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Clinical Nurse Specialist Orientation:

A New Framework Emerged from Regional Collaboration

March 10, 2017

Disclosure

We have no conflicts of interest in relation to this presentation.

Anushree R. Ahluwalia, MSN, RN, ACNS-BC Margaret McNeill, PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, NE-BC, FAAN

Samantha Young, MS, RN, CCRN, ACNPC, CCNS Tania Randall, MS, RN, ACCNS-AG

Denise Moore, PhD, APRN-BC

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Objectives

The learner will be able to:

– Identify the key tenets of the conceptual framework to orient a CNS

– Identify the components of the CNS tool

–Discuss application of the framework

–Provide feedback on the strengths and weaknesses of the proposed approach

Situation

• The Chesapeake Bay Affiliate of the National Association of Clinical Nurse Specialists (CBANACNS) identified that CNS orientation was inconsistent across Maryland

– A workgroup was commissioned to

• Develop a structured yet flexible approach

• Design it to meet organization- and CNS-specific needs

Background • Review of the literature found framework

needs to be

– Flexible, self-paced, individualized

– Be applicable to orientation and

ongoing competency evaluation

• Limited literature on best practices

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Background

DiMauro K., & Mack, L.B. (1989)

Background

Miga, K.C., Rauen, C.A., Srsic-Stoehr, K. (2009)

Background

Urden, L.D., & Stacy, K.M. (2011)

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Assessment • The workgroup evaluated existing practices

• Key tenets were identified to fulfill needs across all types of facilities:

– Experience

– Competence

– Scope: Advanced Practice

– Regulatory Readiness

Conceptual Framework

• The Joint Commission

• Donna Wright’s Model

• Benner’s Model: Novice to Expert

• NACNS Core Competencies

• NACNS Spheres of Influence

• APRN Competencies (Hamric & Spross)

• Synergy Model

Scope Experience

Regulatory Readiness

Competence

Key Tenet: Scope • NACNS Core Competencies

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Key Tenet: Experience

• Tracks to match level of experience

cft.vanderbilt.edu

Key Tenet: Competence

• Learner-centered validation

Wright, D. (2005)

Key Tenet: Regulatory Readiness

• Meet recommendations from The Joint Commission to document orientation

– Method of Validation

– Verification by Validator

– Date of Verification

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Assessment

• The prototype:

– Included tracks based on experience

• Offered an opportunity to self-assess

• Based on individual’s expertise as a CNS

–Characterized core competencies of the CNS

• Specific to the spheres of influence

Assessment

• The prototype:

–Addressed learner-centered validation methods

– Integrated regulatory requirements

–Allowed flexibility to customize content

–Usable for ongoing evaluation/development

Example Research Competency:

The work of thorough and systematic inquiry. Includes the search for, interpretation, and use

of evidence in clinical practice and quality improvement, as well as active participation in

the conduct of research.

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Behavioral Statement Sphere of

Influence

Nurse

Characteristics F.III.1 Participates in conduct of or implementation of research which may include one or more of the following: F. III 1 a. Identification of questions for clinical inquiry F. III 1 b. Conduct of literature reviews F. III 1 c. Study design and implementation F. III 1 d. Data collection F. III 1 e. Data analysis F. III 1 f. Dissemination of findings

Patient,

Nurse &

System

Facilitation of

Learning,

Clinical Inquiry,

Collaboration,

Systems

Thinking

Example

Self-Assessment (Select one with exemplar)

Novice/Advanced Beginner/Competent Proficient/Expert

● Participates in a research project

● Identifies a question for research

● Conducts literature reviews

● Collects data during a research study

● Participates in data analysis of

research results

● Contributes to dissemination efforts:

posters, manuscript preparation,

podium presentation

● Completes research ethics education

● Principal Investigator on a research

project

● Designs and implements research

● Garners IRB approval for research

studies

● Leads data collection during a

research study

● Leads data analysis of research

results

● Leads dissemination efforts: posters,

manuscript preparation, podium

presentation

● Member of the Institutional Review

Board

Example

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Recommendations

• Feedback

– Supervisors

– CNS group at each facility

• Revise as needed

– Maintain broad applicability

– Ability to tailor to facility needs

Implications for Future Practice

• Adoption of framework in different settings

• Use for goal-setting for professional development

Contact Information:

Margaret M. McNeill, PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, NE-BC, FAAN Clinical Nurse Specialist, PeriAnesthesia

Department of Professional and Clinical Development

Frederick Regional Health System

mmcneill@fmh.org

240-566-4913

Chesapeake Bay Affiliate of the National Association of Clinical Nurse Specialists

website: www.cbanacns.org

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References

• Clinical Nurse Specialist Core Competencies: Executive Summary 2006-2008. Retrieved from NACNS.org.

• DiMauro K., & Mack, L.B. (1989). A competency-based orientation program for the clinical nurse specialist. Journal of Continuing Education in Nursing, 20(2): 74-78.

• Hamric, AB, Spross, JA, & Hanson, CM. (2008). Advanced practice nursing: An integrative approach. 4th ed. St. Louis: Elsevier.

• Hardin, S. Kaplow, R. (2004). Synergy for clinical excellence: The AACN Synergy Model for patient care. Aliso Viejo, CA: American Association of Critical Care Nurses.

References

• Miga, K.C., Rauen, C.A., Srsic-Stoehr, K. (2009). Strategies for success: orienting to the role of a clinical nurse specialist in critical care. AACN Advanced Critical Care, 20(1): 47-54.

• Urden, L.D., & Stacy, K.M. (2011). Clinical nurse specialist orientation: ready, set, go! Clinical Nurse Specialist, 25(1): 18-27.

• Wright, D. (2005). The ultimate guide to competency assessment in health care. 3rd ed. Minneapolis, MN: Creative Health Care Management.