CNS Collaboration and Innovation Drives Sustainable Change

Transcription

1 CNS Collaboration and Innovation Drives Sustainable Change Mary E. Lough PhD, RN, CNS, CCNS, FCCM, FAHA Research Scientist / Clinical Nurse Specialist Stanford Health Care Clinical Assistant Professor, Stanford University Clinical professor, Dept Physiological Nursing, UCSF mlough@stanfordhealthcare.org CACNS Annual Conference September 29 th 2018 A little bit of history. A call to action!! Experience of collaboration in a small community hospital Experience of collaboration in an academic medical center What were you taught about collaboration in CNS school? Who were you taught to collaborate with? 1

2 Clinical Nurse Specialist Collaboration: Google Search Search results Clinical Nurse Specialist Collaboration: PubMed Search Search results

3 Search results Clinical Nurse Specialist Collaboration CINAHL Search The Team Player Clinical Nurse Specialists: We are the ultimate team players We are such good team players that it is really hard to find CNS outcomes and CNS impact in the literature We ae so busy collaborating with other professions and our patients, we forget to collaborate with each other. Or we forget to document that we collaborate CNS-to-CNS. Yes, there is evidence! 3

4 Ask a Colleague 90 seconds each (aprox) Turn to the person next to you, introduce yourself, and ask about a project they have worked on (now completed) that effectively demonstrated their CNS role impact How was the impact disseminated? Presentation in the hospital Presentation at a local / national conference Publication in a hospital newsletter Poster at a local or national conference Publication in a national journal Other Bay Area CNS Research Collaborative Aim: Facilitate CNS-to-CNS Collaboration Aim: Demonstrate CNS Impact in the literature Aim: Enable a CNS to become involved in research Elizabeth Scruth PhD, RN is the CNS who thought of this collaborative CNS collaborative membership growth is by word of mouth We schedule a phone conference every 1 2 months (aprox) First project: Identifying CNS outcomes in the literature (in process) This topic was suggested by Jan Fulton PhD, RN editor Clinical Nurse Specialist 4

5 Looking for CNS Outcomes in the Literature Methods#1 Step 1: Librarian searched for publications with CNS in title or abstract Step 2: Each CNS (n=28 initially) had 100 abstracts to review Step 3: Eliminated studies before 2007 coincides with the LACE APRN regulatory model as APPs were asked to demonstrate impact Step 4: Eliminated duplicates / incomplete data Step 5: Find measurable CNS outcomes In process Looking for CNS Outcomes in the Literature Methods#2 7 CNS Core Competencies Direct Care Consultation Systems Leadership Collaboration Coaching Research Ethical Decision-Making 3 CNS spheres of influence Patients Nurses and Nursing Organizational Systems Foster, J., Flanders, S., (May 31, 2014) Challenges in CNS Practice and Education OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 1. 5

6 My Missed Publication Opportunities to Explain the CNS Role#1 Clinical Nurse Specialists We could have added Clinical Nurse Specialists to the title so easily!! But we did not even think of it!! Lough & Klevay (2012) Collaborative partnerships between critical care and psychiatry. Crit Care Nurs Clin N Am 24 (2012) My Missed Publication Opportunities to Explain the CNS Role#2 Collaboration by Clinical Nurse Specialists Lough, Shinn, Haynes, (2016) STTI, South Africa 6

7 CNS-Driven Sustainable Change Some Questions How many work in a setting with other Clinical Nurse Specialists? Are you involved in a multidisciplinary change project? Leader Participant Are you collaborating on a QI/PI project with another CNS? Do you have baseline / ongoing data? Ask a Colleague 120 seconds each (aprox) Turn to the person next to you, introduce yourself, and ask about a project they are working on that exemplifies the CNS role Ask which CNS spheres or CNS competencies are involved? Ask, who is working on the project? Ask, can baseline data and ongoing data be obtained? Methods? Is there a publication plan to demonstrate CNS role impact? 7

8 Individual Sustainability is a Myth Who has led a project that showed great outcomes as long as you were on-it 110%? Who has been involved in a project that was suddenly discontinued mid-way because organizational strategic initiatives changed or for another reason ( staff shortages / cost) Who has had the experience of leaving a CNS position and seeing the next person in the role (a wonderful CNS person) have different priorities, so older priorities faded and new ones flowered. Because sustainability cannot be guaranteed, we need to think of new ways of documenting CNS impact Ways to Document CNS Impact Evaluation of Outcomes Leads to Publication Chart reviews of your patient-centered outcomes CNS students can help you collect data during a residency Include CNS students on your successful publication Have the evaluation part of the project set-up before the student begins their residency May need IRB approval to do retrospective chart audits. Identify an intervention / outcome Need a standardized data retrieval form If you have access to a nurse scientist, ask them to guide you 8

9 If it was not documented it was not done Clinical Nurse Specialists are wonderful team players We spend our professional lives encouraging others to reach their full professional potential. Now, it is time to be a team player for the CNS role before it disappears This involves documenting what you, the CNS made happen so that others can see the importance of the CNS role Step 1: Recognition in your hospital / community is important Step 2: Publication must be part of our CNS role documentation Step 3: Build the publication plan into your project and start writing before it ends and a new priority takes its place. Ask a Colleague 90 seconds each (aprox) Ask your colleague can they commit to documenting a CNS outcome in a publication Ask are there other CNS colleagues or students who can help? Brainstorming ideas is a talent to be nurtured be creative be bold 9

10 Summary The CNS works in solo practice or in multidisciplinary teams Solo: As soon as you leave the change disappears Multidisciplinary Team: The CNS role contribution may be less visible, but there is more opportunity for sustainability and impact CNS-to-CNS collaboration Unclear if less/more frequent than multidisciplinary collaboration Not well documented in the literature Offers an opportunity for publishing on CNS outcomes Sustainability only lasts until the next change. It will never be perfect, pick a time in your project timeline and write about CNS impact We need to put the words Clinical Nurse Specialists into more abstracts and titles!! Questions mlough@stanfordhealthcare.org 10