Nursing Capstone: An Analysis of Clinical Nurse Specialist - Essay Example

? Nursing Capstone: An Analysis of Clinical Nurse Specialist Nursing Capstone: An Analysis of Clinical Nurse Specialist Background Hamric (2008) defines a clinical nurse specialist (CNS) as an expert clinician working in a specialized field of nursing. They act as clinical leaders for an area or program of nursing practice. CNSs are products of advanced nursing practice i.e. application of advanced range of theoretical, practical and research based skills, knowledge and competencies to improve the quality of services offered to patients in a defined clinical area or in the general nursing profession. Educational For an individual to be considered a legitimate Clinical Nursing Specialist (CNS), Duffy et al. (2009), assert that they are required to possess a graduate degree (Masters or Doctorate) in nursing. The graduate level should reflect clinical application of the CNS concept. If a person lacks graduate training in CNS, they are required to compensate by acquiring a post-master’s certificate within three years after the date of hire. Practice Dissemination of the specialized skills and knowledge possessed by CNSs is focused on three prominent areas; patient/family, nurses/the nursing profession, and nursing organizations/systems (Lewandowski and Adamle, 2009). CNS partners with nurse managers in promoting leadership in the clinical practice. They also act as coordinators and guides to the nursing projects or activities in clinical areas. CNSs are responsible for collaborating with other members of the health care fraternity to design and implement efficient and cost effective care strategies. Some of the specialty areas purported by Lewandowski and Adamle (2009) as identified with CNS include population e.g. adults, disease or medical specialty e.g. cancer, the setting e.g. emergency room, type of care e.g. psychiatry as well as the nature of the problem e.g. eating disorders. The main role of CNS is the provision of direct patient care. The specialist also collaborates with the nursing personnel in a wide variety of ways in ensuring effective delivery of care services. They utilize their expertise to perform roles related to clinical, education, consultancy, research and leadership. This improves the quality and cost-effectiveness of the medical services offered to patients as well as the professional development among nurses. CNS can be practiced in a wide range of settings such as community health settings, educational institutions mental health settings, long term care facilities as well as private practice. Certification Requirements According to Duffy et al (2009) and Goudreau & Smolenski (2008), CNSs receive certification through American Nurses Credentialing Centre (ANCC) as well as other specialty organizations. Potential candidates are required to fulfill all the certification requirements before applying for the exam. Issues and Challenges One of the prominent challenges faced by the CNSs includes difficulty in the implementation of scientific findings (Fulton, Lyon and Goudreau, 2010). The modern advances in medical technologies allow medical researchers to generate standards and accurate findings for the people working in the medical profession. However, CNS may find it difficult to implement the research and analyzed information into the actual clinical practice especially in critical disease cases. The CNS practice may also be faced with low staff levels that place more performance demand on the inadequate workforce; making implementation difficult. The specialist may also lack adequate training on efficient and professional techniques of implementing the scientific findings. CNSs may also fall victim to conflict of roles. The clinical nursing specialists belong to a diverse category of advanced practice nurse practitioners, certified nurse midwives and nurse anaesthetists (Leary et al, 2008). Their roles overlap with that of other practitioners in research, education, consultancy as well as administrative functions. Ambiguity of roles complicates the integration of the nurses in the health care industry; negatively affecting their performance. The specialists also face challenges related to the protection of title. Protection of the title regulates the role of the nurses in ensuring that only qualified nurses offer services. However Duffy et al (2009) affirms that many states lacks title protection regulations related to CNSs. This implies that the CNSs in such states are not recognized as advanced nurses. This restricts their services and negatively affects their roles as they are subject to discrimination. According to Leary et al (2008) and Duffy et al (2009), another issue that affects the CNS practice is reimbursement and billing challenges. All CNSs are subject to reimbursement through Medicare program when engaging in physician roles. Although some regions possess concrete and efficient billing and coding systems, others deny specialists the reimbursements even after they perform the physician’s work. The problems related to billing and reimbursement discourages CNSs leading lowering of the service quality standards. Even the process of obtaining the reimbursement is complicated and lengthy. This implies that most of them would not be willing to engage in the physician’s work because the motivation that rewards and remuneration generates is unavailable. Philosophy of Nursing Professional nursing has made significant improvements since inception, advancing from a skill-based concept to a discipline and profession. The discipline has continued to justify its unique place in health care delivery due to the need of establishing a unique body of knowledge that is acceptable by scholarly and other scientific disciplines. Understanding the nature (ontology) and structure (epistemology) help people to philosophically realize that nursing emanates from the world view (Fulton, Lyon and Goudreau, 2010, p. 29). Nursing philosophy endorses the ethical values that the CNS as well as other stakeholders in the clinical practice consider basic. Most of the arguments have theological allusions to moral beliefs of communities. Therefore, the philosophical aspect of CNS should address factors such as the society, environment, recipients of the specialist’s services and the interaction of the environment, society and an individual. Human beings have a right to be handled with dignity and respect; from conception to death. This is an indication that any behavior by the CNS’s that may compromise body health is subject to violation of the human rights. This philosophy also upholds the fact that human beings are affected by both external and internal environment. Any specialized health considerations should incorporate the well-being of the patient’s environment to ensure effective administration of health care. The CNSs’ roles should always be focused on health improvements and offer additional assistance in critical or desperate health situations. They should also desist from viewing their roles as tasks that must be checked off or burdens, but rather they offer significant contribution in life preservation. Nursing philosophy emphasizes on upholding human ethics and values appropriate for recognition of the sanctity of human life. According to Pesut, B. (2008), this amounts to spiritual care. Some of the CNS activities that exhibits spiritual care includes sympathizing and helping patients in during times of suffering and pain, listening to patients and carefully analyzing their situations with the view of improving their conditions and supporting the spiritual believes that different patients possess. Caring Successful CNSs possess skills related to the art of caring and apply their scientific knowledge to implement it. One of the strategies that can be applied in enhancing care is focusing on collaboration (Peters-Watral et al, 2008). A collaborative team has a higher capability of implementing as well as improving the roles and responsibilities of CNS. Complex health organizations are characterized by the presence of various roles whose successful implementation requires cooperation to ensure effective management of medical care. However, collaboration may be affected by the disparity in professional perspectives that occur among the health care providers. Successful implementation of collaborative strategies requires mutual respect, understanding and support for individual roles. Collaboration can only be realized if the members possess a shared vision, goals and skills such as communication. The roles of CNS exemplify care and concern towards human life. Another way in which they enhance the continuum of care is through acting as independent agents of health improvement. They promote care among the nursing staff through acting as the clinical leaders of the staff. They also employ engagement through working with other nurses to promote care. The direct approach of dealing with patients ensures that their care concerns are adequately addressed. They offer superior care service compared to other nurses as they undergo special and enhanced training. This ensures enhanced education and experience that enables them serve as expert practitioners. With their wide knowledge in health care, the patients are assured of superior care services. Stahl, Nardi and Lewandowski (2008), asserts that the concept of care is also exhibited by the counseling the CNS offer to patients; emotional encouragement enhances healing. Ethical Issues Ethical conduct is a crucial aspect of CNS that is embedded in the values and beliefs. It involves applying knowledge related to the ethical principles, analysis of difficult situations and making decisions in response to these situations. According to Martin-Misener et al (2010), the ethical conduct is determined by the possession of the emotional competency such as self-awareness, social-awareness and relationship competency as well as the knowledge on the health care ethics and moral reasoning. Analysis of the ethical conduct of CNS leads to the identification of three ethical issues; nonmaleficence, autonomy and justice. According to Fulton, Lyon and Goudreau (2010), autonomy defines a situation whereby individuals are given freedom to choose and enact their own decisions. The CNSs are required to respect the decision of their clients. Most importantly, focus on autonomy emphasizes on the respect for human dignity. They are required to deliver nursing services according to the human need and values irrespective of their economic, social, physical or political orientation. For instance, a deceptive or dishonest interaction with patients violates the principle of autonomy. Another issue is the failure to adhere to nonmaleficence i.e. the CNS should not commit any action that may inflict harm to the health care recipients. The inability or the unwillingness of a CNS to deliver high quality services amounts to the violation this ethical aspect. The policies may cause harm to the service recipients if they retain the least experienced CNS as they will not deliver the required health care standards. According International Council of Nurses (2008), another potential ethical issue that the CNS may face is justice. This guides on equal distribution of resources characterized by scarcity. Conflict related to ownership of intellectual property, new innovations or products leads to conflict of interest and injustices. Most of these problems are caused by some of the innovators in the nursing industry that may share research resources leading to conflict of results ownership. The CNS may also fail to deliver justice to the patients due to limitation or lack of resources required in promoting the health of the patients. Legal Implications According to Walker, Urden and Moody (2009), the prominent legal implications that characterizes the CNS role is credentialing. The clinical nurse specialists undergo credentialing to ascertain whether they have attained the minimum standards and requirements at the required time. Credentialing mechanisms includes all the legal or regulatory mechanisms such as registration and licensure. The process also incorporates professional mechanism such as accreditation and certification. These legal/regulatory/professional mechanisms assist in ensuring that the public is safe from the negative impact that can be caused by unqualified CNSs. For the CNS to legitimately position themselves in the nursing practice, they should remain updated on the changes occurring on credentialing processes. CNSs are also subjects to legal implications related to licensure. Licensure is the legal authorization for practicing a profession within a certain field of practice (Fulton, Lyona and Goudreau, 2010, p. 341). Apart from prohibiting people from operating under the field of study they are not designated, licensures can prevent an individual from using the CNS title. Licensure protects the health, welfare and safety of the public through minimizing or eliminating any form of professional incompetence that may result from engagement or hiring unqualified CNSs. One of the conditions that licensure focuses on is education qualification. Registration is another from of legal requirement that a CNS has to fulfill if they wish to be recognized as a legitimate advanced specialist nurse. The government maintains the official list of the qualified CNSs. Most state boards only rely on the academic qualifications when offering registration forms. Another legal implication certification offered by the American Nurses Credentialing Centre (ANCC) as well as other specialty organizations (Goudreau & Smolenski, 2008). Potential candidates are required to fulfill all the certification requirements before applying for the exam. Cultural Competence The cultural competence describes the strategies applied by the CNS in fulfilling their roles and obligations according to the role demands. According to Sanders (2008), their entire basic roles should exhibit in superior role play compared to the other nurses. For a CNS to be an independent provider for quality standard care as well as a leader for the nursing staff, the cultural competencies required include: exploring and studying the mechanisms of improving the patient care; devising the most effective means of understanding the patient needs; applying the theoretical knowledge to practice and observing as well as reporting the results in an objective manner (Fulton, Lyona and Goudreau, 2010, p.5). To justify their position as professional nurses with competence and advanced knowledge in nursing, the CNS should be involved in activities such as provision of leadership in the planning of patient care, teaching and engaging in direct nursing care. As expert professional practitioners, the CNSs are expected to demonstrate high standards of cognitive ability and knowledge. The individuals should also portray the skills of an excellent decision maker as well as the ability to easily identify a problem and find effective solutions. Self-awareness requires these individuals to undertake a self-reflection on their experience and the impact their past decisions. Health Care Delivery CNSs should be equipped with personal improvement strategies that can enhance the capacity to deliver efficient services to patients. This enables them to raise their self-knowledge and acquire confidence in dealing with emotional situations encountered when handling clients. One of the strategies applied in ensuring effective care delivery is self management (Duffyet al, 2009). They should remain clear-headed and maintain composure when looking for effective ways of dealing with the health situations. Professionals that have high levels of self-regulation share many experiences with their colleagues and other stakeholders. This enables them to receive essential responses that can enhance their service delivery standards to the clients. Self-management improves the capability of a CNS to perform in situations defined by immense emotions and unpredictable outcomes. These professionals can also enhance service delivery through increasing their levels of social awareness. CNS interacts with a wide range of clientele while undertaking their roles. High interaction levels enable them to understand the problems facing their clients better through establishment of relationships. This allows them to apply improvement strategies such as engagement, availability and service competence. At a personal level, the CNS should be able to apply their self awareness capabilities to recognize their moods, drives and emotions (Fulton, Lyon and Goudreau, 2010). They should be able to understand how these emotions affect their performance. Emotional analysis of their personal feelings is crucial in anticipating the impact such a scenario may impact on service delivery. Self awareness is also crucial in understanding the reasons why patients may act in an unpleasant manner. This enables them to relate the past experience in dealing with such issues; thus, enhancing the standards of the care services delivered. Professional Goals According to Hamric, (2008), the professional goals of a CNS includes improving the personal level of knowledge in CNS and nursing in general, attain proficiency and acquire excellent leadership skills. The BSN program is of surmountable significance in enhancing the knowledge level because it borrows on a wide range of literary sources such as social and humanities literature. This helps the participants to acquire a holistic view of the concept of nursing care. The program has also imparted knowledge related to integrating the nursing practices in assisting families as well as communities suffering from a variety of health problems. The knowledge attained from the program is also sufficient in the evaluation of the trends and issues in the health care delivery among the health care organizations and systems. The program also assists in the acquiring of leadership goals through involvement in the activities under the system of leadership. Such activities include consulting with all units and professionals involved in the provision and improvement and participation in need identification and evaluation of health equipments to ascertain their effectiveness in promoting health care (Royal College of Nursing, 2010). One of the roles of the participants is designing and developing programs as well as spearheading the innovative activities required in the improvement of the service delivery. Attainment of proficiency has been enhanced by communication programs that enhanced the use of oral, written and interpersonal communicating patterns. The program also allows incorporation of evidence –based practice for delivery and evaluation of the practice as well as evaluation of health issues for use in various settings. References Bryant-Lukosius, D. (2010). The Clinical Nurse Specialist Role in Canada: Forecasting the Future through Research. Canadian Journal of Nursing Research. 42(2): 19–25. Duffy, M., Dresser, S., Fulton, J. S., & National Association of Clinical Nurse Specialists. (2009). Clinical nurse specialist toolkit: A guide for the new clinical nurse specialist. New York: Springer. Fulton, J. S., Lyon, B. L., & Goudreau, K. A. (2010). Foundations of clinical nurse specialist practice. New York: Springer. Goudreau, K., & Smolenski, M. (2008). Credentialing and Certification: Issues for Clinical Nurse Specialists. Clinical Nurse Specialist. 22(5): 240–4. Hamric, A. B. (2008). A definition of advanced nursing practice. St. Louis, MO: Saunders Elsevier. International Council of Nurses. (2008). 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