Purpose/Objectives:
To describe an opportunity for the clinical nurse specialist (CNS) as an internal consultant to optimize patient care and outcomes through the continued monitoring of previously implemented evidence-based practice (EBP) projects and the reestablishment of workgroups as needed.
Significance:
Once an EBP project has been successfully implemented, the CNS may hand off the project to a responsible individual for maintenance over time. Although it can be resource intensive, there is value in the CNS maintaining project leadership long after implementation.
Background/Rationale:
The internal CNS is uniquely qualified for sustained EBP project management and can offer system-oriented leadership for further improvements needed over time.
Description:
In 2006, our intensive care unit (ICU) fully implemented use of the Central Line Bundles for prevention of catheter-related bloodstream infections. This practice change was led by the critical care and infection control CNSs and was strongly supported by both nursing and medical leadership as well as the healthcare system as a whole. Data collection and audits for infection rate and compliance with bundle elements were incorporated into the workflow of the unit. Over the next 3 years, the CNSs reinforced education at least every 6 months, monitored data, and modified the data collection form and process as needed. In fall 2008, a spike in the infection rate and concomitant publication of updated guidelines prompted the CNSs to coordinate a thorough analysis of the data and a reevaluation of processes. The initial implementation workgroup was reestablished, but hospital-wide strategies were now being considered, so interdepartmental personnel were added. Use of the bundles was expanded into the medical-surgical areas, evaluation of connectors for dialysis was completed, and dressings were modified. Infection data were organized and collected in all areas.
Outcome:
Central line infection data as well as compliance with central line bundle elements are now monitored for the ICU, the medical-surgical areas, and dialysis. Infection rates have decreased in critical care to 1.0 per 1,000 device days for November to April as compared to the previous 6-month rate of 1.9.
Interpretation/Conclusion:
CNS project surveillance and management are valuable for continued optimal patient outcomes.
Implications for Practice:
CNSs should continue leading and maintaining EBP projects after implementation.
Section Description
The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.
A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.
The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.
Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.