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Nurses challenge editorial.

In response to the editorial "Demonstrating advanced nursing capabilities" (Kai Tiaki Nursing New Zealand, February 2007, p2), Christchurch Hospital clinical nurse specialists (CNS) would have welcomed an opportunity to comment on the opinions expressed by Becky Hickmott and acknowledged educators, regarding the CNS role.

We recognise the overall aim of the editorial was to affirm the professional development and recognition programme (PDRP) as a way of validating, acknowledging and celebrating nurses' achievements. We know how important this is, having recently critically analysed and updated our out-dated generic position descriptions to reflect Christchurch Hospital CNS' contribution to health care, which was subsequently endorsed by the outcome of the senior nurses' scoping exercise.

The article reflected one of the questions we asked during our analysis and preparation for the scoping exercise: "What is it that makes me different from a PDRP expert nurse?" It was by extracting the continually expanding expert knowledge and skills (that all nurses have the potential to develop), that the generic attributes of a CNS evolved. Each CNS develops their role to meet recognised clinical need, becoming an acknowledged expert within their defined area, wider community and the profession. Pushing boundaries and the ability to make autonomous decisions in less "routine" cases can have an immediate clinical impact for the patient. In addition, the CNS must consider how these decisions impact on broader issues for the family, health care staff and resources. Subsequently, the CNS role often has ongoing accountability, and requires a greater level of skill and knowledge in its many layers. A new hospital CNS at Canterbury District Health Board, is expected to have a level 8 qualification and a clinical masters is desired, to develop the necessary skills of critical analysis. Recent funding has facilitated this pathway.

Naively, with our masters in hand we, too, could say "I am doing the same things as a nurse practitioner". However, hindsight shows us that with such a title comes increased expectations and much more work for responsible clinicians. All new senior nurses will draw on the knowledge they have previously acquired, but soon face problems that take them out of their area-specific comfort zones and, in the broader context, lead them to use their advanced skills and knowledge to develop robust strategies and to problem solve with safety.

Selena Nikora, chair, CNS Group, on behalf of the CNS Group, Christchurch Hospital

Rebecca Hickmott, editorial writer and professional practice end practice facilitator at Christchurch Hospital replies: It is good to see my editorial has prompted discussion, which I hoped would happen as we continue to define our profession in the various nursing roles, positions and practice.

As the CNS have rightly stated, the editorial was from a broad perspective, seeing nursing across o professional evolutionary framework, rather than purely from the perspective of position titles and roles/responsibilities at a particular point in time. From the inaugural NZNO/District Health Board (DHB) Multi-Employer Collective Agreement and the designated senior nurses'/midwives' job endorsed titles agreement, which came out of it, we have afresh reminder that position titles and roles and responsibilities change. In my editorial, I was looking at the innovation and knowledge values/attitudes embedded in each nurse's practice.

The staff acknowledged to have contributed to discussions, as I prepared my editorial, are PDRP committee member/assessors. They have been part of the process of assessing the portfolios submitted by outstanding professionals within the DHB. Again, I raise the questions: "Is advanced practice limited to defined roles such as CNS and nurse practitioner? Does being in one of these roles define you as a nurse working at an advanced practice level? The registered nurse mentioned in the editorial was an outstanding example of "pushing boundaries and the ability to make autonomous decisions in less "routine' cases that can have an immediate clinical impact for the patient." However, she is by no means the only example in our DHB.

The involvement of other expert RNs in national and international committees, national policy, end work/consultation across the broader health care continuum specifically looking at the "less routine" cases, highlights the key points of my editorial argument.

The CNS' letter is a positive contribution to this debate, as we continue to define our profession, and explore the depth of knowledge and advancing/advanced capabilities of the various nursing roles, responsibilities, positions and practice. I hope that as we look to the future, all nurses in designated senior positions continue to recognise the outstanding nurses in our profession.

I am not claiming to have all the answers, but I am committed to my profession and to challenging my peers end colleagues to actively engage in debate, that we might successfully unite to face future challenges for our profession and for those patients in our care.
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Article Details
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Title Annotation:LETTERS
Author:Hickmott, Rebecca
Publication:Kai Tiaki: Nursing New Zealand
Article Type:Letter to the editor
Date:Apr 1, 2007
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