1. Muller, Anne MSN, RN, APRN-BC
  2. Feil, Michelle MSN, CRNP
  3. Harrington, Paul MSN, RN, MBA

Article Content


This presentation outlines the role of clinical nurse specialists (CNSs) in assuming leadership in integrating a comprehensive patient tracking system for bed flow management at a 700-bed academic medical center. Successful strategies supporting patient throughput are discussed to achieve "virtual beds."



As federal targets for surge capacity and reduced wait times in emergency departments are defined, resource management and facilitating discharge are paramount to maximizing bed capacity and patient flow. Reducing inefficiencies in care leads to the availability of virtual beds and to the ability to safely respond to fluctuating patient volume and care demands while providing opportunities for revenue growth.



Estimates from the Healthcare Advisory Board indicate that hospitals could create about 25% more virtual beds with faster patient throughput. Clinical nurse specialists, as systems and process improvement experts, are uniquely positioned to facilitate care coordination to improve outcomes related to timeliness of discharge and patients' perceived preparedness for discharge.



Redesigning care processes to facilitate discharge is accomplished through CNS systems leaders who develop and implement strategies such as comprehensive review of current practices and established targets for discharge based on national and internal comparator data, integration of best practices, and technology utilization and evaluation. Electronic tools monitored patient flow for better communication among healthcare teams. Multidisciplinary meetings were used to analyze performance and benchmark data. Outcomes from our automated tracking system were disseminated to all healthcare professionals.



Regular care coordination audits demonstrated sustained process improvements in care delivery. Outcomes (eg, length of stay, timely discharges, and patient's perception of readiness for discharge) improved for all service divisions and interdisciplinary departments.



Clinical nurse specialists in our organization have made substantial contributions to improving bed management and patient flow, which has resulted in increased availability of virtual beds. Clinical nurse specialists play an important role in the evolving solutions for better care coordination, expediting discharge, ensuring quality outcomes and patient safety, and contributing to the financial viability of hospitals.


Implications for Practice:

Current demands for more efficient care coordination and patient throughput have placed increased responsibilities on CNSs to maximize bed capacity and achieve financial targets while providing high-quality and safe patient care.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice 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 thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.