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Clinical Nurse Specialist


Hahn School of Nursing and Health ... care setting Remainder indicated home health care, long term care, public health ... Organization Role in Policy ... – PowerPoint PPT presentation

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Title: Clinical Nurse Specialist

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

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 masters and doctoral
  • CNSs have additional certifications or licenses
    as a CNS

Where Do CNSs Practice?
  • CNSs are expert clinicians who work in a variety
    of clinical practice settings
  • Population pediatrics, geriatrics, womens
  • Setting critical care, emergency room
  • Disease or medical subspecialty diabetes,
  • 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

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
  • Instrumental in managing change of practice (EBP)

Where Do CNSs Work ?
  • CNSs practice in a variety of health care
  • 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

CNSs Are
  • Leaders of teams in organizations to improves
    quality and safety of care
  • Developers of programs to prevent avoidable
  • 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).

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
  • Reducing the costs of care

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

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

Typical CNS Day
  • Make rounds on high risk cases
  • Coordinate/attend multidisciplinary care
  • 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

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
  • Meet with staff who is presenting an inservice
    for the first time

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 ?????

CNS Summary
  • Clinical experts in diagnosis and treatment of
    illness in specialties across the continuum of
  • Provide evidence-based care in a variety of
  • 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