The role of the Clinical Nurse Specialist (CNS) in managing chronic conditions, both malignant and benign, is not new to health care and has rapidly developed over the last thirty years. More recently the financial climate, increasing incidence of disease, improved survival rates, an ageing population living with many co-morbidities and rising client expectations has led to the implementation of more advanced practice roles. However these roles are extremely varied, often difficult to evaluate, intangible and historically this nursing group struggled to gain credibility and recognition. (Duke 2012 and Gordon et al 2012).
The importance of gradual level education and ability to prescribe has facilitated the development of clinical nurse specialists from their role as key worker and expert in their field to develop autonomy within advanced practice roles. Many nurses in these roles have established their own caseload, perform assessments, request diagnostic tests, diagnose, prescribe, and perform specialised procedures.
The CNS is in a prime position to become the main point of contact and develop individualised care plans for patients through holistic assessment, are available for consultation, can clinically assist nursing colleagues with complex patients, prevent unnecessary admissions, and it has been shown that patients’ with a dedicated Clinical Nurse Specialist have better clinical outcomes with improved quality of life. (Oliver and Leary 2012 and RCN 2010).
As such advanced practice nurses have been involved in clinical audit, research and education in an aim to improve services. In more recent years commissioners have recognised that advanced practitioners are pivotal in front line leadership with the experience and insight to be able to identify, drive and implement initiatives to improve the patient experience. This has led to initiatives to share good practice through nurse forums, which has further compounded the significance of the advanced practice role and placed the CNS in an ideal position to strive towards quality and excellence in healthcare. (NCAT 2010 and RCN 2010).
Nonetheless, as with all roles, there are many barriers to implementing innovate practice that are often resource based. Funding is a rapidly becoming the primary issue in this financial climate, as well as reduced staffing and space in increasingly burdened units. CNSs’ are also often bogged down in administrative tasks, which are frequently not the best resource of the practitioners’ skill. (Oliver and Leary 2012).
The cost and service benefit of the CNS, however, is widely documented and both commissioners and the practitioners themselves need to be able to demonstrate their value. (DoH 2007 and Macmillan 2010). There are now resources now available to assist practitioners in both job planning and service evaluation, and the importance of this has been stressed through regional and national nursing groups. (Apollo Nursing 2018 and RSCI 2010).
An example of local service evaluation of a CNS nurse led clinic for MSc dissertation completing September 2018 will be included.