DEFOGGING THE LENS PAN-CANADIAN CORE COMPETENCIES • The Canadian Nurses Association (CNA), the national professional voice for Registered Nurses in Canada and the Canadian Association of Advanced Practice Nurses is one of the 44 specialties from the Canadian Network of Nursing Speciality within CNA. • In 2014, CNA developed and published Canada’s first Pan-Canadian Core Competencies for the Clinical Nurse Specialist. For the first time in the history, CNSs in Canada have a document that describes their role and that solely belongs to the Clinical Nurse Specialist. • The release of the core competencies has provided a great opportunity for the CAAPN-ACIIPA CNS Council to examine how the model in this presentation aligns with the new competencies listed below. • The new competencies can be viewed as an expansion of the former clinical, consultation/collaboration, leadership and research competencies which were a foundation of the role competencies in our model. • An immediate strength of the new core competencies is demonstration of the pillars of the CNS practice and how the CNS influences complex health issues to achieve client safety and positive health outcomes. • Within this context, the document is a stepping stone in the efforts to clarity the CNS role within the Canadian health care system. • These core competencies will be used to reduce the ongoing role ambiguity and lack of clarity as to who the clinical nurse specialist is. A PATHWAY TO ROLE CLARITY FOR CLINICAL NURSE SPECIALISTS Josephine Muxlow, RN, MS, CPMHN (C) ROLE IMPLEMENTATION AND MEASUREMENT Elizabeth Cooper, RN, MN Following a literature review of relevant documents and papers, three groups were formed. The groups chose activities related to defining the CNS role, reviewing evidence to determine the education level, scope of practice, standards of care and implementation of the CNS role using a variety of tools. Donna Flahr, RN, MSc, CMSN (C) Lorraine J. Avery, RN, MN, CNCC (C) CNS ROLE DEVELOPMENT CLINICAL NURSE SPECIALIST COUNCIL Within the governance structure of CAAPN’s ByLaws, Vision, Mission, Values the CNS Council is mandated to: • “promote sustainable, integrated, comprehensive CNS practice • enhance CNS professional development • support the ongoing development of advanced practice nursing, and • promote the health of Canadians by advocating for human health issues “ GUIDING PRINCIPLES • National voice for CNSs recognizing and respecting the expert knowledge of its diverse membership. • Support the development of CNSs as advanced practice nurses by graduate level education and utilization of the core competencies Spheres of Influence System - Gap Analysis Nursing: CNS & Nurses Clinical Population Clinical Specialties Population Settings and Competencies Define Model of Care Varies from Population to Population Role Implementation Process and Outcomes Measurement Evaluation CNS and Clinical Practice Individuals/Families/ Communities • Support approaches and frameworks that address disparities in educational preparation, licensing, regulation, legislation, practice environments • Foster strong leadership, and close collaboration with nursing colleagues in advancing professional nursing practice. OBJECTIVES • Describe strategies for role clarification within the Canadian Health Care System • Acquire knowledge of core competencies within the model • Examine the development and implementation of the CNS role using a Canadian Lens CNS Competencies Clinical Care & Education Leadership and Change Agent Collaboration Research Systems Internal/External Define CNS Role Education Level Scope of Practice Clinical Care System Leadership Advancement of Nursing Practice Evaluation and Research The Draft Standards of Care were developed with the following components: Definition, Process for Developing the Standards, Guiding Principles, Characteristics and Competencies. The work on the Standards of Care became redundant with the decision to develop specific core competencies for the CNS. However, some content was used to inform aspects of the Pan-Canadian Competencies. Clinical Stories Define Area of Nursing Expertise and Population Define CNS Role Education Level Scope of Practice Role Implementation Define Standards of Care and Evaluation and Process and Outcomes CNS Role Compentencies Measurement Evaluation Process and Outcome Measurement Evaluation Poster and Follow-up This work was completed by members of the Clinical Nurse Specialist Council of the Canadian Association of Advanced Practice Nurses/l’Association Canadienne des infirmières et infirmiers en pratique avancée (CAAPN-ACIIPA). CAAPN-ACIIPA is the National Nursing Association that represents the voice of the two groups of Advanced Practice Nurses (Clinical Nurse Specialist and Nurse Practitioners) from across Canada. The Role Implementation and Evaluation component explored ways to capture and measure positive health outcomes within our respective settings through logic model, clinical stories, survey, posters & follow-up and quality management activities. Quality Management Research has demonstrated the important contributions of the Clinical Nurse Specialist (CNS) role in the improvement of patient safety and health outcomes. Despite the significant advantages of the CNS contributions within the Canadian healthcare system, role ambiguity and the lack of full integration of the CNS within care teams is evident. Logic Model CONTEXT The National Association of Clinical Nurse Specialist Spheres of Influence, the American Association of Critical-Care Nurses – Synergy model and Newhouse et al., (2011) paper were amongst the US documents that were reviewed to shape the Role Development Diagram. The essential components were defining the expert knowledge required to address complex issues across the lifespan, areas of clinical speciality, models of care based on population in a variety of settings, CNS role, education level and scope of practice, standard of care and CNS competencies, policies and protocols, goals and anticipated outcomes, logic model to evaluate role implementation processes and outcome measures. Education level proved to be a challenge resulting in lack of consensus on the requirement of a graduate degree in Nursing. In defining the CNS, the newly released Pan-Canadian Core Competencies for the Clinical Nurse Specialist document addresses the education level as well as the field . WHO WE ARE Josephine Muxlow, RN, MS, CPMHN (C) Adjunct Professor, Dalhousie School of Nursing 5869 University Avenue, PO Box 1500 Halifax, Nova Scotia, Canada B3H 4R2 [email protected] 902.426-4764 Elizabeth Cooper, RN, MN Clinical Nurse Specialist IWK Health Centre 5850/5980 University Avenue Halifax, Nova Scotia, Canada B3K 6R8 [email protected] 902.470-8751 Donna Flahr, RN, BSN, MSc, CMSN (C) Clinical Nurse Specialist General Medicine Saskatoon Health Region 1702 20th St W Saskatoon, Saskatchewan, Canada S7M 0Z9 [email protected] 306.655-5409 Lorraine J. Avery, RN, MN, CNCC (C) Regional Clinical Nurse Specialist Winnipeg Regional Health Authority CR1045-369 Tache Avenue Winnipeg, Manitoba, Canada R2H 2A6 [email protected] 204.258-1286 Permission granted to publish abstract on SCNSE website (http://scnse.org/) REFERENCES Identify Goals and Anticipated Outcomes Develop Policies and Protocal Define Standards of Care and CNS Role Compentencies 1. APRN Consensus Working Group & the National Council of State Boards of Nursing (2008). APRN Joint Dialogue Group Report . Retrieved from https://www.ncsbn.org/ Consensus_Model_Report.pdf 2. Canadian Association of Advanced Practice Nurses (2010). Clinical Nurse Specialist Council: Terms of Reference. Retrieved from http://caapn-aciipa.org/ ClinicalNurseSpecialistsCouncil.html 3. Canadian Nurses Association (2008). Advanced Nursing Practice: A National Framework. Canadian Nurses Association, Ottawa 4. Canadian Nurses Association (2014). Pan-Canadian Core Competencies for the Clinical Nurse Specialist Canadian Nurses Association, Ottawa 5. McCabe, P. J (2005). Spheres of clinical nurse specialist practice influence evidence-based care for patients with atrial fibrillation. Clin Nurse Spec, 19 (6) 308-17 6. McMaster University, The Clinical Nurse Specialist: Getting a Good Return on Healthcare Investment. Retrieved November 8, 2013 from www.apnnursingchair,mcmaster. ca/documents/CNS_BN_ref.pdf 7. Muller, A. C, Hujcs, M., Dubendorf, P., and Harrington, P. T. (2010). Sustaining Excellence: Clinical Nurse Specialist Practice and Magnet Designation. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 24 (5), 252-259 8. Patti Rager Zuzelo (2003). Clinical Nurse Specialist Practice—Spheres of Influence. AORN Journal 77(2), 361- 6, 369-72 9. Summers, L. (2011). Coming to a consensus about APRN regulation. Nursing Management, 42(12), 10-14
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