An Overview of the Roles of CNSs

Clinical nurse specialists (CNSs) play a significant role in fostering the success of the healthcare delivery leadership group of any institution. According to Melnyk, Gallagher?Ford, Long and Fineout?Overholt (2014), the qualities of services delivered by a healthcare institution to its clients have a direct relationship with the levels of experience and professional expertise of its CNSs. According to Bryant? Lukosius et al. (2016), the roles played by the CNSs of a given medical facility play a significant role in fostering the advancement of patient care by providing a direct link between the professional practices of the facility with the desired evidence based outcomes among patients both at the unit and organizational areas. In the prevailing areas of practice in Australia’s medical facilities, the underlying functions of CNSs is considered to be of critical essence in fostering the provision of high quality services more than ever. Wilson et al. (2015) reveal that in their positions as key players of the healthcare leadership teams, clinical nurse specialists are presented with adequate operational opportunities that may have a direct effect on the quality and standards of patient care by ensuring that they avail adequate support to the needs of their clients, give novice clinicians the professional and moral support they need to undertake their day to day activities as well as availing operational backing among expert practitioners. The current study seeks to undertake a critical analysis of the exponentially evolving functions of a clinical nurse specialist in the Australian healthcare settings by reviewing the significant roles played by these practitioners in fostering the advancement of evidence based practices.

The roles of clinical nurse specialists have undergone multiple changes over time to ensure that these practitioners meet the expectations of their institutions based on the responsibilities they are assigned to. According to Brush et al. (2015), CNSs in healthcare institutions play a significant role in fostering professional advancements of novices. For instance, McDonnell et al. (2015) explain that these professionals act as key connectors of the novices and their healthcare facilities of assignment by availing proper environments of practice that allow for building of skills through implementation of continued professional support. As a consequence, the CNSs occupies a significant position in impacting care and fostering effective attainment of the desired outcomes by impacting individuals  foster practices that are aimed at yielding positive results. According to Kalb, O’Conner-Von, Brockway, Rierson and Sendelbach (2015), CNSs reveal the unique characteristic of availing other practitioners with instructions that are patient focused; an aspect that increases their operational effectiveness when availing their facilities with staff development roles. Fulton, Lyon and Goudreau (2014) reveal that CNSs undertake the staff development roles through adoption of direct and indirect academic activities that span from collaborative care planning to the issues of collective discussions particularly when dealing with certain specialized patient problems, client specific evaluations and the advancement of shared decision making.

Clinical nurse specialists act as key role models in institutional settings. According to Melnyk et al. (2014), CNSs are considered as active players in the processes of developing other members of staff based on the essential roles they play in availing training and empowering other members of the healthcare delivery teams to foster independent interventions in their future endeavors. Bryant? Lukosius et al. (2016) explain that clinical nurse specialists mentor other practitioners by availing ample environments of practice that are aimed at encouraging these members of staff to advance their careers to their full potentials while envisioning the flaws they initially committed as opportunities that will allow them to learn and develop key potencies required in this profession such as the ability to think critically, as well as the potencies aimed at instilling personal growth. Brush et al. (2015) reveal that in their positions as mentors, CNSs are required to depict the cues of listening attentively, acknowledging the points of view of their mentees, and availing the frameworks that will instill career advancements on the side of the “trainees” they are assigned to. For effective functioning in their positions as trainee counselors, Woollard (2015) reveals that the CNSs must be readily available, depict the ability to express nonjudgmental ideas, reveal higher degrees of sensitivity to territorial and professional boundaries and depict effective interpersonal communication cues using by focusing on the individualized requirements of the mentee while advocating for the frameworks that will lead to the endorsement of work based ties that are supportive and caring. As a consequence, CNSs in their position as connoisseurs, consultants and trainers are presented with unique opportunities that will allow them to impose positive influences on the desired patient care outcomes based on their inherent capabilities of fostering continuity of care, and workplace advancement of other practitioners through institutionalization of avenues aimed at fostering the critical processes of mentoring, training and coaching.

The Roles Played by CNSs in Fostering Evidence Based Practices

Evidence based practice (EBP) is one of the underlying prerequisites of positive practice environments in healthcare settings. According to Woollard (2015), clinical nurse specialists play a core role in fostering the advancement of practice environments that are aimed at institutionalizing proper frameworks of supporting performance excellence through provision of services that depict higher levels of safety, quality and efficiency. According to McDonnell et al. (2015), CNSs adopt EBP as a framework of developing and sustaining a workforce that reveals higher levels of professional motivation and preparedness to deal with emergent situations in institutional settings.

CNSs advance evidence based healthcare operations in their institutions by fostering proper advancement of collaborative practice and leadership. According to Melnyk et al. (2014), collaborative practice is a positive cue applied in healthcare delivery systems with the aim of emphasizing on effective advancement of interdisciplinary teamwork. Bryant? Lukosius et al. (2016) reveal that by adopting a collaborative model of practice, caregivers are presented with an ample opportunity that allows individual stakeholders to work together  to pool their skills, potencies, professional experiences and scholarly knowledge acquired in academic training when attending to their patients. Further, Brush et al. (2015) demystify that clinical nurse specialists are highly influential in availing the avenues needed to support and advance leadership skills among the caregivers and other practitioners that work under them. McDonnell et al. (2015) reveal that CNSs support leadership development among stakeholders in healthcare institutions by availing the avenues that foster proper advancement of negotiation, mentoring and relationship building and strengthening cues. CNSs adopt these evidence based cues in making contributions to critical operational aspects of their institutions such as continuous quality advancement, institutionalizing clinical participations and collaborations as well as strengthening the avenues put in place by these institutions to foster effective application of proven innovative models of healthcare. Woollard (2015) explains that such practices can be of critical essence in allowing CNSs to undertake a wider range of leadership roles in equal proportions in the primary care system and in the nursing career.

The processes of translating the underlying evidence based practices into the real environments of practice in the nursing profession can be of critical essence in imposing positive outcomes in healthcare settings. According to Fultonet al. (2014), clinical nurse specialists achieve their EBP goals by adopting proper frameworks aimed at reinforcing their degrees of commitment to the underlying change management practices put in place by their institutions as well as their interdisciplinary collaborations. Further, McDonnell et al. (2015) reveal that clinical nurse specialists are faced with the obligation of availing proper and adequate support to other caregivers by ensuring that they attain post graduate qualifications as a way of enabling them to have efficient success and interpretation of peer reviewed journals. According to Fultonet al. (2014), CNSs need to consider the application of evidence based practices in their professional settings as viable avenues of fostering career satisfaction and retention. As a consequence, Wilson et al. (2015) explain that CNSs are squarely obliged to ensuring that they present their employers with effective avenues of implementing clinical and leadership practices aimed at supporting their pursuits for post graduate studies.

The standards of practice refers to the legal document which is provides a detailed and systematic outline of the exact job roles and responsibilities that the nursing professional has to carry out while in practice. For the clinical nurse specialists, the NMBA in accordance with the AHPRA, has set out a series of standards or practice that they have to follow (Nursingmidwiferyboard.gov.au, 2018). The first standards is “Assesses using diagnostic capabilities”, which is associated with conducting comprehensive assessments of the patients, involving both physical and psychosocial assessments, to perform diagnosis of the patients and provide adequate care practices. Hence, the clinical nurse specialists have the endorsement registration which allow them to not only conduct assessments as a RN, but also take a strong role in diagnosis as well. The second standard is “plans care and engages others”, which is associated with translating and integrating evidence into practice. In this case, the primary responsibility of a clinical nurse specialist will be to plan care activities that is derived from evidences to ensure safe and effective care being provided to the patient. It is also the responsibility of the Clinical Nurse Specialists to overlook the practice of the junior nurses and ensure that evidence based practice is carried on under all circumstances (Nursingmidwiferyboard.gov.au, 2018).

The third standard is “Prescribing and implementing therapeutic intervention”, which is associated with both indicated pharmacological and non- pharmacological interventions. In both of the cases, the use of both of the interventions is managed and administered in the guidance of the CNS or by the CNS itself, addressing the exact and individualized care needs of the patient. The interventions are needed to be planned and implemented in collaboration with the patient, keeping him or her at the centre of the care. Along with that, it is also necessary for the CNS to take into consideration the federal, state and territorial legislation and professional regulation governing practice while planning and implementing the interventions to ensure utmost safety and efficacy of practice (Nursingmidwiferyboard.gov.au, 2018). The last standard of practice for this advanced practice role is “Evaluating outcome and improving practice”, which is associated with not just evaluating practice of own practice but also evaluate the overall care outcome for the patient and audit the recovery progress that the patient is exhibiting. It also needs to be mentioned that advocating for, participating in, or leading systems that support safe care, partnership and professional growth is also a vital role or responsibility of the CNS or the advanced practice nurse (Fox et al., 2015).

The applications of the role that is associated with advanced practice is immense in any primary care setting. The role of a clinical nurse specialist is also associated with many benefits in employed in the primary health care setting. First and foremost, it has to be mentioned in this context that the role of advanced practice nurses like the clinical nurse specialists is diverse and it encompasses many domains of practice. As discussed by Kramer et al. (2017), the practice scope of the nurses are very extensive and diverse, and as a result the clinical nurse specialist is a job role which often encompasses the job roles of a doctor as well. Hence, in general primary care setting, the CNS can take over some of the responsibilities of the doctor or the general practitioner, such as diagnosis, administration of pharmacological and non- pharmacological interventions, and evaluating care outcomes as well (Kaasalainen et al., 2015).

Chronic disease management is another very important benefit of implementing the role of a clinical nurse specialist in the primary care setting. Providing acute and chronic care management is a very crucial and extensive practice role which can be provided by the clinical nurse specialists by the virtue of their advanced training, skill enhancement procedure and ability to provide consultation, coaching, assessment and advocacy. As in the primary care settings, elderly patients with chronic conditions are common, the introduction of the role of the clinical nurse specialist will provide the opportunity to expand clientele and enhance patient satisfaction (Boot & Wilson, 2014).  

Another crucial advantage of the implementation of the role of Clinical nurse specialist in the primary care settings is the overall reduction of health care costs. As discussed by Kilpatrick et al. (2015), the CNS job roles are associated with higher evidence based practice in care planning and implementation which results in lesser errors committed and reduced need for hospice stay. In support, Donald et al. (2014) have stated that the CNS and their advanced and systematic practice can help in reducing the incidences of adverse events drastically. The CNS with their expert knowledge, training and guidance can lead to better infection control, safer medication administration and safe care practices, which in turn leads to reduced rate of adverse events occurring in the health care facility. As a result, not only the CNS help in enhancing care standards and quality, they reduce the costs and enhance patient satisfaction rates leading to higher market reputation. Hence, if applied to our workplace setting of a primary care facility, the CNS will positively address the staffing shortage, takeover most of the responsibilities of the GPs and be able to provide advanced care to the patients in any emergency or crisis setting (Boot & Wilson, 2014).

Conclusion:

On a concluding note, the impact of the any advanced job role in the health care industry is immense. It has to be acknowledged in this context that in the advancing health care industry, the advanced practice roles such as the CNS widens the opportunities for nurses immensely. This job role is advanced in not just scope of practice or responsibilities, it is also a great opportunity for career growth for RNs with right skills and experience. This paper had been successful in highlighting the array of different job roles, responsibilities, scope of practice, and practice standards. The paper also discussed the applicative benefits of the job role of a CNS to primary care facility which is my workplace and has outlined all the possible benefits that can be attained by introducing this job role.

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