Lessons learned from clinical nurse specialist longevity

This paper provides insight into issues related to longevity and retention of experienced clinical nurse specialists (CNS). To date, this phenomenon has received little attention in both clinical and administrative literature. To prepare for a national presentation on this component of advanced practice, the author questioned 12 professional colleagues who had practised in their role for over 10 years in the same setting. The CNS responses are described and critiqued and suggestions for support of veteran CNS are provided by the author.     

The role of the clinical nurse specialist in acute pain management

The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).     

Informatics nurse specialist: roles in health care organizations

The cost of managing and processing health care information is a significant component of hospital operating budgets, yet health care lags far behind other industries in the effective use of information technology. As nurses are the largest group of users of health care information, improving nurses' information management capability could have a significant impact. Informatics nurse specialists understand the concepts and technology of nursing information management and can provide operational and strategic benefits to nursing organizations. In this article, educational preparation, certification, and roles of informatics nurse specialists are discussed along with functions of health care information technology and nursing informatics.     

The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role

The purpose of this article is to provide an historical overview of the clinical nurse specialist and nurse practitioner roles in psychiatric nursing. This article is written as a follow-up to that of Dyer, Hammill, Regan-Kubinski, Yurick, & Kobert, (1997), Archives of Psychiatric Nursing, 11, 2-11, in which a new paradigm for delivering comprehensive mental and general health services is conceptualized, i.e., the psychiatric-primary care nurse practitioner role. In this article an alternative model is presented: the psychiatric clinical nurse specialist/nurse practitioner role. Similarities and differences in the two roles are discussed.     

The clinical nurse specialist as expert practitioner in the obstetrical/gynecological setting

The role of the advanced practice nurse (APN) continues to evolve in specialty areas while healthcare systems seek solutions to issues of cost-containment, equity in access, and quality care. APNs have a significant role in facilitating the positive outcomes of clients utilized as measurable indicators in a managed care environment. The CNS as expert practitioner in the obstetrical/gynecological hospital setting integrates specialty knowledge and demonstrates specialty skills when working with childbearing and perimenopausal women and their families. Maintaining a holistic orientation to practice and keeping comprehensive documentation of activities facilitate achievement of quality outcomes for patients in this specialty field. Competencies essential to successful implementation of the expert practitioner role include: clinical expertise, effective communication skills, critical thinking and analytical skills, and a theoretical orientation to problem solving. The Roy Adaptation Model is an effective framework that can be used by the CNS in the obstetrical/gynecological hospital setting to promote, maintain, and restore health, as well as facilitate positive patient outcomes.     

The evolution of change: from nurse auditor to clinical reimbursement specialist

The effect of administration of cadmium alone in non-irradiated mice as well as the effect of pre-irradiation administration of cadmium on the reparation processes of haemopoiesis were investigated in mice irradiated by a dose of 7.5 Gy. The pre-irradiation administration of cadmium accelerated the reparation processes in the bone marrow and spleen as well as the number of leukocytes and thrombocytes in the peripheral blood. The administration of cadmium alone caused a temporary weight decrease of the thymus and reduced number of erythrocytes, reticulocytes and haemoglobin values in the peripheral blood. The temporary rapid increase in the number of leukocytes on the 21st day after cadmium administration was investigated.     

The specialist nurse in HIV/AIDS medicine

The management of patients with human immunodeficiency virus infection requires a multidisciplinary holistic approach. Hospital-based specialist nurses can both co-ordinate and facilitate their hospital care, and also ensure early and effective discharge back into the community.     

The development of the paediatric nurse specialist

Eighty operations on the fifth toe in 59 patients were retrospectively reviewed to determine the effect of skeletal variation on the occurrence of pathological conditions requiring surgery. The two-boned fifth toe occurred in 60% of the operated group. This is statistically significant (P < .05) as compared with 45% in our prospective control group. Our results support the theory that the stiffer two-boned fifth toe predisposes it to increased pathology, which includes hammertoes, interdigital and dorsal corns, and clawtoes.     

Taking down the walls: a nurse manager's experience in acute care and home care

Changes in the health care system are stimulating trends in where and how nursing services are delivered. Nurse managers are responsible for the overall management of the nursing work unit and must be prepared to practice in settings other than acute care. Home care is a rapidly growing practice that emerges as patients are discharged from the hospital sooner with ongoing medical and nursing needs. The job responsibilities of a nurse manager remain similar across practice settings, including the transition from acute care to home care. A detailed checklist highlights specific similarities and differences in the nurse manager's role in acute care and home care settings. As the walls of the practice setting are taken down, nurse managers must build on current knowledge and creatively develop new skills to remain successful in ongoing job responsibilities.     

The Diabetes Center home care nurse: an integral part of the diabetes team

The changing face of health care and the widely variable needs of families have forced practitioners to change the traditional education approaches for pediatric patients with diabetes. Initial management and education for pediatric patients with newly diagnosed type 1 diabetes is now moving to the outpatient setting. The Diabetes Center for Children (DCC) at The Children's Hospital of Philadelphia has created an innovative program using a diabetes home care nurse as its coordinator. The role of the home care nurse is to manage and coordinate all of the diabetes education done by the field nurses in the Children's Hospital home care department. This program has enabled the DCC to manage and educate families during an initial 3-day inpatient stay, providing a safe transition to home. With follow-up by trained home care nurses, the families receive advanced education and support in their homes. The evolution of this program over the last several years has shown that patient care can be moved safely from a complete inpatient format to one that includes a large outpatient component.     

Improving home care. A survey on physician and nurse communication

Home health care is growing, and phone calls between physicians and home care nurses are essential to successful home care patient management. This preliminary study analyzed several aspects of the physician and home health nurse telephone communication, including effectiveness, time expenditure, percentage of calls resolved by physicians, and documentation of phone contacts between 90 medical/surgical physicians and six home health nurses in Cleveland, Ohio. The phone conversations involved 154 patient contacts during a 3-month period. Overall, we found 75% of the home calls were effective. Eighty-five percent of calls required 15 minutes or less for completion, 47% of nurse-generated calls were resolved by physicians, and 26% of calls were documented in the patient's medical record. Our results illuminated several aspects of home care communication amenable to improvement.     

Role of the clinical nurse specialist: an integrative review of the literature

This review of the literature related to the role of the clinical nurse specialist was commissioned by the AACN in order to provide a comprehensive resource for advanced practice nurses. This review provides a historical overview of clinical nurse specialists and some of the gaps or barriers to practice that have been experienced. A summary of these gaps shows that many have repeated themselves over the years. Also provided are potential solutions to facilitate the progression of this role in the future.     

The single care home

This paper discusses the importance of nursing in the long-term care setting and the issues arising from the possible introduction of a single registration care home. The current situation is examined and the implications for patients are highlighted.