Linda D Urden, DNSc, RN, CNS, NE-BC, FAANProfessor and Director

Master’s and International Nursing ProgramsHahn School of Nursing and Health Science

University of San Diego

There are four types of advanced practice nurses:◦ Clinical Nurse Specialist (CNS)◦ Nurse Midwife◦ Nurse Practitioner◦ Nurse Anesthetist

CNSs are licensed registered nurses who have graduate preparation at the master’s and doctoral levels

CNSs have additional certifications or licenses as a CNS

CNSs are expert clinicians who work in a variety of clinical practice settings◦ Population: pediatrics, geriatrics, women’s health◦ Setting: critical care, emergency room◦ Disease or medical subspecialty: diabetes,

oncology◦ Type of Care: rehabilitation, home health, mental

health, palliative care◦ Type of Problem: pain, stress, wounds

CNSs are independent practitioners and may form their own practice

Patient◦ May coordinate the care of a certain specialty

population, e.g., HF, transplant◦ May manage clinics for specialty◦ May be consulted to provide teaching, support for a

newly diagnosed condition Staff

◦ Mentor, role model for staff◦ Teach, rounds, consultant for complex cases

Organization◦ Lead system wide initiatives, multidisciplinary teams◦ Instrumental in managing change of practice (EBP)

CNSs practice in a variety of health care settings◦ Per 2010 survey, 70% practice in some type of

inpatient care setting◦ Remainder indicated home health care, long term

care, public health centers, ambulatory care, correctional facilities, and private industry

CNSs teach in schools of nursing….increasing numbers with full time CNS practice while teaching courses in the schools

Leaders of teams in organizations to improves quality and safety of care

Developers of programs to prevent avoidable complications

Coaches of those with chronic diseases to prevent hospital readmissions

Consumers of evidence-based practice to ensure best care and services (MSN, DNP)

Researchers to create new knowledge to improves outcomes of care (PhD).

CNSs are uniquely positioned due to their expertise and skills to be leaders as we move forward with new models of care◦ Improving the quality and safety of care◦ Eliminating unnecessary care◦ Improving the care for those with chronic illnesses◦ Reducing the costs of care

Increase effectiveness of transitioning care from hospital to home and prevent readmissions (create a Medicare benefit that would support providing transitional care)

Improve the quality and safety of care and reduce health care costs (leading EB system-wide changes: med errors, HACs, etc.)

Educate, train, increase the nursing workforce needed for improved health care system (EB orientation programs, mentor new and tenured staff)

Increase access to community-based care through the expansion of Nurse Managed Health Care Centers (slow down progression of chronic disease

Increase the availability of effective care for those with chronic disease (promote self care and manage symptoms)

Improve access to wellness and preventive care (wellness company owned/managed by CNSs reduce costs)

Make rounds on high risk cases Coordinate/attend multidisciplinary care

conference Consult with staff on complex cases

(anywhere in the organization) Discuss cases with MDs, other care team

members Teach a specialty class Meet with nurse residency program

participants

Attend leadership meeting Meet with pharmacist on join EBP project Meet with Director regarding new orientees Consult with another CNS Conference call with professional

organization committee meeting Intervene with new equipment that

appeared with a patient from the OR- that staff had never seen before

Meet with staff who is presenting an inservice for the first time

Work on revising one of the many procedures that need updated

Discuss with faculty the CNS student who you will be precepting next semester

Prepare for the system-wide EBP team meeting that you will lead tomorrow

Did anyone say lunch ?????

Clinical experts in diagnosis and treatment of illness in specialties across the continuum of care

Provide evidence-based care in a variety of settings

Direct providers of Medicare services

Prescribers of medications (38 states)

Coordinators of care across settings

Leaders and facilitators of change among large groups and organizations

Researchers in identifying effective interventions with proven outcomes

Urden@sandiego.edu