1. Bennett, Trish MSN, RN, CCRN
  2. Fowler, Kimberly MSN, RN
  3. Harne-Britner, Sarah MSN, RN, CCRN

Article Content


The objective of this study was to describe the role of the clinical nurse specialist (CNS) in a multiphase collaborative project to bring evidence-based plans of care to the bedside registered nurse.



Lack of time, knowledge, and resources were barriers to providing evidence-based care. This project merged resources of an online evidence-based vendor and a data management system to provide CNSs with an opportunity to enhance evidence-based plans of care within an organization.



Four issues prompted the current development and utilization of plans of care:


(1) Interventions were chosen based on "tradition" versus evidence.


(2) Plans were viewed as a regulatory requirement and not a tool to guide patient care.


(3) Plans were focused on medical orders and not unique nursing interventions.


(4) Plans were rarely incorporated into daily nurse-nurse communication or used to develop discharge plans.




Clinical nurse specialists collaborated with a pilot unit and the Nurse Practice Council to develop 18 evidence-based plans of care. Plans were selected based on patient populations and commonly used diagnoses within the pilot unit. Clinical nurse specialists customized vendor plans of care, seeking input from the pilot unit. The care plan software from the data management vendor allowed care plans to be suggested to the nurse based on assessment findings. The CNSs identified triggers within the assessment to suggest problems and plans of care that may then be individualized for the patient. Selected plan interventions were displayed on the nurse's documentation screen within the electronic clinical record. This prompted the nurse to complete the intervention and allowed for easy documentation. A collaborative education plan was developed to provide staff with the key components of evidence-based assessment triggers, nursing interventions, and patient outcomes. Clinical nurse specialists served as mentors to support staff in this paradigm shift.



A preimplementation/postimplementation survey regarding the evidence-based care planning process is being completed by the pilot unit nurses. Quality indicators and adherence to internal policies and procedures pertinent to the plans of care are being monitored preimplementation/postimplementation.



This project is being piloted in June 2008; results are to be reported. Based on recommendations and experiences from the pilot unit, evidence-based plans of care will be expanded and implemented throughout the organization.


Implications for Practice:

Evidence-based plans of care will be used by the nurse to guide practice and focus on nurse-driven outcomes while providing evidence at the bedside.


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.