The pandemic shuffled the deck on health care delivery. Non-emergent surgery was suspended with nurses reallocated to acute care areas. Care delivery models were reconfigured to balance nurse skills with clinical demands. Outpatient care became telehealth and providers, including advanced practice nurses, were granted privileges for expanded and interstate practice. We coped with horrendously sick patients, isolated and confused family members, supply shortages, staffing shortages, and way too many deaths including those of our nurse colleagues. We have arrived at a more stable time, though COVID-19 remains with us and for the foreseeable winter is being joined by the seasonal flu.

The aftereffects of the pandemic have taken a toll on nurses. A two-year impact assessment survey of 12,694 nurses practicing in the United States found 89% reported working with insufficient staffing, 66% have experienced an increase in bullying/violence, 60% feel burned out, and 52% plan to leave or are considering leaving their organization.1 The World Health Organization estimates a need of nine million additional nurses and midwives by 2030, accounting for 50% of the healthcare workforce.2

Reasons cited by nurses for leaving practice included the inability to provide high quality care.1 Nowhere are challenges of delivering safe, quality care more evident than in the acute care hospital setting. Considering the nurse workforce recover will likely be a long period of years, clinical nurse specialists (CNS) are needed in acute care settings to support delivery of safe, quality care during the workforce rebuild. As expert clinicians and strategic leaders, CNSs possess the relational and strategic skills necessary to support nursing practice and maintain quality clinical outcomes. CNS practice in three synergistic domains including providing direct patient care, supporting nurses and nursing staff in care delivery, and influencing systems to remove best practice barriers and create innovative programs of care. During the pandemic, CNSs engaged in strategic initiatives that reconfigured models of care delivery, modified and developed procedures and protocols, served as communication channels between bedside patient care nurses and the C-suite, and positively influenced nursing practice by empowering the nursing workforce.

Continued CNS leadership is needed to support nurses in the delivery of high quality, safe, nursing care during the workforce rebuild. To probe just what CNS leadership will look like during this time, I asked six CNSs working in acute care settings for their thoughts. Here are some of their responses.

* Nursing is grounded in relationship. CNSs develop trusting relationships with nurses practicing at the bedside, which allows us to exert a great deal of influence on the delivery of care. Sometimes all a nurse needs is a reassuring nod or affirming comment. Other times we can prevent problems with proactive intervention.

* As clinical experts, we are "elbow consultants" modeling care. Having a clinical focus in a specialty area of practice is especially important now because our recently graduated nurses had limited clinical learning experiences due to the pandemic. We serve as a bridge between textbook knowledge and real-world practice.

* We are vanguards of quality and safety. The new nurses may know how to perform a procedure, yet they often lack a deeper understanding of the why. Quality is maintained by seeing the patient in context, which may mean modifying a care procedure to fit the circumstances. We help nurses connect the dots, think critically, evaluate options, and make thoughtful decisions.

* CNSs are excellent at providing support and encouragement. And engagement. When something comes along that needs nursing staff buy-in, we are on the front line of getting others engaged. We take time to listen, clarify, and reinforce.

* Staff perceive CNSs as a safe harbor for sharing problems. Because we have no managerial authority over performance evaluations, nurses will discuss their concerns, making us problem detectors for all manner of things from interprofessional feuds to equipment failures. We communicate their concerns to managers for problem solving while preserving confidences.

* Supply shortages are easing, but there remains a constant need to evaluate and adjust supplies and equipment. CNSs serve as an interface between supplies/suppliers and clinical care. We are excellent at product evaluation and cost-comparison to assure our systems get the best value and highest quality.

* Hospital budgets are tighter than ever post-pandemic. Nurse retention is crucial. Supporting nurse retention is an expectation of CNSs; it's a core CNS practice competency!

Experienced and newly graduated nurses need support. In a recent survey, only 20% of nurses indicated feeling supported; 17% indicated they were motivated, and 11% reported feeling fulfilled and empowered.1 CNSs help nurses feel supported, motivated, and empowered though our work in mentoring, teaching, coaching, consulting, and listening to nurses. In fact, CNSs were first envisioned as a professional nursing role in the 1950's as an advanced clinical practice expert serving as a provider and leader who would solve problems, role model nursing care, study ways to improve patient care, develop innovations in practice, and create patient care programs. Proving clinical leadership for improved nursing care for specialty populations has been the essence of CNS practice for the last 70 years.

Nursing is a demanding, fulfilling, and exciting career. In rebuilding the nursing workforce, CNSs are needed now more than ever to provide clinical leadership, support and engage nurses, assure quality and safety, create innovative models of care, and serve as a voice for nursing practice in complex health care systems. We look forward to the challenge!

Acknowledgments

Thanks to Laura Blazier, Alyson Keen, Tiffany Rader, Jo Tabler, Brandy Wornhoff, and Megan Zondor for sharing their insights on CNSs contributions to the workforce rebuild.

References