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... Ongoing concerns included role overlap, mostly with the Clinical Nurse Specialist (CNS) role, and the lack of rigorous scientific data on CNL practice effectiveness (Bender, 2014). In response, articles were written to delineate CNL practice from other roles such as the CNS and the case manager (Foster et al., 2011;Stachowiak & Bugel, 2013;Thompson & Lulham, 2007). There remained confusion about the defining of CNL. ...
The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.
Nurse executives in 2 adult, acute care hospitals support utilization of the clinical nurse specialist (CNS) and clinical nurse leader (CNL), as master’s prepared roles with specialized education, training, and content expertise in clinical care. Utilizing both roles created a dynamic structure to facilitate high quality patient care that is efficient, safe, and cost effective. As the nursing shortage continues to grow and demands of health care continue to expand, the CNS and CNL will ensure high quality care through implementation of evidence-based practice, ongoing quality improvement initiatives, and providing an added layer of clinical care and decision-making support for bedside nurses.
To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain.
A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken.
Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996-March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field.
Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective.
Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation.
Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain.
Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit.
Consistent with the sphere of clinical nurse specialist (CNS) practice related to advancing nursing practice and patient outcomes, a CNS task force of 20 of the 60 CNSs in our large teaching hospital was convened to plan, implement and evaluate a comprehensive wound care education program. The purpose of the program was to ensure the 24-7 hospital-wide availability of nurses with evidenced-based wound care knowledge and skills. The facilitative environment, in which the program was developed and operates, is analyzed using the Promoting Action on Research Implementation in Health Services framework. Outcomes of the CNS task force include (1) designation of unit-based CNS as the first line resources for wound care at the unit level, (2) education of almost 10% of the 3,800 nurses at Massachusetts General Hospital as staff nurse resources, and (3) a shift in the nature of CNS wound care consultations from prescription to validation of the staff nurse-initiated wound care plan.
Discharge telephone calls made by hospital staff provide invaluable opportunities to prevent adverse events, improve quality of care, and increase patient satisfaction. Similarly, the effect of rounding on patients can improve clinical quality and improve both patient and staff satisfaction. The author discusses how the combination of implementing both nurse leader rounding and discharge telephone calls simultaneously produced powerful positive outcomes in satisfaction and patient quality of care.
The clinical nurse leader (CNL) role is being rapidly implemented in healthcare settings. A major component of the CNL role is to provide a leader at the center of the microsystem to promote quality outcomes. To examine the impact of CNLs at the Department of Veterans Affairs Tennessee Valley Healthcare System, outcomes from 5 diverse microsystems were evaluated before and after CNL implementation using electronic scheduling system reports, patient medical records, and quality improvement reports. Statistically significant improvements were found in all 5 of the indicators evaluated. The authors discuss the implications of improvement for clinical, satisfaction, and financial performance.
The goal of care coordination is to facilitate and enhance positive patient outcomes. The contribution that the clinical nurse specialist (CNS) can make toward the achievement of this goal is supported in the literature. The CNS can impact patient outcomes by influencing nursing practice and organizational systems for the delivery of quality, cost-effective patient care. These CNS practice activities can be uniquely tailored to specialty populations. Three CNSs within the Department of Care Coordination report how they have developed their own individual practices within their distinct specialties. Although the approach varied, the outcomes of influencing the quality of nursing care, patient education, and safe, uncomplicated transition from the hospital to next disposition were the same.
This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life.
Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being.
The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8-10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention.
The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0.005), depression (P = 0.001) and quality of life (P = 0.02) 3 months after the intervention.
This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis.
More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors explore differences and similarities between the CNL and the clinical nurse specialist roles, describing the working strategies between a CNL and clinical nurse specialist, and role delineations that have resulted from their cooperation, collaboration, and planning.