The ROLE OF THE CLINICAL NURSE SPECIALIST AS

MAGNET PROGRAM DIRECTOR

Presented bySherri Mendelson, PhD, RNC, CNS, IBCLCDirector Nursing Research, Magnet ProgramProvidence Holy Cross Medical Center15031 Rinaldi St. Mission Hills, CA 91345

The participants will be able to:1. Describe the roles of the MPD2. Discuss the competencies of the CNS that can

lead to success in the MPD role3. Evaluate the current literature on the CNS as

an MPD4. Develop a research question to shorten the

knowledge gap about the value of the CNS as MPD

OBJECTIVES

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• A competency model encompasses all the competencies, tasks and skills, behavioral examples, and proficiency requirements for a particular job.

• Success in a role requires a specific set of competencies that relate to the job, as well as to the organization's goals.

• What competencies increase the success of a role?

ROLE COMPETENCIES

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3 Spheres of CNS Practice

• Patient/Client Family• Clinical Nurse • Organizational

MPD Roles

• Leading improved patient outcomes

• Leading the nursing practice environment

• Disseminating Magnet expectations and information

• Development of timelines, budget, documents, teams

MERGING THE CNS AND MPD ROLES

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CLINICAL NURSE SPECIALIST COMPETENCIES

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• Advanced practice role requirements include:– clinical expertise in a focus area– evidence-based practice– collaboration – consultation– education– mentoring– change leadership

CNS: KNOWLEDGE AND SKILLS REQUIRED

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MAGNET PROGRAM DIRECTOR

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• Collaborative relationship with nurse managers; nursing directors; CNO

• Participate in leadership groups to be able to identify work that applies to this area

TRANSFORMATIONAL LEADERSHIP

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• Systems Leadership Competency: The ability to manage change and empower others to influence clinical practice and political processes both within and across systems.– TL-6

CNS COMPETENCIES

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• Leadership and or participatory role in shared governance

• Collaboration and communication regarding aspects of the demographic data

• Leadership or participation in nursing staff recognition

STRUCTURAL EMPOWERMENT

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• Coaching Competency: Skillful guidance and teaching to advance the care of patients, families, groups of patients, and the profession of nursing. – SE-7EO; SE-8EO

CNS COMPETENCIES

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• Influence on nursing practice environment• Influence on patient environment• Influence on quality measures and outcomes

– EP-18EO; EP-19EO; EP-20EO; EP-21EO• Communication and collaboration regarding

aspects such as ethics

EXEMPLARY PROFFESSIONAL PRACTICE

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•Direct Care Competency: Direct interaction with patients, families, and groups of patients to promote health or well-being and improve quality of life.

•EP-12•Characterized by a holistic perspective in the advanced nursing management of health, illness, and disease states.

•EP-18EO; EP-19EO; EP-20EO; EP-21EO

CNS COMPETENCIES

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• Collaboration Competency: Working jointly with others to optimize clinical outcomes. The CNS collaborates at an advanced level by committing to authentic engagement and constructive patient, family, system, and population-focused problem-solving– EP-6EO

CNS COMPETENCIES

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• Ethical Decision-Making, Moral Agency and Advocacy Competency: Identifying, articulating, and taking action on ethical concerns at the patient, family, health care provider, system, community, and public policy levels. – EP-13

CNS COMPETENCIES

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• Evaluation of Clinical Practice– Standards of professional practice

• EP-11; EP-12

CNS COMPETENCIES

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• Consultation Competency: Patient, staff, or system-focused interaction between professionals in which the consultant is recognized as having specialized expertise and assists consultees with problem solving. – EP-15EO; EP-16EO; EP-17

CNS COMPETENCIES

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• Participation and influence over research conduct and dissemination

• Participation and influence over innovative initiatives

NEW KNOWLEDGE AND INNOVATIONS

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• Interpretation, Translation and Use of Evidence – Development of policies and procedures– Development of workflow

• NK-7EO– Education on EBP– Quality Improvement

• NK-3; NK-4

CNS COMPETENCIES

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• Research Competency: The work of thorough and systematic inquiry.

• Systematic inquiry. • Active participation in the conduct of

research. – NK-1

CNS COMPETENCIES

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• Conduct of Research• Role modeling ethical conduct for research• Identification of the research team roles

CNS COMPETENCIES

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• Meet with TIPs (transition into practice residents and fellows)

• Make rounds on high risk cases• Coordinate/attend multidisciplinary care

conference• Consult with staff on complex cases• Discuss cases with MDs and other care team

members

THE CNS WORK DAY (Linda Urden)

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• Teach a specialty class• Prepare for the system-wide team meeting

you will lead tomorrow• Discuss with faculty the student you will be

precepting next semester• Attend leadership meeting• Meet with multidisciplinary team for joint EBP

project

THE CNS WORK DAY (Linda Urden)

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• Meet with Nursing Director regarding new orientees

• Consult with other CNS• Work on revising a policy• Meet with staff to create a poster presentation

for 1st time presenter• Intervene regarding new unfamiliar equipment

that appeared with patient from the OR• Conference call with professional organization

planning committee

THE CNS WORK DAY (Linda Urden)

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Definitions of Chronic Conditions Magnet Program

Uncertain etiology What caused the desire for Magnet?Multiple risk factors Start with patient satisfaction; CAUTI…Prolonged course of care 4 yearsFunctional impairment and disability We all have someUncertain etiology Long latency period

Between designation and re-designation

Non-contagious origin We need the contagion to build interest!

Incurability You cannot cure everythingNo physical outward signs Need to explore to find the problemsImpairment in ADLs and community experiences

the need to build within your community

THE CHRONIC CARE CNS

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CNS MPD

WHAT IS KNOWN ABOUT THE CNS IN THE MPD ROLE?

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Research

• Descriptive research (maybe)– Use of the Six Sigma Champion Model by CNSs to engage staff

nurses– EBP group membership led by CNSs– CNSs and change implementation

Results include positive quality improvement and patient and nurse satisfaction and validation of the importance of the CNS role on the Magnet journey.

Limitations include use of CNSs in the above roles but not as MPDs

RESEARCH

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Muller A, Hujcs M, Dubendorf P, Harrington PT. (2010).

• This document outlines the core clinical nurse competencies that may lead to MPD success but does not reflect research related to the CNS in the MPD role

NACNS 2018 DOCUMENT B

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NACNS, 2018

• Transformational Leadership– Leading implementation– Change facilitation– Dissemination– Communication and collaboration

ROLE OF THE CLINICAL NURSE SPECIALIST ON THE JOURNEY TO MAGNET DESIGNATION

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Hansen, MD, 2015

• There are not adequate research study results to confidently state that having a CNS as MPD will result in Magnet designation more often than hospitals that do not have a CNS as MPD.

• There are not adequate research study results to confidently state that having a CNS as MPD will result in Magnet document acceptance more often than hospitals that do not have a CNS as MPD.

KNOWLEGE GAP

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WHAT DO I BRING TO THE MPD Role AS A CNS

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• In clinical practice 33 years prior to becoming MPD

• Continue in practice as a lactation consultant• Continue to review clinical practice updates

CLINICAL KNOWLEDGE

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• Participation on ethics committee• Serve on surrogacy committees

CONSULTATIVE ABILITIES

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• Staying current• Competent in reading research literature to

support EBP

UNDERSTANDING OF EBP

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• Participation in development and updating standardized procedures

POLICY AND PROCEDURE DEVELOPMENT

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• Orientation• Continuing education• Theoretical models

NURSING EDUCATION

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• Collaboration as a regional lead for Magnet and Research

• Collaboration as a system lead for Magnet• Collaboration with other disciplines

COLLABORATION

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• Magnet Council• Shared governance

DEVELOPMENT OF A TEAM

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• Party planning!!• Development of budget• Development of a timeline• Socialization of new staff to Magnet

DEVELOPMENT OF A PLAN

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• As a CNS, the MPD is generally comfortable being on clinical units and communicating with frontline clinical nurses

• Participation in shared governance and meetings at every level

IDENTIFICATION OF STORIES

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• The devil is in the details• Preparation began during the multiple papers

that were assigned in the CNS educational programs

• Knowledge of the importance of each word is gained through research experience and policy development

DOCUMENT WRITING

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• Understanding of the outcomes data• Design of graphs• Understanding the difference between

process and outcomes

DEVELOPMENT OF OUTCOMES

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• The MPD/CNS cannot be the central figure in all of the documents submitted for designation/re-designation

MENTORING

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• Muller A, Hujcs M, Dubendorf P, Harrington PT. (2010). Sustaining excellence. Clinical nurse specialist practice and Magnet designation. Clinical Nurse Specialist, 24(5), 252-259.

• Hansen MD. (2015). Role of the clinical nurse specialist in the journey to Magnet recognition. AACN, 26(1), 50-57

• Gordon JM, Lorilla JD, Lehman CA. (2012). The role of the clinical nurse specialist in the future of health care in the United States. US Army Research. 196.http://digitalcommons.unl.edu/usarmyresearch/196

REFERENCES

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The ROLE OF THE CLINICAL NURSE SPECIALIST AS �MAGNET PROGRAM DIRECTOROBJECTIVESROLE COMPETENCIESMERGING THE CNS AND MPD ROLESCLINICAL NURSE SPECIALIST COMPETENCIESCNS: KNOWLEDGE AND SKILLS REQUIREDMAGNET PROGRAM DIRECTORSlide Number 8CNS COMPETENCIESSlide Number 10CNS COMPETENCIESSlide Number 12CNS COMPETENCIESCNS COMPETENCIESCNS COMPETENCIESCNS COMPETENCIESCNS COMPETENCIESSlide Number 18CNS COMPETENCIESCNS COMPETENCIESCNS COMPETENCIESSlide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26ResearchSlide Number 28�Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44