1. McEwen, Katherine L. MBA, BSN, RN
  2. Cangany, Martha MSN, RN, CNS, APRN, BC
  3. Greenan, Lisa D. RN, BC

Article Content


To provide the CNS with a structured framework for understanding work complexity and utilization of this information to optimize patient safety and hospital care quality in complex health care systems.



Heightened awareness of the need to focus on patient safety has created the need to implement effective performance improvement strategies that ensure optimal outcomes. Positive outcomes that have system-wide impact are best accomplished by understanding work complexity and barriers for performance. The CNS is uniquely qualified to examine work complexity, and develop strategies to reduce error-prone processes.



Healthcare organizations strive to optimize care quality and safety. Environmental and/or practice modification often leads to system redesign. Economic challenges require thoughtful evaluation of redesign prior to implementation. Evaluating the real work of bedside clinicians allows for the greatest opportunity for improvement with the most efficient expenditure. Facilitation of performance improvement teams, involving targeted departments, requires the CNS to act as data analyst and change agent.



This framework provided rich data, from a variety of sources, revealing that nursing staff was encountering problems regarding IV therapy administration and maintenance. These problems were further analyzed by the CNS-lead focus group, evaluating (1) nursing practice, (2) nursing policy, (3) supplies and equipment, and (4) the work environment. Examples of work complexity, and implemented improvement plans with outcomes-to date-will be presented.



Analysis of work complexity as it relates to patient safety allowed the team to make effective decisions regarding redesign. Process changes were received well, since the work complexity was understood and the improvement plan was logical. Patient safety, regarding IV therapy and administration, has been favorably impacted.



The CNS has a crucial role in relating data, understanding work complexity, and impacting patient safety. Intradepartmental and interdepartmental collaboration bridges safety gaps and optimizes outcomes.


Implications for Practice

Understanding work complexity for targeted departments and resultant system impact is crucial to develop an effective performance improvement plan. Work complexity awareness will allow the CNS to identify gaps that may impact patient safety.


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.