1. Morrison, Dolores MSN, RN, ACNS-BC

Article Content


The purpose of this presentation was to provide information for the CNS whose goal is to become a consultant in a specialized area of nursing. The CNS developed a new role as IV therapy consultant after identifying clinical problems and learning of the unacceptable catheter-associated blood stream infection (CLABSI) rate in an acute care facility.



Each year, an estimated 250,000 cases of CLABSI occur in the United States, leading to at least 30,000 deaths. The additional cost for each infection is over $36,000. The CNS is responsible for benchmarking this nursing-sensitive indicator and can improve outcomes. The CNS provides consultation to influence the identified plan, enhances the abilities of others, and effects change. The CNS must possess skill, expertise, and knowledge in the particular area of consultation to navigate a struggling system.



Prior to the development of the CNS role of IV Therapy Consultant, the CLABSI rate at the Albert Einstein Healthcare Network (AEHN) was 6.5%, above benchmark. The IV team was the only resource for nurses. Clinical practice was guided by tradition and nurses were reluctant to change.



The CNS reviewed the literature and collaborated with nursing staff, physicians, interventional radiology, and national IV consultants to develop evidence-based policies. Products were piloted to determine efficacy, and a new central line dressing kit was designed. House-wide education and a mandatory bedside competency were completed. An audit tool was developed for monitoring compliance. Additionally, an IV "super user" group was created to support staff. Data were analyzed in collaboration with the infection control department.



One year following the development of the role of the IV Therapy Consultant, the CLABSI rate for AEHN had decreased to 2.27%. Bedside audits revealed 90% compliance with changing CVC dressings and discontinuing CVCs when no longer clinically indicated.



Engaging in the consulting process requires multidirectional analyses. Navigating a healthcare facility system is daunting but can be very informative especially for the new CNS.


Implications for Practice:

Current health care affords opportunities for CNSs to serve as consultants. Problem identification, action planning, and evaluation are key components to successful consultation.


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.