Clinical Nurse Specialist: Acute Care

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Clinical Nurse Specialist Acute Care

• Doris Sawatzky-Dickson RN MN RLC
• Neonatal Intensive Care,
• Childrens Hospital

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Outline

• Needs Assessment
• Model of Advanced Practice Nursing
• Role of CNS in acute care

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(Found in CNS Toolkit on page 7)
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Needs Assessment

• (Outlined in the CNS Guide starting on page 4, NP
  Guide starting on page 9)
• Stakeholders if you dont involve them you may
  be setting up failure
• Population some obvious, others must choose
  priority group
• Service Utilization formal and informal
  patterns find out what is really happening

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Needs Assessment

• Assessment of needs use stakeholders to
  identify the gaps
• Goals prioritize, be clear on what you want to
  accomplish
• Solutions match the skills needed with the
  skills potentially available use this workshop
  to help determine what the options are

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Needs Assessment

• Planning
• Implementation
• Evaluation
• Concurrent sessions this afternoon will deal with
  some of those issues

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Role Options

• Nurse
• Physician
• Clinical Nurse Specialist
• Nurse Practitioner / RN (Extended Practice)
• Clinical Assistant / Physician Assistant

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Advanced Practice Nurses

• An overall term that encompasses both Clinical
  Nurse Specialists and Nurse Practitioners

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Strong Model of Advanced Practice Nursing

• Model adopted by the WRHA Advanced Practice
  Nursing Steering Committee
• Incorporated by all advanced practice nurses at
  the Health Sciences Centre over the past 2 years
• (Full description of this model starts on page 16
  of the CNS Guide and page 22 of the NP Guide)

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(No Transcript)
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Clinical Nurse Specialist

• Functions fully within the scope of nursing
  practice
• At HSC and with the proposed WRHA job
  description, requires Masters degree
• Takes the nursing role beyond the bedside

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CNS in NICU

• Intensive Care for newborn infants up to 45 weeks
  post conceptual age
• Approx. 500 admissions a year
• 80 staff nurses
• 1 patient care manager
• 1 nurse educator
• 3 clinical resource nurses
• CNS role started in 1998

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Needs Assessment

• Priority needs
• Decrease length of stay
• Coordinate complex patients
• Improve outcomes, decrease complication rates
• infection,
• brain hemorrhage,
• blindness from prematurity
• developmental delay

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Direct Comprehensive Care

• 20 of time
• Consults, care coordination, parent support,
  skill-specific patient care (lactation support,
  PICC line insertion, wound care)
• Case load does not focus on management of medical
  issues or provision of direct care, but on
  facilitation of issues and discharge planning

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Support of Systems

• 20 of time
• Various management committees at unit,
  program,facility, regional and national level
• Facilitate review, revision and development of
  Neonatal Practice Guidelines
• Develop new programs and initiatives
• Neonatal / Child Health Family Support Program

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Education

• 15 of time
• Nursing Education
• Family Education
• nil appointment with U of M provide guest
  lectures and faculty advisor for students

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Research

• 10 of time
• Principal or co-investigator on at least one
  project at any one time
• Evidence-Based Practice initiatives and
  application of research

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Publication and Professional Leadership

• 20 of time
• Various committees, working groups at all levels
  to keep nursing moving forward, in step,
  providing better service
• Publication of projects and research
• Presentation at conferences local, national,
  international

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Time?

• The other 15 spent doing
• Administrative duties (no admin support for most
  CNS positions)
• Traveling to and from meetings
• Professional development (attending workshops,
  conferences, etc)

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Project Example high infection rate

• System support facilitate project to address the
  issue. Develop a better tracking process and
  practice change plan
• Research literature review. Evaluation survey.

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Infection Rate Project

• Direct Care work through nursing practices and
  procedures that could be adapted
• Education develop learning package, video,
  lectures for education days. Do one-on-one
  sessions with staff. Mentor a student working
  with project

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Infection Rate Project

• Leadership present at conferences. Publish
  results
• Results Infection rate cut by half after one
  year. Nurses highly supportive of practice
  changes!
• Fewer infections shorter intensive care stays,
  potential lives saved!

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Clinical Example

• Infant born with multiple problems resulting in
  prolonged hospitalization in NICU and will likely
  go home with tracheostomy esophagostomy and
  gastrostomy feeding

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CNS Contributions to Care

• Wrote educational packages for parents
• Monitored literature for best ways to care for
  tracheostomy, esophagostomy and gastrostomy tubes
  
• Insert PICC line during early hospitalization
• Consult for mom on breast milk management issues

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CNS Contributions to Care

• Consult for infant on skin care issues related to
  gastrostomy
• Coordinate team meetings with multiple
  disciplines to make decisions regarding treatment
  options
• Facilitate communication with community and
  hospital team to ensure home team is ready when
  baby is ready

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CNS Goals

• Decisions made in the infant and familys best
  interest in full partnership with them
• Discharge not a day too early or a day too long
• Family satisfaction with service