Kathleen M. Baldwin

Developing Clinical Nurse Specialist Practice Competencies

Background: In 1998, the National Association of Clinical Nurse Specialist (NACNS) developed the first ever core competencies for clinical nurse specialist (CNS) practice. Purpose: This article describes the method used to develop, validate, and revise CNS core practice competencies. Methods: The stepwise method of identifying core CNS competencies included content analysis of CNS position/job descriptions, extensive literature review, development by role experts, first-tier corroboration, second-tier corroboration encompassing stakeholder review, final review/editing, approval by the board of directors, and dissemination. Discussion: The process used by professional organizations to develop competencies and standards varies; however, it should be transparent and consist of adequate review and validation for accuracy and applicability by members of the representative group for whom the standards and competencies apply. Conclusions: The stepwise method used by the National Association of Clinical Nurse Specialist generated valid CNS core competencies and may be instructive to professional organizations interested in developing competencies and standards.

A vision of the future for clinical nurse specialists: prepared by the National Association of Clinical Nurse Specialists, July 2007.

This document represents a compilation of thought from the past, present, and future leaders of the National Association of Clinical Nurse Specialists (NACNS) and clinical nurse specialists in both Canada and the United States. It is our presentation of the vision of what the future holds for clinical nurse specialists (CNSs) as seen from the present. It has been a labor of love that has taken 17 months to create, validate, and edit into the document you see today. The work involved volunteers from a variety of backgrounds and represented CNS students, educators, and clinicians from a diverse set of specialties. These individuals may be invisible in the author list, but their contributions are invaluable. A call to the membership attending the annual conference held in Salt Lake City in March 2006 initiated the creation of this document. More than 100 volunteers stepped up to assist in the creation of a vision of the preferred future for CNSs. Past, present, and future leaders of NACNS were then commissioned to write sections of the paper, including content on education, practice, certification, and regulation of CNSs as visioned into the future. Once edited into a single document, the full paper was sent to a task force of NACNS members who volunteered to serve as reviewers. We are grateful for their comments, feedback, and edits. Those edits were incorporated, and the document was further scrutinized by a broad variety of stakeholders through a call on the CNS listserve for additional comments, feedback, and edits. This additional feedback was incorporated into the document, which was reviewed and approved by the NACNS Board of Directors in June 2007. Heartfelt thanks to the unnamed volunteers who spent time in thoughtful edit of the concepts presented here and how they fit with their current CNS practice. It is with honor that this author team is able to present to you the work of our members.

Developing a rural transitional care community case management program using clinical nurse specialists.

Purpose: This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. Background: As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Rationale: Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. Description: After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. Outcomes: The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Conclusion: Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. Implications: The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.

Development and implementation of an online CNS program.

Purpose/Objectives Online educational programs are rapidly increasing in all fields. This article describes a private universitys online clinical nurse specialist graduate program that included supervised clinical practicum experiences. Methods The program was designed using the 1998 National Association of Clinical Nurse Specialists (NACNS) Statement on Clinical Nurse Specialist Practice and Education as a curriculum guide. Issues that occur with online program development/design, implementation, and evaluation are described and solutions are presented. Conclusions The online education program for clinical nurse specialists faced challenges; however, faculty and students agreed that this innovative program is a success.

Best practices for care of older adults: highlights and summary from the preconference: NACNS National Conference, March 10, 2004, San Antonio, Tex.

I 2003, the National Association of Clinical Nurse Specialists (NACNS) received a Nurse Competence in Aging Grant. This grant is a 5-year initiative funded by the Atlanta Philanthropies (USA) Inc, awarded to the American Nurses Association (ANA) through the American Nurses Foundation (ANF), and represents a strategic alliance among ANA, the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing at New York University in the Steinhardt School of Education, Division of Nursing. NACNS thanks the grant funding sources. The NACNS grant funded a Gerontological Nursing Preconference for NACNS members during the 2003 NACNS National Convention. The aim of the preconference was to provide an opportunity for CNSs of any specialty to advance their knowledge about best practices and evidence-based care of older adults. The objectives for the preconference were to

Integrating Retired Registered Nurses Into a New Graduate Orientation Program.

Purpose: The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area. Description of Project: All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist–led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues. Outcome: All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA. Conclusion: Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.