3 Ways a CNS Can Influence Quality of Care

Nurse Leader Insider, June 23, 2016

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Written by Jennifer Thew, RN for HealthLeaders Media.

When it comes to advanced practice nurses, what's old is news again.

In May, the Department of Veterans Affairs proposed amending its medical regulations to permit full practice authority of all VA advanced practice registered nurses when they are acting within the scope of their VA employment.

And in keeping with recent history, the American Medical Association, the American Association of Anesthesiologists, and the American College of Radiology are against the proposal.

The AMA asserts that "all patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine," and "physician-led team-based care results in improved access to high-quality, cost-effective health care."

The ACR's position is that allowing the VA's APRNs to "practice independently of a physician's clinical oversight, regardless of individual state law, could seriously undermine the quality of care that our nation's heroes receive."

The ASA calls the VA's proposed policy change "untested and ill-advised for the Veterans population."

What these statements overlook is that APRNs are not trying to take over physicians' roles. 

APRNs, and in particular, clinical nurse specialists, share some of the same goals as physicians, says Sharon Horner, RN, PhD, FAAN, president of the National Association of Clinical Nurse Specialists.

"They [physicians] have their own lens or blinders on, too, with how they approach certain things," she told me in March, soon after she assumed the role as the organization's 2016-2017 president.

"And yet, if you're talking about improving care, they're right on board with you. Just give them the evidence and tell them what you're about."

What the role of the CNS is about, says Horner, is providing safe, high-quality, cost-effective care, that improves both the health of populations and patient outcomes.

The NACNS, she says, sees the CNS role functioning within three spheres of influence in order to achieve these goals.

1.The Patient

This sphere encompasses things that improve patient outcomes and patient care and can take place in multiple settings, Horner says.

"The CNS really shines in this complex chronic illness management and self-management. They're doing management of [the problems] and they're helping the patients learn to be good self-managers of really complex health problems," she says.

Rather than being strictly hospital unit-based as CNSs often were in the past, Horner now sees them focusing on patient populations.

"Patients are going to be seen more and more in the community and so these specialists are helping with the transition so that you don't drop people. It's this huge continuity of care piece that's so important," she says.

2.The Nurse and Nursing Practice

The CNS works with other healthcare staff, including physicians, to educate them on organizational processes and policies, disease processes, and evidence-care practices.

"They bring staff people up to speed, correcting anything that needs to be corrected, enhancing what they know," Horner says.

"It's the staff development piece that fits into what's going on in the whole system so that we improve what we're doing at as a group."

3.The Health System

The CNS looks at policies and procedures and makes corrections to avoid any deficiencies in the delivery system. To help prevent medication errors, a CNS would play the role of detective, assessing a system for areas that could contribute to an error.

The CNS proactively makes adjustments and institutes safety measures to avert the occurrence of any errors.  "You go through the steps for catching and correcting [the problem] before it's a real error," Horner says.

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