The CNS Role as an Agent

QUESTION

Write about “Clinical Nurse Specialist role as a change agent.” please use Foundations of clinical nurse specialist practice (Fulton, J. S., Lyon, B. L., & Goudreau, K. A) book it is excellent source check chapter 6, 8, 11, and 24. I attached articles you can use, you do not have to use them all, and you can add articles. Any article you add has to be current (within last 5 years). There is no specific number of references that need to used.

ANSWER

Clinical Nurse Specialist (CNS) Role as an Agent of Change

Introduction

As the world continues to change, so does the healthcare system and the provision of quality healthcare. With continuous technological and knowledge improvement, healthcare organizations and experts have to embrace change continuously to improve service delivery. Changes in technology, healthcare systems, and organizational policies are taking place within the clinical settings as healthcare organizations strive to adapt to changes in the business environment and healthcare industry (Soltis, 2015). One of the major roles of the nursing profession is to function as an agent of change within the clinical environment. Clinical nurse specialists (CNSs) and other healthcare experts constantly have to find new ways of effecting change within the healthcare system (Soltis, 2015). They have a critical role to play in the implementation of change, whether it is in the application of evidence-based practices, technological systems, or changes in operational and management practices. CNSs, therefore, need to be involved in decision-making and execution to ensure that change is effected successfully within the healthcare system.

The most common organizational change within the clinical system is the adoption of technology that can improve the quality of healthcare provided to patients and the application of new operational methods. The number of patients that lose their lives, because of medical or clinical errors that are preventable in hospitals, continues to increase over the years. However, through the use of modern healthcare information technology and systems, patient safety and the quality of healthcare services can be improved (Henry et al., 2016). To this end, healthcare organizations and providers are moving towards more patient-centered healthcare systems through the increased use of technologically innovative systems such as electronic health records (EHR), the internet, as well as management information systems, which provide new, effective and efficient tools to improve patient care. By using technological systems that provide online clinical resources with around the clock access to clinical data and global networks, nurses and other healthcare specialists can make better clinical decisions and provide better care to patients. CNSs, therefore, have a critical role to play, as agents of change regarding the implementation of technology and new methods for healthcare provision within healthcare systems. In this paper, the role of a CNS as an agent of change within the healthcare system is discussed.

The Role of a CNS

CNSs are Advanced Practice Registered Nurses (APRNs) who serve as clinical experts in evidence-based nursing practice in various fields of specialization. CNSs are popular for making unique contributions to the safety and health of the public by working either directly or indirectly with patients, communities, groups, and other nurses (Fulton, Lyon, & Goudreau, 2014). The contributions of CNSs occur through their leadership and clinical intervention during clinical or nursing care delivery or their guidance in the provision of clinical care. CNSs are clinical experts who work in various areas of specialty while providing expert advice and guidance about issues that are central to the nursing practice (Fulton et al., 2014). They play a critical role in the clinical environment because their focus is on trying to discover new ways to positively influence healthcare service delivery. CNSs work over a wide range of clinical practice areas, with specialization in either population – such as pediatrics or women’s health; type of care – disease or medical subspecialty; type of problem – such as pain management or wound care; and setting – such as emergency or critical care settings.

A CNS that is involved in the provision of direct patient care conducts healthcare assessments, provides prescriptions and medication, treats patients, and requests for laboratory and diagnostic tests. Their main focus, however, is the design, implementation, evaluation of population-specific and patient-specific programs for care, providing leadership for multidisciplinary groups and the implementation of alternative solutions to solve patient care challenges. There is a strong relationship between the presence of a CNS at a healthcare organization and the provision of efficient and safe patient care. Through the efforts and knowledge of CNSs, healthcare organizations and patients benefit from reduced hospital stays, better pain management practices, improved care, reduced emergencies, improved patient satisfaction, and faster response to patient complications.

CNSs strive to improve clinical outcomes through the provision of direct patient care and by liaising between the patients, patient’s families, and the healthcare team. They fulfill this role through the provision of consultation services, effective communication, monitoring the quality of and coordinating care. CNSs are further involved in the processes of treating injuries as well as diagnosing illnesses and disabilities. They provide consultation services and advice to nurses and other healthcare specialists to improve the delivery of patient care, hospital and healthcare systems and also serve as researchers who supervise evidence-based practice studies to develop new ways of improving healthcare practices. They are furthermore involved in research that aims at developing new research standards and protocols for improving clinical knowledge and patient care.

The CNS as a Change Agent

CNSs are defined as clinicians by their title. However, CNSs have many roles to fulfill including education, providing clinical expertise and conducting research within the healthcare system. CNSs also manage, consult, innovate as agents of change and have leadership roles (Kaasalainen et al., 2015). All these responsibilities require skills that define the complex and wide-ranging duties of CNSs. The individual attributes and competencies of CNSs that are demonstrated in the process of fulfilling their roles allow them to operate at a specialist level. CNSs have graduate-level education and training that sets them apart from other healthcare providers, uniquely equipping them for assessment, analysis, and improvement of healthcare operations and business, whilst simultaneously prioritizing the interests of patients. CNSs provide healthcare organizations with nursing practice leadership, systems and practice innovation, and clinical expertise, in whichever specialty they find themselves in. CNSs essentially contribute to the development of healthcare systems and the provision of quality healthcare by providing their expertise.

Kaasalainen et al., (2015) conducted exploratory, multiple-case design research to explore the role played by a CNS and a nurse practitioner (NP) as agents of change in the process of implementing evidence-based pain protocol in long-term care (LTC) homes in Canada. The research showed that CNSs and NPs used various strategies to assist in the implementation of the pain protocol in LTC homes and became agents of change by playing an important role in educating staff on the protocol and its implementation. They also played an important role in the phasing in of the pain protocol through review and feedback, by providing prompts and reminders to nursing staff, facilitating interdisciplinary practice to augment the pain protocol, carrying out in-depth pain assessments, assessing residents by using physical assessment skills, prescribing pain medication and establishing good relationships with staff for the purposes of implementing practice change (Kaasalainen et al., 2015).

These CNSs also facilitated change implementation by educating the staff on the management of pain in older adults, as well as the process of pain protocol implementation (Kaasalainen et al., 2015). Together with the NPs, the CNSs also provided one-on-one sessions with staff members to inform them about the procedures for protocol implementation. They furthermore listened to staff members and considered their suggestions on ways of reducing the workload related to the pain protocol to render its implementation smooth and seamless. They educated the staff members on diagnoses and pain and the use of pain medication as well as the recognition of pain responses (Kaasalainen et al., 2015). The CNSs and NPs were also instrumental in prompting the staff to implement the pain protocols successfully. They would check in with nurses during their daily rounds and would post newsletters with information about pain management to inform staff members on the importance of the pain protocol. They were also responsible for facilitating and organizing monthly interdisciplinary team meetings with staff members to help with the implementation of the pain protocol and to solve any issues that ensued.

Saunders (2015) conducted research on the work and work outcomes of CNSs. The study also looked at the emerging trends regarding the work and roles of CNSs as they are responsible for transforming patient care into high-quality, affordable healthcare. However, the complex nature of their work often results in role confusion, which the study by Saunders (2015) sought to minimize. The study ascertained that the roles of a CNS revolve around three main areas: nursing, patient care, and organizational work. CNSs, therefore, have to balance taking care of patients with nursing practice and organizational work. A typical day for a CNS involves the identification of high-risk patients, going through emails, project work, developing budgets, writing and reviewing existing policies and procedures, data analysis and developing improved clinical methods.

CNSs work with nurses and do patient rounds on a daily basis (Saunders, 2015). They communicate with nurses to find out how work and patient care is going and identify any safety and operational hurdles that they may have experienced. They also provide support to nurses by assisting them to ensure that quality patient care is provided and by working with the patients and NPs to improve safety, minimize infections and reduce medication errors (Saunders, 2015). While doing patient rounds, CNSs focus on providing patients with all the resources they need, looking at the complexity of their care and providing guidance to nurses and/or caregivers on better healthcare service provision. They may not provide hands-on care to patients, but they guide nurses and act as their role models for care provision. CNSs further provide coaching to nurses towards the achievement of improved clinical competence (Saunders, 2015). They hold meetings with nurses to provide guidance and listen to their contributions and concerns. They encourage the nurses to provide ideas regarding performance and patient experience improvement as well as the provision of better patient care. CNSs also investigate medical and clinical errors and find ways of eliminating them to mitigate any mistakes in the future.

As demonstrated by Saunders (2015), the scope of work for CNSs involves three major areas – engaging the patients, working with nurses and healthcare systems management. The main goal for CNSs is to keep up with changes within the healthcare system and the healthcare industry and to implement them appropriately to improve patient care (Hanson, 2015). They work through and with nurses and practitioners by mentoring them and ensuring successful change implementation. Reimers and Miller (2014) address the role of the CNS as an agent of change in the process of implementation of a quality improvement program that was designed to assess and prevent delirium, a common condition that is not well-known among patients in the ICU, at a community-based healthcare center. The authors subsequently found that the roles played by CNSs (communication, collaboration, and education) are crucial to the implementation of successful and lasting change (Reimers & Miller, 2014). CNSs fulfill these roles with the aim of achieving core competencies across the three areas of influence (patient, nursing, and organization) to ensure successful change implementation and patient care improvement.

The goal of a CNS within a healthcare organization is to provide quality, safe, patient-centered and cost-effective care (Reimers & Miller, 2014). The quality improvement program for assessment and prevention for delirium was known as the ABCDE Bundle and its aim was to ensure the provision of better care to patients. The implementation of the ABCDE Bundle program was successful and accepted by the critical care team at the hospital, which was accomplished through the efforts of the CNS (Reimers & Miller, 2014). By providing evidence of the benefits of the quality improvement program and educating the critical care team on its importance, the CNS was able to ensure that the program was adopted and successfully implemented. The critical care team fully-understood the program and why it was being implemented, which led them to change their conventional practice, move forward and implement improved practices for patients (Reimers & Miller, 2014).

The CNS’s knowledge and expertise in the change process enabled easy assessment, reassessment, planning, and implementation of the quality improvement program that paved the way for better practice and successful change, despite the many challenges faced in the past with the implementation of the program (Reimers & Miller, 2014). Even with their expertise, CNSs still need the cooperation of other stakeholders to ensure the successful implementation of evidence-based practice change. The ABCDE Bundle project was successful, because of the efforts and expertise of the CNS with the cooperation of other healthcare stakeholders. After successful implementation of change, the CNS needs to maintain good relationships with the critical care team and nurses to measure, analyze and review the implementation data. They must, therefore, stay updated with any changes and guidelines in their efforts to adopt the changes successfully in practice.

Besides implementing change, CNSs also initiate change through various procedures, which show their unique abilities to identify challenges and develop new programs, implement them and evaluate their effectiveness (Reimers & Miller, 2014). They identify, collect and analyze data before the design of programs, collaborate with healthcare professionals and patients; identify environmental, interpersonal and system barriers of nursing practice and also develop educational and training programs for clinical staff to improve patient outcomes and nursing practices. Further, they are instrumental in identifying barriers to the proposed change, planning for system-wide change, developing solutions to clinical problems, leading program implementation and providing feedback on the effectiveness of the programs and practices.

CNSs have the necessary education and training to assess, plan, and evaluate problems and issues that affect the patient, organizational and nursing sphere of influence. They have the ability to influence change positively within these areas of expertise to ensure lasting change within a healthcare organization. Semper et al. (2016) conducted a study that was aimed at understanding the role of the CNS in the development and implementation of a staff nurse education program to promote accountability through the use of peer-review principles. Peer review is one of the most essential practices in nursing practice. Its application within a healthcare organization calls for cultural change. For the study, CNSs were tasked with the development of a peer review education program for nurses (Semper et al., 2016). The CNSs were able to develop an education program that increased staff nurse knowledge about peer review and its application in nursing practice. They played a critical role in helping nurses understand peer review and the benefits of using it in practice.

Conclusion

Three spheres of influence namely; the patients, nurses, and healthcare system are influenced by the CNS, who has a very unique APRN role. These areas overlap, but each of them has a distinct focus. The principal objective of the CNSs in their various filds of influence is to ensure constant improvement of patients’ health outcomes. To this end, they endeavor to implement organizational and practice changes through mentoring to help nurses to develop evidence-based practices that ease patient distress. Healthcare organizations also have to remain flexible to ensure that they can adapt to changes in the industry and the needs of the socio-economic environment. The CNS plays an important role as an internal consultant to promote and influence change at healthcare organizations by initiating and implementing change through focusing on various structural aspects – interpersonal, individual, team, intergroup and organizational. CNSs roles also involve solving ant challenges related to decision-making, leadership, authority, culture, communication, plans, projects, practices, and goals. They are consultants, educators, researchers, and leaders.

By introducing and inducing change, the CNS can improve healthcare services and provide patient care that is better, more cost-effective, safe and comprehensive. The provision of better services also provides care that reflects the wishes of patients more accurately. As healthcare organizations strive to remain flexible in the dynamic healthcare industry, CNSs play a key role in the implementation of organizational or practice change. They keep up to date with changes and implement change when appropriate to improve patient care by actively engaging in care innovation in the clinical field and implementing appropriate improvement. Even though CNSs play the role of agents of change, they do not work in isolation. CNSs collaborate and work with their colleagues, mostly nurses, to innovate and implement change to improve patient care. To survive and perform well in today’s dynamic healthcare environment, healthcare organizations have to adopt or implement change that aims at improving patient care. This is made possible by the efforts of the CNSs, who act as innovators, change influencers and/or agents of change.

References

Fulton, J. S., Lyon, B. L., & Goudreau, K. A. (Eds.) (2014). Foundations of clinical nurse specialist practice. (2nd ed.). New York, NY: Springer.

Henry, J., Pylypchuk, Y., Searcy, T., & Patel, V. (2016). Adoption of electronic health record systems among US non-federal acute care hospitals: 2008-2015. ONC Data Brief, 35, 1-9.

Kaasalainen, S., Ploeg, J., Donald, F., Coker, E., Brazil, K., Martin-Misener, R., … Hadjistavropoulos, T. (2015). Positioning Clinical Nurse Specialists and Nurse Practitioners as Change Champions to Implement a Pain Protocol in Long-Term Care. Pain Management Nursing, 16(2), 78–88. https://doi.org/10.1016/j.pmn.2014.04.002

Reimers, M., & Miller, C. (2014). Clinical Nurse Specialist as Change Agent. Clinical Nurse Specialist, 28(4), 224–230. https://doi.org/10.1097/nur.0000000000000063

Saunders, M. M. (2015). Clinical Nurse Specialists’ Perceptions of Work Patterns, Outcomes, Desires, and Emerging Trends. The Journal of Nursing Administration, 45(4), 212–217.https://doi.org/10.1097/nna.0000000000000187

Semper, J., Halvorson, B., Hersh, M., Torres, C., & Lillington, L. (2016). Clinical nurse specialists guide staff nurses to promote practice accountability through peer review. Clinical Nurse Specialist, 30(1), 19-27.https://doi.org/10.1097/nur.0000000000000157

Soltis, L. M. (2015). Role of the Clinical Nurse Specialist in Improving Patient Outcomes After Cardiac Surgery. AACN Advanced Critical Care, 26(1), 35–42.https://doi.org/10.1097/nci.0000000000000070