Sawatzky-Dickson Clinical Nurse Specialist Role Presentation


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  • The Strong Model of Nursing Practice was developed in 1994 at the University of Rochester Medical Center. This model defines five domains of practice that comprise the Advanced Nursing Practice role: direct comprehensive care, support of systems, education, research, publication and professional leadership. The fulfillment of each of the domains varies with the individual Advanced Nursing Position and is dependent upon the needs of the population served, the practice setting, and the individual APN interests and strengths. These domains are not mutually exclusive, as some aspects of practice may fall within the bounds of more than one domain. Conceptual strands of collaboration, scholarship and empowerment, which describe the attributes of practice, the approach to care and the professional attitude are included. These strands are circular and unifying threads that envelop the domains of practice. They influence each of the domains including direct and indirect care activities. Benner’s principles of professional advancement are also built into the model to illustrate the five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. Although most advanced practice nurses begin in the role as clinical experts there is a progression from novice to expert in the provision of advanced care in the five domains.
  • Sawatzky-Dickson Clinical Nurse Specialist Role Presentation

    1. 1. Clinical Nurse Specialist: Acute Care Doris Sawatzky-Dickson RN MN RLC Neonatal Intensive Care, Children’s Hospital
    2. 2. Outline <ul><li>Needs Assessment </li></ul><ul><li>Model of Advanced Practice Nursing </li></ul><ul><li>Role of CNS in acute care </li></ul>
    3. 3. (Found in CNS Toolkit on page 7)
    4. 4. Needs Assessment <ul><li>(Outlined in the CNS Guide starting on page 4, NP Guide starting on page 9) </li></ul><ul><li>Stakeholders – if you don’t involve them you may be setting up failure </li></ul><ul><li>Population – some obvious, others must choose priority group </li></ul><ul><li>Service Utilization – formal and informal patterns – find out what is really happening </li></ul>
    5. 5. Needs Assessment <ul><li>Assessment of needs – use stakeholders to identify the gaps </li></ul><ul><li>Goals – prioritize, be clear on what you want to accomplish </li></ul><ul><li>Solutions – match the skills needed with the skills potentially available – use this workshop to help determine what the options are </li></ul>
    6. 6. Needs Assessment <ul><li>Planning </li></ul><ul><li>Implementation </li></ul><ul><li>Evaluation </li></ul><ul><li>Concurrent sessions this afternoon will deal with some of those issues </li></ul>
    7. 7. Role Options <ul><li>Nurse </li></ul><ul><li>Physician </li></ul><ul><li>Clinical Nurse Specialist </li></ul><ul><li>Nurse Practitioner / RN (Extended Practice) </li></ul><ul><li>Clinical Assistant / Physician Assistant </li></ul>
    8. 8. Advanced Practice Nurses <ul><li>An overall term that encompasses both Clinical Nurse Specialists and Nurse Practitioners </li></ul>
    9. 9. Strong Model of Advanced Practice Nursing <ul><li>Model adopted by the WRHA Advanced Practice Nursing Steering Committee </li></ul><ul><li>Incorporated by all advanced practice nurses at the Health Sciences Centre over the past 2 years </li></ul><ul><li>(Full description of this model starts on page 16 of the CNS Guide and page 22 of the NP Guide) </li></ul>
    10. 11. Clinical Nurse Specialist <ul><li>Functions fully within the scope of nursing practice </li></ul><ul><li>At HSC and with the proposed WRHA job description, requires Master’s degree </li></ul><ul><li>Takes the nursing role beyond the bedside </li></ul>
    11. 12. CNS in NICU <ul><li>Intensive Care for newborn infants up to 45 weeks post conceptual age </li></ul><ul><li>Approx. 500 admissions a year </li></ul><ul><li>80 staff nurses </li></ul><ul><li>1 patient care manager </li></ul><ul><li>1 nurse educator </li></ul><ul><li>3 clinical resource nurses </li></ul><ul><li>CNS role started in 1998 </li></ul>
    12. 13. Needs Assessment <ul><li>Priority needs: </li></ul><ul><ul><li>Decrease length of stay </li></ul></ul><ul><ul><li>Coordinate complex patients </li></ul></ul><ul><ul><li>Improve outcomes, decrease complication rates: </li></ul></ul><ul><ul><ul><li>infection, </li></ul></ul></ul><ul><ul><ul><li>brain hemorrhage, </li></ul></ul></ul><ul><ul><ul><li>blindness from prematurity </li></ul></ul></ul><ul><ul><ul><li>developmental delay </li></ul></ul></ul>
    13. 14. Direct Comprehensive Care <ul><li>20% of time </li></ul><ul><li>Consults, care coordination, parent support, skill-specific patient care (lactation support, PICC line insertion, wound care) </li></ul><ul><li>Case load does not focus on management of medical issues or provision of direct care, but on facilitation of issues and discharge planning </li></ul>
    14. 15. Support of Systems <ul><li>20% of time </li></ul><ul><li>Various management committees at unit, program,facility, regional and national level </li></ul><ul><li>Facilitate review, revision and development of Neonatal Practice Guidelines </li></ul><ul><li>Develop new programs and initiatives </li></ul><ul><ul><li>Neonatal / Child Health Family Support Program </li></ul></ul>
    15. 16. Education <ul><li>15% of time </li></ul><ul><li>Nursing Education </li></ul><ul><li>Family Education </li></ul><ul><li>nil appointment with U of M – provide guest lectures and faculty advisor for students </li></ul>
    16. 17. Research <ul><li>10% of time </li></ul><ul><li>Principal or co-investigator on at least one project at any one time </li></ul><ul><li>Evidence-Based Practice initiatives and application of research </li></ul>
    17. 18. Publication and Professional Leadership <ul><li>20% of time </li></ul><ul><li>Various committees, working groups at all levels to keep nursing moving forward, in step, providing better service </li></ul><ul><li>Publication of projects and research </li></ul><ul><li>Presentation at conferences local, national, international </li></ul>
    18. 19. Time? <ul><li>The other 15 % spent doing: </li></ul><ul><li>Administrative duties (no admin support for most CNS positions) </li></ul><ul><li>Traveling to and from meetings </li></ul><ul><li>Professional development (attending workshops, conferences, etc) </li></ul>
    19. 20. Project Example: high infection rate <ul><li>System support: facilitate project to address the issue. Develop a better tracking process and practice change plan </li></ul><ul><li>Research: literature review. Evaluation survey. </li></ul>
    20. 21. Infection Rate Project <ul><li>Direct Care: work through nursing practices and procedures that could be adapted </li></ul><ul><li>Education: develop learning package, video, lectures for education days. Do one-on-one sessions with staff. Mentor a student working with project </li></ul>
    21. 22. Infection Rate Project <ul><li>Leadership: present at conferences. Publish results </li></ul><ul><li>Results: Infection rate cut by half after one year. Nurses highly supportive of practice changes! </li></ul><ul><ul><li>Fewer infections = shorter intensive care stays, potential lives saved! </li></ul></ul>
    22. 23. Clinical Example <ul><li>Infant born with multiple problems resulting in prolonged hospitalization in NICU and will likely go home with tracheostomy esophagostomy and gastrostomy feeding </li></ul>
    23. 24. CNS Contributions to Care <ul><li>Wrote educational packages for parents </li></ul><ul><li>Monitored literature for best ways to care for tracheostomy, esophagostomy and gastrostomy tubes </li></ul><ul><li>Insert PICC line during early hospitalization </li></ul><ul><li>Consult for mom on breast milk management issues </li></ul>
    24. 25. CNS Contributions to Care <ul><li>Consult for infant on skin care issues related to gastrostomy </li></ul><ul><li>Coordinate team meetings with multiple disciplines to make decisions regarding treatment options </li></ul><ul><li>Facilitate communication with community and hospital team to ensure home team is ready when baby is ready </li></ul>
    25. 26. CNS Goals <ul><li>Decisions made in the infant and family’s best interest in full partnership with them </li></ul><ul><li>Discharge not a day too early or a day too long </li></ul><ul><li>Family satisfaction with service </li></ul>