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Role of the Periop Clinical Nurse Specialist

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Association of periOperative Registered Nurses (AORN)
Association of periOperative Registered Nurses (AORN)

Discover what it takes to be a Perioperative Clinical Nurse Specialist. This presentation is from AORN's webinar which describes the role of the perioperative CNS, RN. Receive 0.5 contact hours by registering for the webinar replay and successfully completing the evaluation. The webinar is available at http://bit.ly/1aROqKI. Interested in obtaining the new CNS-CP nursing credential? Learn valuable test-taking strategies and more through a CNS-CP Certification Exam Preparation Course: http://bit.ly/GQ5Yy0.

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The Role of the Perioperative Clinical Nurse Specialist Dr. Mary A. Hillanbrand, RN, DNP, CNOR October 9, 2013
Dr. Mary A. Hillanbrand Dr. Mary A. Hillanbrand, is a perioperative Clinical Nurse Specialist on active duty in the US Air Force currently assigned as an assistant professor and Deputy Program Director in the Clinical Nurse Specialist program at the Uniformed Services University in Bethesda, Maryland. Dr. Hillanbrand earned her Doctorate of Nursing Practice from the University of Alabama, in Tuscaloosa, Alabama. Her capstone project “Identifying Gaps in Perioperative Registered Nurses Knowledge of the Cleaning and Decontamination Process for Surgical Instruments” provided the groundwork for the development of educational interventions aimed at increasing knowledge of recommended practices to improve practice and patient outcomes. Dr. Hillanbrand has worked in the perioperative environment for over 30 years, which includes more than 12 years as a certified surgical technician. Her field of interest is the development of educational interventions to increase compliance with recommended practice guidelines with a focus on improved patient outcomes. Additionally, Dr. Hillanbrand is involved with promoting certification for all perioperative team members including advanced practice nurses in the perioperative environment.
Disclosure Information Speaker: Dr. Mary A. Hillanbrand, RN, DNP, CNOR Disclose No Conflict Planning Committee: AORN Nurse Educator Ellice Mellinger, MS, BSN, RN, CNOR Disclose No Conflict AORN’s policy is that the subject matter experts for this product must disclose any financial relationship in a company providing grant funds and/or a company whose product(s) may be discussed or used during the educational activity. Financial disclosure will include the name of the company and/or product and the type of financial relationship, and includes relationships that are in place at the time of the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are indicated according to the following numeric categories: 1. Consultant/Speaker’s Bureau 2. Employee 3. Stockholder 4. Product Designer 5. Grant/Research Support 6. Other relationship (specify) 7. No conflict of interest Successful completion of this educational activity includes attendance at 90% of the webinar and completion of the evaluation form. Accreditation Statement AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.
Objective • Discuss the history of the Clinical Nurse Specialist • Identify the four APRN roles within the Regulatory Model • Discuss the 5 domains of CNS practice within the 3 spheres of influence
History of CNS • Early 20th century “Nurse Specialist” was brought forward • 1943 - Frances Reiter promoted the idea of a “nurse clinician” – A nurse with advanced knowledge, clinical competence and commitment to providing high quality nursing care – Recognized need for graduate education • Clinical Nurse Specialist (CNS) – 1944 - NLNE’s Committee to Study Post-graduate Clinical Nursing Courses inception of the specialty – 1949 - University of Minnesota National Conference of Director’s of Graduate Programs credited with genesis of the clinical-nurse specialty (Towers, J, 2011)
APRN
Consensus Model for APRN Regulation APRN SPECIALTIES Licensure occurs at levels of Role and Population foci Focus of practice beyond role and population focus linked to health care needs Examples include but not limited to: acute care (perioperative, trauma, intensive care), oncology, older adults, orthopedics, nephrology, palliative care POPULATION FOCI Family/ Individual across lifespan Adult/Gerontology Neonatal Pediatrics Women's Health/ Genderrelated Psychiatric Mental Health APRN ROLES Nurse Anesthetist Nurse Practitioner Clinical Nurse Specialist Nurse Midwife (APRN Consensus Work Group, 2008, p 9.)
APRN Similarities • Certification • Prescriptive Authority **(NCSBN, 2013) – 36 States authorize CNS Prescriptive Authority • 13 States: Independent Authority • 23 States: Not Independent Authority • 15 States: No Prescriptive Authority • Independent Practice** (NCSBN, 2013) – 22 States: CNS Independent Practice – 23 States: NP Independent Practice **Defined by State Boards of Nursing Scope of Practice Acts (National Council of State Boards of Nursing [NCSBN], 2013)
AORN Position Statement “The APRN functioning in the perioperative setting is a registered professional nurse who: – is competent in the use of specialized perioperative nursing knowledge and skills in the care of patients and families undergoing operative and other invasive procedures…; – functions autonomously and collaboratively with the surgeon in the preoperative and postoperative management of surgical patients and their complex responses to the surgical process…; – integrates clinical practice, education, research, management, leadership, and consultation into a single but multifaceted role...; – continually functions in a collegial relationship with nurses, physicians, health care organizations, and systems to influence care of the surgical patient.” (AORN, 2013, pp. 299-300)
Clinical Nurse Specialist - CNS • Unique role to integrate care across the continuum throughout the three spheres of influence – Patient – Nurse – System • Improve patient outcomes and nursing care • Create environments to empower nurses – Evidence-based practice – Facilitate ethical decision making • Responsible for diagnosis, treatment, and management of health and illness • Health promotion • Prevention of illness and risk behaviors (APRN Joint Dialogue Group, 2008)
Domain 1: Clinical Expert • Complex surgical patients • Surgical consults – Differential diagnosis – Metabolic needs – Pain management – Pharmacology • Pre-op history and physical – Treatment plans
Domain 2: Consultant • Interdisciplinary and multidisciplinary • Committee membership – Expert resource for perioperative continuum • Infection control • Risk mitigation • Root cause analysis
Domain 3: Education • Nurses and staff – In-services – Continuing education offerings – Competency validation • Patient/Family – Surgical expectations – Pain management – Post-operative management/wound care • Community – Health promotion
Domain 4: Clinical Inquiry • • • • • • Evaluate current practice Patient safety initiatives Evidence-based practice Recommended practice guidelines Literature reviews Synthesize and disseminate research finding
Domain 5: Manager/Leader • Policy and procedure • Organization – Fiscal accountability – Process improvement – Risk management – Patient safety • Informatics – Utilization – Staffing
Professional Accountability • Professional development – Perioperative team members – Continuing education – Professional organizations • Mentorship • Certification • Health policy and legislation
Final thoughts • The perioperative CNS is an APRN who provides care within the patient, nurse, and organization spheres of influence • The domains that define the CNS role are: – Clinical expert – Consultant – Education – Clinical inquiry – Manager/leader
References APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Association of periOperative Registered Nurses. (2013). AORN Position Statement: Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN Journal, 97(3), 299-301. National Council of State Boards of Nursing. (2013). APRNs in the U.S. Retrieved from https://www.ncsbn.org/2567.htm Towers, J. (2011). The evolution of advanced practice in nursing. In J. Stanley (Ed.) Advanced practice nursing: Emphasizing common roles (pp.3-31). Philadelphia: F.A. Davis Company. All pictures in this presentation were obtained from public domain on Google images at https://www.google.com/imghp?hl=en&tab=ii
Contact Hours You must complete the Learner Evaluation online to earn the 0.5 nursing contact hour. Registered for this webinar? Complete the evaluation by using the link in your purchase confirmation e-mail or by visiting the AORN website: o Visit www.aorn.org and login using your AORN Web Login. o Navigate to My AORN and select “Manage Your Education”. o Earn your Contact Hour by selecting and completing the appropriate webinar evaluation. Once you have submitted your evaluation, you can print your certificate immediately, or you can visit MY AORN > View All Contact Hours > select the session > click Print Your Certificate at any time.
Contact Hours You must complete the Learner Evaluation online to earn the 0.5 nursing contact hour. Not Registered for this Webinar? Follow the below instructions to obtain access to the evaluation: – – – – – Visit www.aorn.org and login using your AORN Web Login. Go to the Product Catalog > Search by name of the webinar or other key word >Select the webinar you just attended that has ‘EVAL’ under it. Follow the shopping cart instructions to complete your transaction. You will then receive an e-mail containing a link to the online evaluation. You may complete the evaluation by using the link in the purchase confirmation e-mail or by visiting the AORN website: www.aorn.org > Navigate to My AORN > select “Manage Your Education”. Once you have submitted your evaluation, you can print your certificate immediately, or you can visit MY AORN > View All Contact Hours > select the session > click Print Your Certificate at any time. If you have any questions or require assistance, please contact AORN Customer Service at (800) 755-2676 or custsvc@aorn.org.
NOTICE/COPYRIGHT NOTICE The content in this publication is provided on an “as is” basis. TO THE FULLEST EXTENT PERMITTED BY LAW, AORN, INC. DISCLAIMS ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT OR THIRD PARTIES RIGHTS, AND FITNESS FOR A PARTICULAR PURPOSE. COPYRIGHT AORN’s training and educational materials are protected under federal copyright and trademark law. Only registered students may use our materials. Any unauthorized use of our materials is strictly prohibited. Violations of these requirements or of our valuable intellectual property rights may incur substantial penalties, including statutory damages of up to $150,000 for a single willful violation of AORN’s copyrights. PRESENTATION/SPEAKER INFORMATION Presenters are responsible for the content of their presentations and for obtaining permission to use any copyrighted material. AORN recognizes the sessions as continuing education for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center’s Commission on Accreditation approves or endorses products mentioned in the activity. AORN is not responsible for and does not assume any liability for presentations.
Take Your Career to the Next Level Go for your CNS-CP Credential. Get there with AORN! The Perioperative CNS Certification Exam Prep Course Includes: • Two-day educational coaching event • Three additional facilitated, interactive webinars and assignments This course will provide advanced knowledge, review the core competencies, and review the domains of nursing practice for the RN, CNS in the specialty of perioperative practice. Denver, CO | AORN Headquarters January 17-18 $450 includes all events www.aorn/CNS-CPCourse

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Role of the Periop Clinical Nurse Specialist

  • 1. The Role of the Perioperative Clinical Nurse Specialist Dr. Mary A. Hillanbrand, RN, DNP, CNOR October 9, 2013
  • 2. Dr. Mary A. Hillanbrand Dr. Mary A. Hillanbrand, is a perioperative Clinical Nurse Specialist on active duty in the US Air Force currently assigned as an assistant professor and Deputy Program Director in the Clinical Nurse Specialist program at the Uniformed Services University in Bethesda, Maryland. Dr. Hillanbrand earned her Doctorate of Nursing Practice from the University of Alabama, in Tuscaloosa, Alabama. Her capstone project “Identifying Gaps in Perioperative Registered Nurses Knowledge of the Cleaning and Decontamination Process for Surgical Instruments” provided the groundwork for the development of educational interventions aimed at increasing knowledge of recommended practices to improve practice and patient outcomes. Dr. Hillanbrand has worked in the perioperative environment for over 30 years, which includes more than 12 years as a certified surgical technician. Her field of interest is the development of educational interventions to increase compliance with recommended practice guidelines with a focus on improved patient outcomes. Additionally, Dr. Hillanbrand is involved with promoting certification for all perioperative team members including advanced practice nurses in the perioperative environment.
  • 3. Disclosure Information Speaker: Dr. Mary A. Hillanbrand, RN, DNP, CNOR Disclose No Conflict Planning Committee: AORN Nurse Educator Ellice Mellinger, MS, BSN, RN, CNOR Disclose No Conflict AORN’s policy is that the subject matter experts for this product must disclose any financial relationship in a company providing grant funds and/or a company whose product(s) may be discussed or used during the educational activity. Financial disclosure will include the name of the company and/or product and the type of financial relationship, and includes relationships that are in place at the time of the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are indicated according to the following numeric categories: 1. Consultant/Speaker’s Bureau 2. Employee 3. Stockholder 4. Product Designer 5. Grant/Research Support 6. Other relationship (specify) 7. No conflict of interest Successful completion of this educational activity includes attendance at 90% of the webinar and completion of the evaluation form. Accreditation Statement AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.
  • 4. Objective • Discuss the history of the Clinical Nurse Specialist • Identify the four APRN roles within the Regulatory Model • Discuss the 5 domains of CNS practice within the 3 spheres of influence
  • 5. History of CNS • Early 20th century “Nurse Specialist” was brought forward • 1943 - Frances Reiter promoted the idea of a “nurse clinician” – A nurse with advanced knowledge, clinical competence and commitment to providing high quality nursing care – Recognized need for graduate education • Clinical Nurse Specialist (CNS) – 1944 - NLNE’s Committee to Study Post-graduate Clinical Nursing Courses inception of the specialty – 1949 - University of Minnesota National Conference of Director’s of Graduate Programs credited with genesis of the clinical-nurse specialty (Towers, J, 2011)
  • 7. Consensus Model for APRN Regulation APRN SPECIALTIES Licensure occurs at levels of Role and Population foci Focus of practice beyond role and population focus linked to health care needs Examples include but not limited to: acute care (perioperative, trauma, intensive care), oncology, older adults, orthopedics, nephrology, palliative care POPULATION FOCI Family/ Individual across lifespan Adult/Gerontology Neonatal Pediatrics Women's Health/ Genderrelated Psychiatric Mental Health APRN ROLES Nurse Anesthetist Nurse Practitioner Clinical Nurse Specialist Nurse Midwife (APRN Consensus Work Group, 2008, p 9.)
  • 8. APRN Similarities • Certification • Prescriptive Authority **(NCSBN, 2013) – 36 States authorize CNS Prescriptive Authority • 13 States: Independent Authority • 23 States: Not Independent Authority • 15 States: No Prescriptive Authority • Independent Practice** (NCSBN, 2013) – 22 States: CNS Independent Practice – 23 States: NP Independent Practice **Defined by State Boards of Nursing Scope of Practice Acts (National Council of State Boards of Nursing [NCSBN], 2013)
  • 9. AORN Position Statement “The APRN functioning in the perioperative setting is a registered professional nurse who: – is competent in the use of specialized perioperative nursing knowledge and skills in the care of patients and families undergoing operative and other invasive procedures…; – functions autonomously and collaboratively with the surgeon in the preoperative and postoperative management of surgical patients and their complex responses to the surgical process…; – integrates clinical practice, education, research, management, leadership, and consultation into a single but multifaceted role...; – continually functions in a collegial relationship with nurses, physicians, health care organizations, and systems to influence care of the surgical patient.” (AORN, 2013, pp. 299-300)
  • 10. Clinical Nurse Specialist - CNS • Unique role to integrate care across the continuum throughout the three spheres of influence – Patient – Nurse – System • Improve patient outcomes and nursing care • Create environments to empower nurses – Evidence-based practice – Facilitate ethical decision making • Responsible for diagnosis, treatment, and management of health and illness • Health promotion • Prevention of illness and risk behaviors (APRN Joint Dialogue Group, 2008)
  • 11. Domain 1: Clinical Expert • Complex surgical patients • Surgical consults – Differential diagnosis – Metabolic needs – Pain management – Pharmacology • Pre-op history and physical – Treatment plans
  • 12. Domain 2: Consultant • Interdisciplinary and multidisciplinary • Committee membership – Expert resource for perioperative continuum • Infection control • Risk mitigation • Root cause analysis
  • 13. Domain 3: Education • Nurses and staff – In-services – Continuing education offerings – Competency validation • Patient/Family – Surgical expectations – Pain management – Post-operative management/wound care • Community – Health promotion
  • 14. Domain 4: Clinical Inquiry • • • • • • Evaluate current practice Patient safety initiatives Evidence-based practice Recommended practice guidelines Literature reviews Synthesize and disseminate research finding
  • 15. Domain 5: Manager/Leader • Policy and procedure • Organization – Fiscal accountability – Process improvement – Risk management – Patient safety • Informatics – Utilization – Staffing
  • 16. Professional Accountability • Professional development – Perioperative team members – Continuing education – Professional organizations • Mentorship • Certification • Health policy and legislation
  • 17. Final thoughts • The perioperative CNS is an APRN who provides care within the patient, nurse, and organization spheres of influence • The domains that define the CNS role are: – Clinical expert – Consultant – Education – Clinical inquiry – Manager/leader
  • 18. References APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Association of periOperative Registered Nurses. (2013). AORN Position Statement: Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN Journal, 97(3), 299-301. National Council of State Boards of Nursing. (2013). APRNs in the U.S. Retrieved from https://www.ncsbn.org/2567.htm Towers, J. (2011). The evolution of advanced practice in nursing. In J. Stanley (Ed.) Advanced practice nursing: Emphasizing common roles (pp.3-31). Philadelphia: F.A. Davis Company. All pictures in this presentation were obtained from public domain on Google images at https://www.google.com/imghp?hl=en&tab=ii
  • 19. Contact Hours You must complete the Learner Evaluation online to earn the 0.5 nursing contact hour. Registered for this webinar? Complete the evaluation by using the link in your purchase confirmation e-mail or by visiting the AORN website: o Visit www.aorn.org and login using your AORN Web Login. o Navigate to My AORN and select “Manage Your Education”. o Earn your Contact Hour by selecting and completing the appropriate webinar evaluation. Once you have submitted your evaluation, you can print your certificate immediately, or you can visit MY AORN > View All Contact Hours > select the session > click Print Your Certificate at any time.
  • 20. Contact Hours You must complete the Learner Evaluation online to earn the 0.5 nursing contact hour. Not Registered for this Webinar? Follow the below instructions to obtain access to the evaluation: – – – – – Visit www.aorn.org and login using your AORN Web Login. Go to the Product Catalog > Search by name of the webinar or other key word >Select the webinar you just attended that has ‘EVAL’ under it. Follow the shopping cart instructions to complete your transaction. You will then receive an e-mail containing a link to the online evaluation. You may complete the evaluation by using the link in the purchase confirmation e-mail or by visiting the AORN website: www.aorn.org > Navigate to My AORN > select “Manage Your Education”. Once you have submitted your evaluation, you can print your certificate immediately, or you can visit MY AORN > View All Contact Hours > select the session > click Print Your Certificate at any time. If you have any questions or require assistance, please contact AORN Customer Service at (800) 755-2676 or custsvc@aorn.org.
  • 21. NOTICE/COPYRIGHT NOTICE The content in this publication is provided on an “as is” basis. TO THE FULLEST EXTENT PERMITTED BY LAW, AORN, INC. DISCLAIMS ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT OR THIRD PARTIES RIGHTS, AND FITNESS FOR A PARTICULAR PURPOSE. COPYRIGHT AORN’s training and educational materials are protected under federal copyright and trademark law. Only registered students may use our materials. Any unauthorized use of our materials is strictly prohibited. Violations of these requirements or of our valuable intellectual property rights may incur substantial penalties, including statutory damages of up to $150,000 for a single willful violation of AORN’s copyrights. PRESENTATION/SPEAKER INFORMATION Presenters are responsible for the content of their presentations and for obtaining permission to use any copyrighted material. AORN recognizes the sessions as continuing education for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center’s Commission on Accreditation approves or endorses products mentioned in the activity. AORN is not responsible for and does not assume any liability for presentations.
  • 22. Take Your Career to the Next Level Go for your CNS-CP Credential. Get there with AORN! The Perioperative CNS Certification Exam Prep Course Includes: • Two-day educational coaching event • Three additional facilitated, interactive webinars and assignments This course will provide advanced knowledge, review the core competencies, and review the domains of nursing practice for the RN, CNS in the specialty of perioperative practice. Denver, CO | AORN Headquarters January 17-18 $450 includes all events www.aorn/CNS-CPCourse