1. Payne, Nancy MSN, BSN

Article Content


This poster will describe the development of a unique advanced practice role, limb loss clinical nurse specialist (CNS), at Duke University Medical Center.



The numbers of people with amputations are increasing dramatically, with an estimated 1.9 million people in the US living with limb loss, 70-80 % of whom demonstrate comorbid diabetes and peripheral arterial disease. This population spans several medical and surgical services and requires interdisciplinary collaboration. Education, coordination, and support are essential for successful integration into living well, work, sporting, and community activities.



CNS positions have been created in many specialties to coordinate services; at our large tertiary medical center, it was decided to hire an advanced practice nurse with interest and experience in orthopedics to develop resources and provide support for amputees. Patients' involvement begins preoperatively and continues throughout their treatment trajectory.



Creating this position was the first challenge, as no professional peers for benchmarking and no comprehensive standards of practice could be identified. This poster will illustrate the barriers and solutions encountered as the role functions were developed. Relationships had to be established with departments of vascular surgery, orthopedics, trauma, plastic surgery, endocrinology, and general medicine, as well as discharge planning, physical and occupational therapy, and prosthetic care. Prevention and treatment of diabetic foot ulcers in partnership with other professionals are a new focus. Care across the continuum is a priority, and services are provided to youth through geriatrics.



The limb loss CNS position has now been in place for 3 years. A much needed interdisciplinary clinic has been established, and information about referrals, caseload, satisfaction, and community support will be provided, which demonstrate improved services for limb loss patients and their families.



A CNS dedicated to individuals with limb loss can achieve high satisfaction in patients, families, healthcare providers, and facilities. Educational materials, community support, and advocacy equip these patients for successful living after limb loss.


Implications for CNS basic and Continuing Education:

Others may benefit from seeing how the implementation of this position was accomplished, stimulating creative use of a CNS to coordinate services for underserved patient populations.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those 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 for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.