Problem and Significance
Albert Einstein Healthcare Network utilizes a shared governance model based upon a matrix design built along service lines. Nurses are challenged to increase EBP activities and struggle to differentiate between EBP, CQI, and research. Staff RNs and managers have diverse educational backgrounds, with few APNs. RNs often view research activities as valuable but disconnected from daily practice.
Purpose
The associate director of nursing for research (ADNR) is a CNS holding a joint appointment between the healthcare network and a local university. The ADNR is charged with promoting an agenda that (1) develops an understanding of research; (2) assists nurses with appreciating the unique values of EBP, CQI, and research; (3) encourages best practice; and (4) promotes professionalism.
Description of Project
The medical-surgical and critical care service line clusters were supported in efforts to identify practice priorities. Three projects were developed: Never Again Stories of Critical Care Nurses; Moral Distress of Acute Care Nurses; and Elders' Pain: A Program Evaluation Project. Steering committees of staff and administrators were formed for each project.
Methods
Each project is chaired by the ADNR. Steering committee members are responsible for critiquing the proposal and directing data collection activities. The Never Again Stories is a critical incident study involving interviews. The Moral Distress project uses survey methodology and will include RNs across a variety of clinical settings. Elders' Pain project is designed to teach program evaluation and improve pain management of elderly inpatients. The ADNR also utilizes an annual newsletter, and attends a variety of meetings to voice consistent application of EBP and CQI principles.
Outcomes
RN project participation is hesitant as nurses are concerned about additional workload and are worried about their perceived inexperience with EBP, outcomes, and research. Steering committee membership has been popular and competitive. Shared governance cluster members are developing an understanding of the various aspects of EBP.
Conclusions
RNs may not recognize EBP, research, program evaluation, and CQI as related but distinct activities. RNs may learn best using a problem-based learning approach that involves staff in different types of activities that may serve as exemplars for EBP, research, and CQI. Mentoring and coaching are critical throughout project development and implementation. Staff participation furthers the empowerment promoted by shared governance.
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.