1. France, Nancey PhD, RN, Conference Co-Chairs
  2. Urden, Linda DNSc RN, CAN, BC, FAAN, Conference Co-Chairs
  3. Waldo, Mary PhD, MS, CNS, Conference Co-Chairs
  4. Alderman, Joanne MSN, RN, BC, APRN
  5. Borges, Wanda J. DNS, RN, CNS
  6. Walent, Ron MS, RN, CNS, BC
  7. Williams, Sheila MSN, RN, CNS

Article Content

The 2007 NACNS National Conference was held in Phoenix, Arizona, February 28-March 1. Over 300 Clinical Nurse Specialists (CNS), graduate faculty, nurse administrators, and nurse researchers attended. This year's theme, CNS Outcomes: Ensuring Safety and Quality, demonstrated how essential the CNS's influence is on the environment as well as the CNS role in implementing evidence-based practice. There were 72 abstracts for podium and poster presentations selected in addition to student posters. The abstracts addressed the 3 spheres of CNS practice emphasizing patient safety and quality care outcomes, evidence-based practice, and ethics. Specialty practice areas represented in the abstracts included workplace and domestic violence, heart failure, rapid response team, ventilator assisted pneumonia (VAP), central line infection, newborn sepsis, oncology, gerontology, and safety in handling medical bariatric patients. Collectively, these abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of the nursing profession, individuals, families, communities, and society. The conference abstracts are published so that we may share new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the talent and clinical scholarship of your CNS colleagues who are advancing the praxis of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your own thoughts and ideas on these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Atlanta, Georgia, at the Westin Peachtree Plaza, March 5-8, 2008.


Using the CNS Role to Promote Safety and Quality in Long-Term Care

Joanne Alderman, MSN, RN, BC, APRN, Tulsa Regional Medical Center, Tulsa, OK, Wanda J. Borges, DNS, RN, CNS, New Mexico State University, Las Cruses, NM, Ron Walent, MS, RN, CNS, BC, The University of California, San Francisco, CA, and Sheila Williams, MSN, RN, CNS, Dayton VMAC, Dayton, OH



This presentation explores actual and potential roles for the CNS in improving safety and quality in residential long-term care (RLTC). Attendees will (1) achieve clearer understanding of clinical, regulatory and organizational challenges facing the CNS in RLTC and (2) appreciate the CNS role in advancing quality and safety in RLTC.



Despite programs enabling more older adults to age in place, concurrent increases in elders requiring complex care suggesting the need for RLTC settings will persist. While the value of CNSs in promoting safety and quality in acute care is well recognized, little has been done to capitalize on their expertise in increasingly challenging RLTC settings.



In RLTC settings, major issues related to patient safety (eg, falls, infections, wandering) and quality (eg, pressure ulcers, nutrition and hydration, comfort, ADL function, and depression) have been identified. Lack of expertise to guide significant change means that improvement strategies are often "all-purpose" and poorly designed, implemented, and evaluated. Although expected outcomes for safety and quality are clear, achieving results commonly requires complex interventions that encompass the healthcare system and nursing practice spheres of influence and demand advanced ability in chronic disease management.



The summer of 2004 marked the establishment of the AdHoc Committee on Long-Term Care of the NACNS Gerontological Task Force. Committee meetings, conference calls, consultation with LTC experts, and literature review have resulted in comprehensive understanding of the CNS/RLTC interface that informs this presentation.



Analysis suggests that individuals and groups outside andwithin nursing have tended to devalue RLTC practice. In addition, organizational and regulatory may hinder CNS practice in RLTC settings.



Addressing barriers is essential to advancing the CNS role. Role elements include the following: (1) managing residents with complex chronic care and behavioral needs, (2) developing and promoting RLTC competencies for nursing staff at all levels, (3) identifying elements of RLTC that justify specialty practice, and (4) functioning as leader/change agent in specific areas of safety and quality.


Implications for Practice:

Delineating and promoting CNS role in RLTC is needed to improve cost-effective care, resident safety, quality of care, and quality of life.