Clinical Nurse Specialists & Patient Safety

Patients are at risk for serious harm within hospitals.

In 1999, the Institute of Medicine (IOM) estimated that between 44,000 and 98,000 Americans die in hospitals annually as a result of preventable medical errors.

The clinical nurse specialist (CNS) is uniquely prepared to address this issue of patient safety by using their education and expert clinical, consultation and collaboration skills in leadership roles and participating in research.

In clinical practice, much of the work of a clinical nurse specialist can be linked to promoting patient safety and translating that knowledge into practice.

Because of this unique background the CNS is well positioned to advocate for patient safety throughout the healthcare system.

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Universal Implications 

Patient safety is an issue of major national interest.

Following the release of the Institute of Medicine seminal report, To Err is Human, healthcare systems in the U.S. began to look seriously at their safety culture.

In the ensuing years policymakers, providers and consumers have joined forces to make the safety of patient care in the U.S. a top priority. The National Quality Forum, for example, details 15 national voluntary consensus standards for nursing-sensitive care.

Since the time of Florence Nightingale (1969; Notes on Nursing) in fact, nurses have had an enduring interest in promoting patient safety and maintaining safe patient care environments.

The NQF Consensus Standards for Nursing-Sensitive Care are the first-ever national standardized performance measures that assess the extent to which nursing personnel in acute care hospitals contribute to healthcare quality, patient safety, and a professional and safe work environment.

Spheres of Influence

Clinical nurse specialists compose one of four categories of advanced practice nurses, each with a distinctively unique practice focus. The other three categories of advanced practice nursing include: nurse practitioners, nurse midwives and nurse anesthetists.

All APNs share a common knowledge base regarding nursing practice. However, each area of advanced practice is supported by a unique knowledge base that supports its distinctive contributions.

A CNS can specialize in any of several different areas of practice.

Regardless of the particular area of specialization, core competencies that describe the functions of a CNS can be recognized in three spheres of influence as outlined by the National Association of Clinical Nurse Specialists.

The three spheres of influence include: Patient Direct Care, Nurse and Nursing Practice, and Organizations and Systems.

Patient Direct Care

Within this first sphere of the CNS practice, the principal goal is health promotion and it is structured to prevent illnesses and diseases.

Nurse and Nursing Practice

The second sphere is a role in which the CNS will educate other nursing staff through consultation and role-modeling. In this sphere the focus is on ensuring that nursing practice is grounded in best practices and evidence-based research.

Organization and Systems

In this sphere of influence, the CNS takes action primarily by acting as an advocate for the practice of nursing. For example, the CNS may take a leadership role in advocating for the staff nurses by drawing attention to the many ways in which nurses already contribute to patient safety, and by promoting the reallocation of resources to further educate nursing staff on patient safety.

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Creating a Culture of Safety

There are a number of models of change that promote evidence based practice. Also, much has been written regarding the culture of safety.

However, many patient safety initiatives have their origins in the observations of frontline registered nursing staff made during day-to-day practice by the APNs employed within a healthcare system.

Facing the potential for reduced reimbursements due to high rates of readmissions, hospital administrators are also aware that attention to patient safety is a priority and understand that sometimes a cultural change is necessary.

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A culture of safety can be role-modeled by APNs and frontline RNs becoming actively involved in promoting patient safety within their hospital, and instilling this culture change in new and existing nursing staff through mentoring and coaching.

Graduate-level education, the APN scope of practice and defined spheres of influence make CNSs ideal candidates for leading the way in promoting patient safety using evidence-based nursing practice.

Meanwhile, every APN and RN can find at least one safety initiative that can be pursued at their facility – and can begin to provide safer patient care immediately.

References for this article can be accessed here..

Sandra Evans is a clinical nurse specialist, acute care, patient care services, at Detroit Medical Center in Michigan.

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