The Role of the Clinical Nurse Specialist
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1 The Role of the Clinical Nurse Specialist Presented by Elizabeth Harrold, RN, BSN, M Sc. (Teaching) Marlene Hoover, RN, BScN, MSN Bernice Johansen, RN, BSN, MN ChrisIne Westland RN, BScN, MA (C) - Maternal Child Health - Public Health - Healthy Living/Chronic Disease - Regional PracIce Consultant Adolescent Mental Health FNIHB BC Region Regional Nursing
2 Outline 1. Introduction 2. Overview of Organizational relationships/maps/ communities 3. Integrated Systems (FTP/FN), Nursing Medicine 4. Components of the CNS Role & Current Activities 5. Summary & Contact Information
3 Goal: The participants will be familiar with: Organizational Relationships Federal/Provincial/First Nations Definitions of Remote/isolated communities Components of the CNS role Current activities How to contact the CNS
4 Definitions Advanced Practice Nursing Nurse Practitioner Clinical Nurse Specialist Health Centre/Nursing Station Remote/Isolated/Remote-Isolated
5 4
6 Hartley Bay Nursing Station
7 Gitanyow Health Centre
8 Lax Kwlaams
9 Quatsino Health Centre
10 Snuneymuxw Health Centre, Nanaimo
11 Interface of Nursing and Medicine Nurse Practitioner (RN) Direct client care advanced nursing practice autonomy autonomy for some medical functions shared responsibility for medical orders, delegation Physician medical/surgical specialist Physician Generalist Overlap Nurse Generalist Nurse Generalist (RN) general nursing practice autonomy shared responsibility for medical orders, delegation Clinical Nurse specialist CNS (RN) In depth knowledge, skills, advanced judgement in nursing care for specific population within RN scope of practice
12 Integrated Systems Health Canada - FNIHB Provincial /Territorial Health Authorities C N S First Nations Health Society First Nations Communities
13 Role of the CNS The role of the CNS includes four components (2008)*. Consultation (Education) Clinical Practice (Education) Leadership (Education) Research (Education)
14 CLINICAL NURSE SPECIALIST ~ ROLES AND FUNCTIONS CQI Transformational Leader CQI Consultant & Researcher CLINICAL NURSE SPECIALIST Advocate CQI Educator CQI
15 Consultation May involve consultation to nursing staff for information, specific patient/client care. May involve regional staff, communities or other care providers in the specific area of speciality. May involve consultation to senior management/band staff about existing resources, policy and procedure development or changes and trends in nursing care.
16 Consultation (examples) Mental Health Assisting staff to access mental health resources outside the community, Working with the mental health program in crisis situations, Youth suicide prevention project Providing appropriate current clinical guidelines or specific topic as requested Consultations with nurses - Just phone Public Health Providing current clinical CD information or advice to staff, management, other directorates, agencies Developing written protocols and processes to access resources and provide related services. Strategic planning for Outbreak management Vision Screening Program Coordination
17 Consultation (examples) Healthy Living / Chronic Disease Maternal Child Health Supporting and assisting in development of chronic disease prevention and self-management (CDPSM) strategies Assisting staff in addressing gaps and barriers to accessing CDPSM resources outside the community to improve client care Partnership in Proposals to introduce a midwifery service in select communities Orienting new staff in both FNIHB and transferred bands Member of working groups SOGC, CAAPN
18 Clinical Practice - Involves direct patient/client care in order to maintain advanced practice skills Mental Health mental health assessment Acute mental health care management Collaboration with mental health services from the province Collaboration between nursing and multidisciplinary team within the community Public Health Maintaining clinical skills such as immunization, surveillance and outbreak management, Emergency Operations Centre Management Indigenous Cultural Competency
19 Clinical practice (examples) Healthy Living/Chronic Disease Utilizing a population health and life course approach Planning, coordinating, implementing and evaluating programs in health promotion and illness prevention Seeking to develop skills in self-management support and health coaching Maternal Child Health Practice support to all CHNs in community, whether transferred or FNIH Clinical lead to the 17 dedicated MCH programs in BC Available for consult to HDs and other program staff re provision of Mat/child services Support to the Tripartite HC initiatives for Doula training in FN communities
20 Leadership Taking the lead or an active role in projects such as policy or guideline development, education projects Liaison role with other agencies Providing an example of professional behaviour Providing input, Updating / revision of community health manual
21 Leadership (examples) Mental Health The use of the depression guideline, library services for FNIHB Nursing conference Working to develop liaison role with HSC, SMHC Public Health Developing liaison role with other agencies such as BCCDC, and subgroups, Input Pandemic Influenza Human health Emergencies Representation on several Public health committees Emergency management skills FNH Council Sub committee Vision Screening
22 Leadership (examples) Healthy Living/Chronic Disease Participation on national committees, i.e. CDPM Advisory group Connect with chronic disease agencies and regional health authorities to identify and address gaps in services for chronic disease in First Nations communities Liaison role with Aboriginal Diabetes Initiative Maternal Child Health Participation on national (SOGC) committees, i.e Society of Obstetricians & Gynaecologists of Canada Aboriginal Affairs Committee Chair of the CNS Council of the Association of Advanced Practice Nurses of Canada (CAAPN) Federal rep on the BC Early Hearing Screening Steering Committee
23 Research Small portion of the role but will increase as other priorities are resolved
24 Research (examples) Mental Health Currently providing information on colonization, intergenerational trauma, Indian Residential Schools & impact on mental health providing current research of social determinates of health and effects on community wellness Public Health Currently researching specific information requests from staff Future considerations for formal research are to be determined
25 Research (examples) Healthy Living/Chronic Disease Keep up-to-date of relevant research findings and when appropriate disseminate and assist in implementation to enhance evidence-based practice Maternal Child Health Developing an evidence-based guideline for the SOGC for Professionals working with Aboriginal women and families Design and introduction of new charting system for mat/child Adjunct professor with UBC School of Nursing
26 Education (examples) Mental Health Nursing orientation Suicide assessment and management the greatest priority Develop further information sessions such as depression Nursing Forum Public Health To be determined - new position Nursing Forum Personal Care Workers Forum CDC Conference
27 Education (examples) Healthy Living/Chronic Disease Articles related to CDPSM in Nursing Times newsletter Regular updates on new and relevant issues/endeavours related to CDPSM Education sessions to CHNs, HCNs, community workers related to health promotion, population health and self-management support Maternal Child Health Regular teleconferences to update current best practice according to the evidence Providing some hands-on experience (with dolls!) of emergency delivery and newborn resuscitation (in Nursing Stations) Workshops: MCH workers Ages and Stages Social and Emotional screening (and referral) for MCH workers & BC POPS annual conference on the effects of Environmental pollutants on newborn growth and development and how to set up a safe daycare environment.
28 FNIH CNS CNS Role Role Implementation Logic Logic Model Model Main Component Leader/ Change Agent Consultant Clinical Practice Research Implement Objective Community Development Role Modelling Evidence-Based Practice Standards Professional Support & Development Clinical expertise in complex cases Knowledge Transfer Group Facilitation Examining the Process Input into National Standards Outputs Countable Indicators Characteristics Of Those Served Recruitment & Retention of Nurses Interagency Collaborative Initiatives Support for Best Practice in Communities Research Findings Dissemination Short-Term Outcomes (To Increase Or Decrease) Personal Satisfaction Increased Job Satisfaction For CHN Increased Information and Awareness Improve Access to Care Promote System Changes Education Long-Term Outcomes (Prevention) Enhanced For Clients at Risk Service Delivery Early Identification, Assessment Integration of & FNIHB Contemporary BC Region and Traditional CNS - Roles 28 Appropriate Treatment Holistic Approach
29 The CNS supports the First Nations Health Council in attaining their vision to: restore, revitalize and strengthen First Nations and their communities and families to eliminate the gap in standards of living with other British Columbians, and substantially improve the circumstances of First Nations people in areas which include: education, children and families, and health. Implementing the Vision BC First Nations Health Governance 2005
30 In Conclusion: The CNS supports frontline health care professionals to provide quality health services that are evidenced based, culturally sensitive and community driven.
31 Clinical Nurse Specialist Contact Information Elizabeth Harrold - Maternal Child Health Tel: Fax: elizabeth.harrold@hc-sc.gc.ca Marlene Hoover, RN, BScN, MSN - CNS Public Health Tel: Cell: Fax: marlene.hoover@hc-sc.gc.ca Bernice Johansen, RN, BSN, MN - Healthy Living / Chronic Disease Telework: Cell: Fax: bernice.johansen@hc-sc.gc.ca Christine Westland Regional Practice Consultant- Mental Health Telework/fax: Cell: christine.westland@hc-sc.gc.ca
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