Critical Care Clinical Nurse Specialist
Definition
The Critical Care Clinical Nurse Specialist (CC-CNS) is an advanced practice nurse who holds a master’s degree or doctorate with clinical expertise in critical care nursing. The CC-CNS practice is based on an in-depth knowledge of critical care nursing and other sciences gained through advanced nursing education and clinical competence. The CC-CNS functions both autonomously and in collaboration with other health care providers to manage, support, and coordinate the care of acute and chronic critically ill patients. To ensure continuity of care, the CC-CNS leads and facilitates the transition of these patients and their families across the continuum of acute and critical care services, which may span a variety of settings including the home, ambulatory care sites, the hospital ward, and the intensive care unit. The CC-CNS provides evidenced-based nursing care to meet the unique needs of the acute and critically ill patients and families through direct care, education, and consultation to clients, as well as education and consultation to their nursing colleagues and other members of the health care team. The CC-CNS enhances excellence in critical care nursing research by role modeling the utilization, participation, and dissemination of research.
Qualifications
The CC-CNS is a registered nurse who is prepared at the graduate level (minimum of a master’s degree in nursing preferred or equivalent graduate degree containing course work and clinical experiences which support the development of the CNS role in the critical care environment). In addition, the CC-CNS has current clinical expertise in the critical care specialty (e.g. pediatrics, neonatal, cardiac, neurosurgical). The CC-CNS has attained the appropriate Canadian Nurses Association specialty certification(s). The CC-CNS has demonstrated superior leadership, communication, critical thinking, clinical decision-making, collaborative, ethical decision-making, and mentoring skills.
Scope of Practice
There are five interrelated components of the CC-CNS role: practitioner, educator, consultant, researcher, and leader. The components are not separate and distinct but are woven into the everyday functioning of the CC-CNS role. The balance of these components will vary depending on the setting in which the nurse is employed and the needs of the patients cared for in that setting.
The foundation of the CC-CNS role is grounded in advanced critical care clinical practice. In the practice component the CC-CNS is prepared to assess and intervene in complex, acute (actual or potential life threatening) health problems within the selected critical care clinical specialty. The CC-CNS provides expert client care, based upon an in-depth understanding of critical care nursing and other relevant sciences. The clients will predominantly be individuals and their families in need of critical care nursing services, but may at times include groups or communities.
The focus of the educator component is clients and their families. In addition, the CC-CNS promotes an environment conducive to learning for staff nurses, students, and other health care professionals. The CC-CNS functions as a resource person, program planner, preceptor, teacher, mentor, and client educator in collaboration with others in educator roles. The CC-CNS shares research and theoretical knowledge through publication, presentations, and educational programs.
As a consultant, the CC-CNS shares specialized knowledge and provides consultation to clients, nurses, other health care professionals, health care institutions, organizations, and policy makers. The CC-CNS consults with others both internal and external to the organization to improve client care, and to deal with complex and challenging situations faced in the critical care setting.
The research component of the CC-CNS strengthens the link between clinical nursing practice and research. The CC-CNS has expertise in research methodology, conducts critical care nursing research, and participates in interdisciplinary critical care research and quality improvement activities. The CC-CNS has particular responsibility for critically appraising research findings and implementing strategies to translate research findings and theoretical frameworks into practice to improve patient care in the critical care setting. The CC-CNS encourages nurses to identify critical care nursing research questions and to participate in nursing research studies.
As a leader, the CC-CNS promotes quality care through the development of policies, standards of care, and clinical programs and services. The CC-CNS directs nursing care activities as well as plans, implements, and evaluates changes in clinical practice. The CC-CNS provides clinical leadership by acting as a resource, facilitator, coordinator, role model, and advocate. The CC-CNS's leadership responsibilities should enhance the clinical focus of the role.
References
American Association of Critical Care Nurses. (2000). Standards of practice and professional performance for the acute and critical care clinical nurse specialist. Washington, DC: Author.
Association of Registered Nurses of Newfoundland & Labrador. (1997). Position statement: Advanced practice clinical nurse specialist. St. John’s: Author.
Canadian Nurses Association. (1993). Policy statement: Clinical nurse specialist. Ottawa: Author.
Canadian Nurses Association. (1997). Out in front - advanced nursing practice. Nursing Now, No. 2, 1-4.
Canadian Nurses Association. (2000). Advanced nursing practice – a national framework. Ottawa: Author.
Canadian Nurses Association. (2002). Advanced nursing practice – a national framework (2nd ed.) Ottawa: Author.
Gawlinski, A., & Kern, L. (Eds.) (1994). The clinical nurse specialist role in critical care. Philadelphia: W. B. Saunders Co.
Sparacino, P. (2000). The clinical nurse specialist. In A. Hamric, J. Spross, & C. Hanson (Eds.), Advanced nursing practice: An integrative approach, (2nd ed., pp. 381-406). Philadelphia: W. B. Saunders Co.
Nurses Association of New Brunswick. (2000). Position statement: Clinical nurse specialist. Fredericton: Author.
Registered Nurses Association of British Columbia (1998). Position statement: Clinical nurse specialist. Vancouver: Author.