Clinical Nurse Specialists and Nurse Practitioners:
Is There a Need to Merge These Roles?
Roles of NP and CNS: Evolution
CNS as “Hospitalist”
Merger of CNS and NP’s
Prior to admission to the hospital for an acute healthcare crisis
Our nation faces a continual and growing shortage of qualified nurses to meet our healthcare needs. To date, there has been a stratification of nursing roles, which includes, among other classifications, clinical nurse specialists and nurse practitioners (Nursing, American Association of Colleges of, 1993) (Hamric, 2000). While there will always be the need for specialization within certain nursing areas, such as CICU and neonatal care, a merging of these roles offers key advantages to patient care, cost-effectiveness, and the career satisfaction of those in the nursing profession (Chaska, 2001). This paper argues that a merger of these two roles can result in an improved and more-efficient nursing practice, which will benefit the whole healthcare system.
Part of the reason for merging the two roles is to reduce the gulf between MSc in Nursing and Bachelor’s degrees in nursing science. While specialized knowledge is necessary, it may make sense for nurses to pursue a generalized nursing career, then achieve a specialist advanced degree.
This paper will argue that there is a continuity of healthcare delivery from the onset of illness, to acute treatment, and follow-on treatment outside the hospital setting. The success in America’s treatment of acute illnesses, such as a.M.I. And stroke, mean that many diseases which in the past led to relatively quick death of the patient are now ameliorated.
Hospitals, which used to play a role of short- and long-term care institution, are now relegated to short acute-care missions. As a result of these two trends, chronic health conditions are now more common, and require a continuity of care.
Roles of NP and CNS: Evolution
CNS’s specialize in certain medical areas, as do NP’s. Both achieve master’s degree specialization; the former in medical specialties, the latter in community care. With the evolution of acute to chronic illness, and the change in treatment modalities from hospital-based to hospital- and community-based longer-term care, the two roles have become somewhat combined. Those nurses who assist patients in a specialty, such as psychiatric or cardiac care nursing, would like to continue their therapy assistance after the patient leaves the acute-care setting. This section will deal with some specialties where this is particularly true.
Nurses in a hospital setting generally see “failed” psychiatric patients: those patients who have either gone undiagnosed, or those who have undergone previous acute-care treatment, and for one reason or another have neglected their medications and other treatment. There is relatively little that a CNS nurse in the hospital can do to help the patient become better and more self-reliant, as in the Orem model of nursing. Since most psychiatric admissions from the Emergency Room remain for less than 72 hours, the CNS can do little to assist the patient to change behavior or compliance with medication prescriptions.
A model of nursing developed at Kent State University has changed the model of nursing care to merge the psychiatric CNS and nurse practitioner role (Cukr, 1997). The benefit is that the same nurse or nursing team can deal with patients in their community before potential ER admissions, and after discharge from the hospital. The advantage to this is that the patient has continuity of care, monitoring of his/her medical compliance and an early-warning system if the patient should go off track.
This work has been supported by trials of the ‘combined’ model in other settings. The Mental Health Nursing Department at East Tennessee State University has incorporated the combined nursing education into its psychiatric curriculum (McCabe, 1999)
Geriatrics is one of the areas that is growing fastest in demand, as the population ages. A study performed in southern Illinois with nursing teams found that the nursing students received a better education in a combined interdisciplinary approach (Rosher, 2001). The adequate development of a geriatric quality improvement program involves the combined work of nursing home and hospital specialists to insure that the patient is well-cared-for in both settings (Rantz, 2006)
The practice of cardiovascular nursing can range from very specific, goal-based work, such as cardiac catheterization laboratory nursing, to more general work with cardiac patients. A life-long CNS, Dr. Susan Quaal, relates her experience in working with and teaching others. Her experience was primarily in-hospital, but she expresses frustration at seeing chronically-ill CHF and ACS patients who she knows need community care.
This specific need for a bridge between acute, in-hospital cardiac care and longer-term community care is recognized in “Family Care in the Coronary Care Unit: An Analysis of Clinical Nurse Specialist Intervention (O’Keefe, 1988).” The authors make it clear that the family needed to be educated and reassured just as the patient did. The family’s involvement in the patient’s treatment needs to continue into the community, as the chronic underlying conditions require medical compliance.
CNS as “Hospitalist”
No argument is absolute, and the need for nurses to span the healthcare continuum between hospital and community, although generally true, sometimes requires additional CNS-type support within the hospital. All who have been nurses in hospitals understand that one of the primary jobs is to make quick decisions about patient care, and to assume the responsibility to allocate scarce resources and improve patient outcomes.
As the “hospitalist” MD practice has developed in the past few years, so has the nurse’s role in improving outcomes and containing costs. A new method for wound management, demonstrated by CNS’s in a clinical setting, demonstrated how better technique both comforted the patient and led to savings for the institution. There are some patient problems which are acute, and are best dealt with at the hospital. These can include rape/sexual assault (Selig, 2000), improving the administration of intravenous drugs (Seemann, 2000) and improving the efficiency (of materials and total cost) in a surgical intensive care ward (McAlpine, 1997).
More generally, many problems which receive their first care in a hospital setting can ‘graduate’ to a community- and family-based therapeutic setting. The bridge between the acute care needs and those after acute care can be very different.
Merger of CNS and NP’s
The preponderance of work reviewed by this author covers the overlap between acute, in-hospital care and longer-term, chronic care. These clinical articles pursue common themes: the patient and medical staff benefit if there is a care continuum for the patient. This continuum benefits patient outcomes in three particular areas:
Prior to admission to the hospital for an acute healthcare crisis
This differs from patient to patient, but one can generalize from specific disease etiologies. For ACS and CHF patients, for example, the record for readmission due to recurrent heart attacks (ACS) and for other symptoms, particularly excess fluid accumulation (CHF) can be reduced by adequate monitoring of the patient by qualified nurses in the community setting. A nursing team developed a Woman’s Prevention Center, for example, which put together a team which included a cardiology fellow, a CNS and an exercise physiologist, plus an outreach professional, to assure that preventative healthcare measures were taken (Halm, 2003).
There is strong clinical documentation that early detection of breast anomalies can lead to a lowered incidence of breast cancer. A multidisciplinary team from a breast clinic organized a community outreach program which educated women on how to find such symptoms early, and to come to the clinic for treatment (Edge, 1999). The continuity from community outreach to acute diagnosis and treatment proved helpful to the overall healthcare setting. This program has been repeated in centers around the United States (Mary’s, 2007).
Many patients who have undergone traumatic events requiring hospitalization have difficulty understanding the causes of their disease, and how best to care for themselves upon discharge. They may find that drugs cause side effects which are inconvenient or painful. Patients who neglect to take Lasix at night, for example, may quickly find themselves back in the hospital for further treatment.
The hospital-based CNS may find her/himself in a frustrating position, as he/she sees patients several times in the hospital with acute problems caused by the patient’s inability to follow medication recommendations.
Community-based bridging projects have demonstrated with heart patients that continual, community-based and family-based ‘bridging’ programs help to increase compliance and reduce cases of rehospitalization (Jacavone, 1999). Psychiatric care bridging acute incidents and supporting the patient in the community (particularly with medications compliance and further diagnostic support) have been shown to reduce patient readmissions and improve management of chronic mental conditions (Kurz-Cringle, 1994) (Bennett, 1998).
The changes that we have witnessed in healthcare systems over past decades has been mirrored in nursing care changes as well. Moving from the Florence Nightingale “medical” theoretical structure to more modern community- and family- based and culturally-based nursing paradigms have enriched the profession, and resulted in a more effective practice of nursing. If one follows the Orem model of self-care and independence, one realizes that the hospital setting alone is not sufficient in which to both care for and teach the patient and his/her family and community.
Since modern medicine can sustain patients with proper medical follow-up for years, it becomes incumbent on the profession to follow the patients and provide them with the knowledge and tracking to insure that they are observing the procedures and medications which prolong their quality of life. Given hospitals’ short-term orientation with the patients, there is a need to bridge patient care before, during and after acute-care visits.
While there are some nursing specialties which can be regarded as solely hospital- or community-based, many of the specialties call for a more holistic notion of patient care. By combining the CNS and NP specialties, this profession has a better chance of assuring better patient outcomes, and a better quality of life for the patient.
Bennett, B.J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.
Berger, a.M.-F. (1996). Advanced practice roles for nurses in tomorrow’s healthcare systems. Clinical Nurse Specialist, 250-255.
Chaska, N.L. (2001). The Nursing Profession Tomorrow and Beyond. Thousand Oaks: Sage.
Cukr, P.L. (1997). The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role. Arch Psychiatr Nurs, 2-12.
Edge, R.M. (1999). The development of a community breast center. Radiol Manag., 38-43.
Elder, R. & . (1990). Nurse Practitioners and Clinical Nurse Specialists: Are the roles merging? Clinical Nurse Specialist, 78-84.
Fenton, M.V. (1993). Qualitative distinction and similarities in the practice of clinical nurse specialists and nurse practitioners. Journal of Professional Nursing, 313-326.
Halm, M.A. (2003). Primary prevention programs to reduce heart disease in women. Clin Nurse Spec., 101-109.
Hamric, a.B. (2000). Advanced Nursing Practice. Philadelphia: Saunders.
Jacavone, J.B. (1999). CNS facilitation of a cardiac surgery clinical pathway program. Clin Nurse Spec., 126-132.
Kurz-Cringle, R.B. (1994). Nurse-managed inpatient program for patients with chronic mental disorders. Arch Psychiatr. Nurs., 14-21.
Lincoln, P. (2000). Comparing CNS and NP Role Activities: A replication. Clinical Nurse Specialist, 269-277.
Mary’s, S. (2007). Breast Services. Retrieved November 28, 2007, from Radiology/Diagnostics: http://smmmc.org/clinicalservices/radiology/breastservices.shtml
McAlpine, L.C. (1997). Reducing resource consumption through work redesign in a surgical intensive care unit: a multidisciplinary protocol-based progressive care area. Heart Lung, 329-334.
McCabe, S. a. (1999). Psychiatric nurse practitioner vs. clinical nurse specialist: moving from debate to action on the future of advanced psychiatric nursing. Arch Psychiatr Nurs, 111-116.
Nursing, American Association of Colleges of. (1993). Position Statement on Nursing Education’s Agenda for the Twenty-First Century. Washington: American Association of Colleges of Nursing.
O’Keefe, B.G. (1988). Family care in the coronary care unit: an analysis of clinical nurse specialist intervention. Heart & Lung, 191-198.
Rantz, M.J.-C. (2006). Entrepreneurial Program of Research and Service to Improve Nursing Home Care. Western Journal of Nursing Research, 918-934.
Rosher, R.B. (2001). Interdisciplinary Education in a Community-Based Geriatric Evaluation Clinic. Teaching and Learning in Medicine, 247-252.
Seemann, S.S. (2000). Hospital-wide Intravenous Initiative. Nurs. Clin. North Am., 361-373.
Selig, C. (2000). Sexual assault nurse examiner and sexual assault response team (SANE/SART) program. Nurs Clin North Am, 311-319.
The Clinical Nurse Specialists and Nurse Practitioners: Is There a Need to Merge These Roles?
Get Professional Assignment Help Cheaply
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Why Choose Our Academic Writing Service?
- Plagiarism free papers
- Timely delivery
- Any deadline
- Skilled, Experienced Native English Writers
- Subject-relevant academic writer
- Adherence to paper instructions
- Ability to tackle bulk assignments
- Reasonable prices
- 24/7 Customer Support
- Get superb grades consistently
Online Academic Help With Different Subjects
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!