1. Manchester, Carol S. MSN, ACNS, BC-ADM, CDE
  2. Madsen, Robin MS, RN, ACNS-BC
  3. Schmidt, Jennifer RN, BSN

Article Content


Research demonstrates the need for improved clinical care for hospitalized patients with diabetes and stress-induced hyperglycemia. Primary objectives of this system initiative have been to establish evidence-based practice standards, professional competencies, and patient education and to provide optimal care.



Evidence must be used to drive professional practice; to develop safe, efficient processes for the delivery of treatment modalities; and to promote clinical quality and patient safety. The clinical nurse specialist (CNS) is key in evaluating systems, improving processes, and developing professional competencies in collaboration with educators to optimize care delivery.



In 2004, the system participated in a statewide medication safety action group. The aim was to eliminate harm caused by insulin utilization measured by rates of hypoglycemia and hyperglycemia. Five sites within this healthcare system participated, one having a dedicated diabetes initiative in place. In 2005, leadership established an inpatient diabetes care committee with representation from all sites. The charge was to establish evidence-based order sets to aid physicians in the care of diabetic patients.



The committee reviewed the literature, which demonstrates that improved glycemic control results in improved outcomes and reduced mortality and morbidity. Standardized order sets, policies, professional competencies, patient education curriculum, and glucometrics needed to be developed, prioritized, implemented, and evaluated.



Standards, tools, education, and measures to improve glycemic management were developed. Significant improvement in glycemic control, reduction of hypoglycemia and insulin errors, and enhanced staff knowledge and competency resulted. Key challenges identified included the culture of each site and unique practice and process variances.



The strength of this project is the collaboration between CNSs and educators to successfully build consensus and implement new standards of care across a complex healthcare system. This collaboration resulted in a synergistic analysis of how a system committee can be effective.


Implications for Practice:

Acute care systems should consider the CNS as key facilitator of change in complex initiatives requiring standardization of practice and processes to enhance quality and safety. The CNS is positioned to work strategically within the system to mitigate the perceived erosion of site decision-making ownership while claiming success with improved clinical outcomes.


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.