Published on October 17, 2013
The Role of the Perioperative Clinical Nurse Specialist Dr. Mary A. Hillanbrand, RN, DNP, CNOR October 9, 2013
Dr. Mary A. Hillanbrand Dr. Mary A. Hillanbrand, is a perioperative Clinical Nurse Specialist on active duty in the US Air Force currently assigned as an assistant professor and Deputy Program Director in the Clinical Nurse Specialist program at the Uniformed Services University in Bethesda, Maryland. Dr. Hillanbrand earned her Doctorate of Nursing Practice from the University of Alabama, in Tuscaloosa, Alabama. Her capstone project “Identifying Gaps in Perioperative Registered Nurses Knowledge of the Cleaning and Decontamination Process for Surgical Instruments” provided the groundwork for the development of educational interventions aimed at increasing knowledge of recommended practices to improve practice and patient outcomes. Dr. Hillanbrand has worked in the perioperative environment for over 30 years, which includes more than 12 years as a certified surgical technician. Her field of interest is the development of educational interventions to increase compliance with recommended practice guidelines with a focus on improved patient outcomes. Additionally, Dr. Hillanbrand is involved with promoting certification for all perioperative team members including advanced practice nurses in the perioperative environment.
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Objective • Discuss the history of the Clinical Nurse Specialist • Identify the four APRN roles within the Regulatory Model • Discuss the 5 domains of CNS practice within the 3 spheres of influence
History of CNS • Early 20th century “Nurse Specialist” was brought forward • 1943 - Frances Reiter promoted the idea of a “nurse clinician” – A nurse with advanced knowledge, clinical competence and commitment to providing high quality nursing care – Recognized need for graduate education • Clinical Nurse Specialist (CNS) – 1944 - NLNE’s Committee to Study Post-graduate Clinical Nursing Courses inception of the specialty – 1949 - University of Minnesota National Conference of Director’s of Graduate Programs credited with genesis of the clinical-nurse specialty (Towers, J, 2011)
Consensus Model for APRN Regulation APRN SPECIALTIES Licensure occurs at levels of Role and Population foci Focus of practice beyond role and population focus linked to health care needs Examples include but not limited to: acute care (perioperative, trauma, intensive care), oncology, older adults, orthopedics, nephrology, palliative care POPULATION FOCI Family/ Individual across lifespan Adult/Gerontology Neonatal Pediatrics Women's Health/ Genderrelated Psychiatric Mental Health APRN ROLES Nurse Anesthetist Nurse Practitioner Clinical Nurse Specialist Nurse Midwife (APRN Consensus Work Group, 2008, p 9.)
APRN Similarities • Certification • Prescriptive Authority **(NCSBN, 2013) – 36 States authorize CNS Prescriptive Authority • 13 States: Independent Authority • 23 States: Not Independent Authority • 15 States: No Prescriptive Authority • Independent Practice** (NCSBN, 2013) – 22 States: CNS Independent Practice – 23 States: NP Independent Practice **Defined by State Boards of Nursing Scope of Practice Acts (National Council of State Boards of Nursing [NCSBN], 2013)
AORN Position Statement “The APRN functioning in the perioperative setting is a registered professional nurse who: – is competent in the use of specialized perioperative nursing knowledge and skills in the care of patients and families undergoing operative and other invasive procedures…; – functions autonomously and collaboratively with the surgeon in the preoperative and postoperative management of surgical patients and their complex responses to the surgical process…; – integrates clinical practice, education, research, management, leadership, and consultation into a single but multifaceted role...; – continually functions in a collegial relationship with nurses, physicians, health care organizations, and systems to inﬂuence care of the surgical patient.” (AORN, 2013, pp. 299-300)
Clinical Nurse Specialist - CNS • Unique role to integrate care across the continuum throughout the three spheres of influence – Patient – Nurse – System • Improve patient outcomes and nursing care • Create environments to empower nurses – Evidence-based practice – Facilitate ethical decision making • Responsible for diagnosis, treatment, and management of health and illness • Health promotion • Prevention of illness and risk behaviors (APRN Joint Dialogue Group, 2008)
Domain 1: Clinical Expert • Complex surgical patients • Surgical consults – Differential diagnosis – Metabolic needs – Pain management – Pharmacology • Pre-op history and physical – Treatment plans
Domain 2: Consultant • Interdisciplinary and multidisciplinary • Committee membership – Expert resource for perioperative continuum • Infection control • Risk mitigation • Root cause analysis
Domain 3: Education • Nurses and staff – In-services – Continuing education offerings – Competency validation • Patient/Family – Surgical expectations – Pain management – Post-operative management/wound care • Community – Health promotion
Domain 4: Clinical Inquiry • • • • • • Evaluate current practice Patient safety initiatives Evidence-based practice Recommended practice guidelines Literature reviews Synthesize and disseminate research finding
Domain 5: Manager/Leader • Policy and procedure • Organization – Fiscal accountability – Process improvement – Risk management – Patient safety • Informatics – Utilization – Staffing
Professional Accountability • Professional development – Perioperative team members – Continuing education – Professional organizations • Mentorship • Certification • Health policy and legislation
Final thoughts • The perioperative CNS is an APRN who provides care within the patient, nurse, and organization spheres of influence • The domains that define the CNS role are: – Clinical expert – Consultant – Education – Clinical inquiry – Manager/leader
References APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Association of periOperative Registered Nurses. (2013). AORN Position Statement: Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN Journal, 97(3), 299-301. National Council of State Boards of Nursing. (2013). APRNs in the U.S. Retrieved from https://www.ncsbn.org/2567.htm Towers, J. (2011). The evolution of advanced practice in nursing. In J. Stanley (Ed.) Advanced practice nursing: Emphasizing common roles (pp.3-31). Philadelphia: F.A. Davis Company. All pictures in this presentation were obtained from public domain on Google images at https://www.google.com/imghp?hl=en&tab=ii
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Take Your Career to the Next Level Go for your CNS-CP Credential. Get there with AORN! The Perioperative CNS Certification Exam Prep Course Includes: • Two-day educational coaching event • Three additional facilitated, interactive webinars and assignments This course will provide advanced knowledge, review the core competencies, and review the domains of nursing practice for the RN, CNS in the specialty of perioperative practice. Denver, CO | AORN Headquarters January 17-18 $450 includes all events www.aorn/CNS-CPCourse
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