1. Coke, Lola A. PhD, ACNS-BC, FAHA, FPCNA, FNAP, FAAN

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As we enter the endemic phase of COVID, we are left with many challenges in nursing including a severe workforce shortage in acute care. Although we have a dire nursing shortage, something good can come out of this dilemma. Leaders from our national nursing organizations, leaders in academe, and our health system nurse executives need to come together to solve the nursing shortage issue. It is not as simple as producing more nurses; although this is 1 solution. We need to come together to explore new nursing care delivery models, revise nursing education in colleges and schools of nursing, develop strategies to minimize workplace violence, and examine new strategies to meet the lifestyle demands of this next generation of nurses. This means looking at work-life balance, incentives to retain nurses at the bedside, development of streamlined onboarding to better prepare graduate nurses for entry into practice, and retention strategies to minimize nurse departure after 1 or 1.5 years of practice. What role does the clinical nurse specialist (CNS) have in this enormous challenge?


During the pandemic, we saw tremendous efforts by CNSs who took the lead in pivoting delivery models of care as acuity increased at the same time many nurses were leaving the bedside. Clinical nurse specialists in palliative and critical care were integral members of interprofessional teams making decisions about rationing of care and use of scarce resources while at the same time creating ways to maintain some semblance of high touch and communication with patients and families. Clinical nurse specialists nurtured and cared for our nursing workforce who experienced burnout and traumatic stress. At the same time, CNSs took the lead in educating nurses and others about COVID as new information about variants, symptoms, and physiological sequelae were identified. They worked to cross-train nurses across specialty areas to promote staffing efficiencies, refreshed retired nurses to assist at the bedside, and continued to work with academic partners to provide as much clinical experiential learning for student nurses in a safe as possible environment.


With the COVID pandemic finally subsiding, leaders in nursing from all healthcare environments and academe need to come together to disseminate and evaluate strategies used to deliver nursing care during the pandemic. Evaluation of what worked and did not work is vitally important for the development of nursing care delivery models. For strategies that worked, nursing education can integrate these into the curriculum to prepare the next generation of nursing workforce. We know from the pandemic that on the basis of patient acuity and workforce shortages, nursing care is not sustainable with a primary care model, so new nursing care delivery models need to be developed. Safe, quality patient care should be at the core of any model.


Historically, hospitals have made decisions largely based on financial efficiencies, and this is prime time for nursing, especially CNSs, to be at the table when these discussions occur to advocate for new models of care that increase efficiency, not reducing the level of nursing expertise. Acute care environments are high acuity, high skill, and high critical thinking environments that require registered nurses who can provide care at their full scope of practice. Hospitals are engaging in strategies to combat the workforce shortage including bringing in foreign nurses, spending millions on traveling nurses, and reinventing roles for licensed practical nurses. It is time to use those dollars to innovate and create new patient care delivery models and partner with academe to educate nurses differently. Clinical nurse specialists are, and will continue to be, at the forefront of acute care nursing and other healthcare environments, and need to engage their voices as hospitals look at these new strategies. We currently do not have sufficient evidence to predict the efficacy of new nursing care delivery models, so as strategies are developed and implemented, they need to be evaluated and the results need to be disseminated. Clinical nurse specialists in all healthcare environments should work with academic partners to develop evaluative methods to test new nursing care delivery models, to streamline onboarding, and to retain nurses. Through dissemination, we can all learn from each other, replicate strategies to strengthen the data, and increase the body of nursing knowledge.


Those in academe also need to take advantage of this pivotal time in nursing education to develop new innovative strategies, working together with practice partners to develop new aspects of nursing education to better meet nursing workforce issues. To provide more nurses, we need to advocate for flexibility to try new methods to deliver nursing education with our state boards of nursing and accrediting bodies including more simulation and flexibility in how we deliver subspecialty nursing education. For example, does every student need a set amount of pediatric clinical hours if they do not aspire to be a pediatric nurse? Instead, can they learn pediatric principles in a simulated environment and have more clinical experiences with the patient environment in which they really want to practice? Do we really know what dose of experiential learning results in student mastery of skills and content? Can we focus on experiential learning in environments where there are identified shortages like ambulatory care? Now more than ever, academe and practice settings need to partner to advocate for and create new and dynamic nursing educational processes and strategies to deliver safe and effective care.


As the new American Association of Colleges of Nursing Essentials are being integrated into accredited nursing programs, the use of competency-based education principles can be integral to including increases in simulation activities to provide low-risk environments for students to master skills and critical thinking. Through the implementation of the 4 spheres of care, the knowledge of the bedside nurse will broaden to prepare a generalist that can perform across a variety of settings. These spheres include wellness and disease prevention, chronic disease management, regenerative and restorative care, and hospice and palliative care. As nursing programs integrate these spheres and competencies into the curriculum, new and dynamic simulation and experiential learning experiences will be developed. Practice partners should be integral to the development of these experiences.


In conclusion, we need to join together as a united voice to demonstrate our effectiveness and ability to impact quality and safety in all healthcare environments. Clinical nurse specialists are key stakeholders in academic-practice partnerships. Colleges of nursing need to meet with practice partners to examine the need for CNSs and to educate on and advocate for the role in acute care as a strategy in combating nursing workforce issues. Now is the time to reopen or develop new CNS programs of study. A doctorally prepared CNS brings to the table specialty expertise in patient populations and skills in planned change and process improvement that can drive new healthcare delivery models and help design nursing program changes that are appropriate in today's complex healthcare environments. We need to be bold in our innovation, experiment with new strategies, and make changes as we learn where the successes are, and the CNS should be at the forefront of this critical time of change in nursing.