Position statement: clinical nurse specialist in critical care.
The clinical nurse specialist in critical care (CNS-cc) is an advanced nursing practice role in critical care (ANP-cc) who holds a minimum of a master's degree with clinical expertise in a critical care specialty. The CNS-cc's practice is based on an in-depth knowledge of critical care nursing and other sciences gained through advanced nursing education and clinical experience. The CNS-cc influences change at the individual and system levels to impact the delivery of health care to the patient and family. The CNS-cc functions both autonomously and in collaboration with other health care professionals to manage, support, and coordinate the care of acute and chronic critically ill patients.
* Registered Nurse
* Minimum of master's degree in nursing
* Current critical care expertise
* Current appropriate life support certificate(s) (e.g., ACLS,
* CNA's specialty certification in critical care or equivalent to critical care subspecialty (recommended)
Scope of practice
The CNS-cc is expected to practise in each of the following ANP-cc core competencies (CNA, 2008): clinical, consultation and collaboration, leadership, and research. These competencies incorporate the previously identified five interrelated domains of practice: clinical, education, research, consultation and leadership (CACCN, 2002). These competencies are not separate and distinct, but are woven into the everyday functioning of the CNS-cc role. The CNS-cc applies these competencies across three spheres of influence: the patient (and family); nursing, both the individual and the profession; and organizational systems. Integrated within the practice of each competency are expert skills related to communication, collaboration, and ethical decision-making, as well as effectively moving through the transition of change.
The foundation of the CNS-cc role is grounded in advanced critical care clinical practice. The CNS-cc is prepared to assess and intervene in complex, actual or potential acute and/or life-threatening health problems within the selected critical care subspecialty. To ensure continuity of care, the CNS-cc 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, but not limited to, the critical care unit, alternate care facilities, ambulatory-care, inpatient units, emergency, and the home. The CNS-cc provides evidence-based nursing care to meet the unique needs of the acutely and critically ill patients and families through direct care, education, and consultation, as well as education and consultation to their nursing colleagues and other members of the health care team.
The CNS-cc promotes an environment conducive to learning for staff nurses, students, and other health professionals. The CNS-cc functions as a resource person, program planner, preceptor, teacher, mentor, and patient educator in collaboration with others in educator roles. The CNS-cc shares research and theoretical knowledge through publication, presentations, and educational programs.
The CNS-cc shares specialized knowledge and provides consultation to patients (and families), nurses, other health professionals, health care institutions, organizations, and policymakers. The CNS-cc consults with others both internal and external to the organization to improve patient care, and to deal with complex and challenging situations faced in the critical care setting.
The CNS-cc enhances excellence in critical care nursing research by role modelling the utilization, participation, and dissemination of research. The CNS-cc 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 CNS-cc has expertise in research methodology, conducts critical care nursing research, and participates in interdisciplinary critical care research. The CNS-cc encourages nurses to identify critical care nursing research questions and to participate in nursing research.
The CNS-cc promotes quality care through the development of standards, policies, procedures, outcome measures and clinical programs and services related to their specialty area. The CNS-cc directs nursing care activities, as well as plans, implements, and evaluates changes in clinical practice, especially through engagement in quality improvement activities. The CNS-cc provides clinical leadership by acting as a resource, facilitator, coordinator, role model, and advocate.
CACCN believes that time, opportunity and other supports are needed for the CNS-cc to engage in the full scope of the role. The integration of the core competencies will continuously evolve depending on the critical care subspecialty in which the CNS-cc is involved, that is, the predictability and complexity of the patients/families, the needs of the nursing staff, as well as the education and experiential learning of the nurse in the CNS-cc role.
Approved by the CACCN Board of Directors
Date: January 19, 2011
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