The Agile Clinical Nurse Specialist: Navigating the Challenges of the COVID-19 Pandemic.

PURPOSE/OBJECTIVES: This article describes the contributions of the clinical nurse specialist in navigating the challenges of the COVID-19 pandemic to ensure patient and staff safety while providing science-based quality of care. DESCRIPTION: The group of clinical nurse specialists using advanced practice knowledge and skills within the 3 spheres of impact (ie, patient, organization, and nurse) developed and implemented strategies that supported frontline clinicians and met emerging organizational needs during the COVID-19 pandemic. OUTCOMES: The clinical nurse specialist's agility was imperative in navigating the challenges of the pandemic to ensure the safety of patients and staff by providing strategies and standardization to workflow processes across the organization. CONCLUSION: The group's combined clinical expertise and support of frontline nurses positioned the clinical nurse specialist to rapidly escalate the bedside nurse's concerns and provide recommendations to improve workflow while maintaining patient and staff safety.

Safety First: An Ambulation Protocol for Patients With Pulmonary Artery Catheters.

BACKGROUND: Patients with indwelling pulmonary artery catheters have historically been excluded from participating in early mobility programs because of the concern for catheter-related complications. However, this practice conflicts with the benefits accrued from early mobilization. OBJECTIVE: The purposes of this quality improvement project were to develop and implement a standardized ambulation protocol for patients with a pulmonary artery catheter in a cardiac surgery intensive care unit and to assess and support safe ambulation practices while preventing adverse events in patients with pulmonary artery catheters. METHODS: From October 2016 through October 2017, this single-center quality improvement project developed and analyzed the implementation of a safe patient ambulation protocol in the cardiac surgery intensive care unit. Frontline nursing staff and the interdisciplinary team were educated on a standardized protocol that facilitated patient ambulation. Data analyzed included distance of ambulation, catheter migration, presence of cardiac dysrhythmias, and adverse events during ambulation. RESULTS: During this 1-year project, 41 patients participated in 94 walks for a total distance of 13 676.38 m. There were no reported episodes of cardiac dysrhythmia, accidental occlusion of the pulmonary artery, catheter migration, or pulmonary artery rupture related to ambulation with a pulmonary artery catheter. CONCLUSIONS: The use of a standardized ambulation protocol can successfully result in safe mobilization of patients with indwelling pulmonary artery catheters.

Inspiring Writing in Nursing: A Clinical Nurse Specialist-Led Program.

BACKGROUND: Hospitals are constantly involved in quality improvement and research projects investing considerable money, time, and effort in supporting these projects; however, there is not always a strong enough focus on publishing the results. The challenge lies in engaging clinicians to publish their work. One of the hallmarks of the clinical nurse specialist is mentoring, and this has led to the creation of our Inspiring Writing in Nursing (IWIN) program. PURPOSE: The goal of IWIN cohort was to engage and promote publication submissions from frontline clinicians. The 18-member Nursing Research and Evidence-Driven Practice Council (NR-EDPC) supports more than 3000 nurses in quality and research projects. Two senior librarians support our council and staff. In 2014, we launched our first IWIN cohort to mentor nurses in writing and submitting for publication. EVALUATION: The NR-EDPC motto "meet them where they are" applies to both location and level of research/EDPC knowledge and skill. An Annual Nursing Research Conference showcases the products of nursing science. The first cohort of IWIN enrolled 11 mentees, and after a yearlong journey, we submitted 5 of 11 manuscripts, 3 withdrew, and 3 are still under revisions. From the 5 submissions, 3 were published, 1 was rejected, and 1 is currently under revision. DISCUSSION: With support and the infrastructure of our NR-EDPC, we are launching our second IWIN cohort.

Systems Addressing Frail Elders (SAFE) Care: Description of Successful Partnerships Across Hospitals.

Systems Addressing Frail Elders (SAFE) Care is an interprofessional team-based program, which was developed and evaluated in a cluster randomized controlled trial. Results of this trial included reduced length of stay and complications for patients. This article describes a successful partnership across 4 Magnet hospitals in the dissemination of the model. A 2-year sequential implementation process was completed, with an approach of adoption, adaptation, and abandonment. The model was successfully implemented at each participating Magnet hospital. Implementation included capacity building, organizational change, and process implementation.