associated to improved care delivery, but there is significant concern over legislative controls that significantly restrict service delivery even in areas the clinical nurse specialists can proficiently perform (LaSala, 2007). In view of this and the challenges in the availability of care, there is a need to increase CNS numbers and review legislative restrictions so as to offer the specialists more room for practice. Nursing Outcomes The development of advanced nursing practice and its implementation has been associated with improved patient outcomes including reducing length of hospitalization among patients and reducing costs of care. The clinical nurse specialists have proven to be indispensable in primary and acute care where they take on specialist or generalist roles. In an at areas where there is limited legislative restrictions care has significantly improved with the cost effectiveness being attributed to the fact that clinical nurse specialists can at times perform physician tasks that could cost slightly higher if the patients were to seek physician care. Additionally, clinical nurse specialists in private practice have been able to take care closer to people, especially in places where there are no physicians. Their tendency to open up service provision in underserved regions has significantly improved access to care. The availability of competent care has been limited to populations in underserved rural areas because of the absence of available and willing ‘supervising’ physicians (Brunnell & Byers, 1998). The proper use of CNS’s physician assistants and nursing practitioners has been cited as one of the solutions to addressing the shortage of physicians. The increasing demand for physician services has already been partly met by the CNS force. However, there might still be greater restrictions in form of legislation which prevent them from fully exercising their expertise. Therefore, their use should be considered a strategic approach towards beating the shortage for physicians meant to implement physician care in underserved areas (Health Affairs, 2009). The implementation of the comprehensive use of the CNS as non-physician primary care providers is thus a solution that can improve the outcome of patient care in the face of physician shortages in underserved areas. Research initiated by CNS as well as data collection and monitoring of patient care indicators by the CNS workforce has also significantly improved clinical research and permitted the implementation of evidence-based practice. The impacts of the outcomes and the overall development of advanced nursing have included improved care for the patient population and further specialization and development of a more specialized nursing force than was in the past. Nursing students seem to seek a preference area to advance their practice according to this latest trend in specialization of advanced nursing (Newhouse et al., 2011). Aspects of Spheres of Influence The spheres of influence in which the clinical nurse specialists operate include three conceptual areas or zones that define the healthcare continuum. These include the patient, system and nursing personnel. These are the three overlapping domains in which the clinical nurse specialist operates. The patient sphere includes all people-healthy and unhealthy-that may have health driven interactions with the nursing specialist for the sake of getting clinical attention. This includes patients under clinical care as well as their families. It is in this sphere that the clinical nursing specialist exercises their clinical care skills. It also involves public health services provision in the preventive primary care approach (Newhouse et al., 2011). The nursing personnel sphere includes the professional space within which a clinical nurse specialist operates collaboratively with the rest of the professionals in the care delivery process. In order to work effectively any clinical nurse specialist has to share information with other professionals offer advice and receive feedback. This involves extensive interaction with other professionals either in placement or practice. As a CNS s/he has a role to influence other practitioners in care delivery by participating the decision-making process, education and research processes that are necessary within this sphere. This sphere is responsible for the generation of professional practice and research-generated evidence that powers evidence-based practice (Safriet, 2011). The whole healthcare system forms the third sphere of operation in which the clinical nurse specialists operates. This sphere encompasses the administrative structures as well as all components that deal with leadership, policy formulation and planning. This sphere is more concerned with the development of guidance structures that guide the delivery of care. The system defines clear policies and regulative frameworks that govern the whole nursing practice. In spite of the differences in these spheres, they all overlap and bear effect upon each other. The primary goal of the clinical nurse specialist is thus to ensure that there is continuous improvement of outcomes across the whole system (Newhouse et al., 2011). In conclusion, clinical nurse specialists have improved not only the quality of care through evidence-based practice, but also the availability of care. In less restrictive states they are able to reach underserved populations and accomplish significant roles in providing primary care and public health. In essence, the whole evolutionary process towards specialization has bettered the nursing profession and overall healthcare delivery. References Brunnell, M. L. & Byers, J. F. (1998). Demonstrating the value of the advanced practice nurse: An evaluation model. American Association of Critical-Care Nurses , 9(2), 296-305. Canam, C. (2005). Nursing Research Illuminating the Clinical Nurse Specialist Role of Advanced Practice Nursing: A Qualitative Study. Nursing Leadership, 18(4), 70-89. Health Affairs (2009). Beware the Siren Song of New GME: Graduate Medical Education and Health Reform. Retrieved from http://healthaffairs.org/blog/2009/06/15/beware-the-siren-song-of-new-gme-graduatemedical-education-and-health-reform/ LaSala, A. C. Connors, M. P. Pedro, T. J. & Phipps, M. (2007). The Role of the Clinical Nurse Specialist in Promoting Evidence-Based Practice and Effecting Positive Patient Outcomes. The Journal of Continuing Education in Nursing, 38 (6), 262-270. Newhouse, R. Stanik-Hutt, J. White, M. K. Johantgen, M. Bass, B. E. Zangaro, G., . . . Weiner, P. J. (2011). Advanced Practice Nurse Outcomes: 1990-2008: A Systematic Review. Nursing Economic, 29 (5), 1-22. Safriet, J. B. (2011). Federal Options for Maximizing the Value of Advanced Practice Nurses in Providing Quality, Cost-Effective Health Care. The Future of Nursing: Leading Change, Advancing Health. Retrieved from http://www.nap.edu/catalog/12956.html Read More