A Statewide Survey of Clinical Nurse Specialist Practice: Opportunities and Challenges.

Clinical nurse specialists are the second largest advanced practice nursing role in the United States and remain underused in many states. Expanding access to care to improve patient outcomes is a national priority, which prompted this state clinical nurse specialist association to identify practice barriers, identify opportunities for practice expansion, differentiate registered nurse from clinical nurse specialist practice, and describe differences in those who have practiced in other states. This study was composed of a 15-question online survey, including demographic information, collected over a 4-week period in 2016. Sixty-one respondents (7% of eligible clinical nurse specialists in the state) completed the survey. Regulations limiting the scope of practice in the state were identified by 75% of participants as a practice barrier. Work environment, educational factors, and organizational support contributed to limitations in practice as delineated in the Consensus Model for Advanced Practice Registered Nurses. Participants support increasing public awareness of clinical nurse specialists as advanced practice nurses. Survey results confirm the need for a multifaceted approach in removing clinical nurse specialist practice barriers and improving access to their care by aligning state law and regulation with the National Council of State Boards of Nurses' Model Nurse Practice Act.

En nuestro país, la formación especializada en Ciencias de la Salud es una formación reglada y de carácter oficial... [editorial] / No disponible

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Overview of the uptake and implementation of non-medical prescribing in Wales: a national survey.

OBJECTIVES: To identify (1) the non-medical healthcare professionals in Wales qualified to prescribe medicines (including job title, employer, where the prescribing qualification is used, care setting and service provided); (2) the mode of prescribing used by these healthcare professionals, the frequency with which medicines are prescribed and the different ways in which the prescribing qualification is used; and (3) the safety and clinical governance systems within which these healthcare professionals practise. DESIGN: National questionnaire survey. SETTING: All three National Health Service (NHS) Trusts and seven Health Boards (HB) in Wales. PARTICIPANTS: Non-medical prescribers. RESULTS: 379 (63%) participants responded to the survey. Most of these prescribers (41.1%) were specialist nurses who work in a variety of healthcare settings (primarily in secondary care) within each HB/NHS Trust, and regularly use independent prescribing to prescribe for a broad range of conditions. Nearly a quarter of the sample (22%) reported that prior to undertaking the prescribing programme, they had completed master's level specialist training and 65.5% had 5 years qualified experience. Over half (55.8%) reported that there were plans to increase non-medical prescriber numbers within the team in which they worked. Only 7.1% reported they did not prescribe and the median number of items prescribed per week was between 21 and 30. Nearly all (87.8%) of the sample reported that they perceived prescribing to have ensured better use of their skills and 91.5% indicated that they believed it had improved the quality of care they were able to provide. CONCLUSION: Non-medical prescribing has been implemented across the whole of Wales; however, its uptake within HBs and NHS Trusts has been inconsistent, and it has not been considered across all services, particularly those in primary care. Opportunities therefore exist to share learning across organisations.

Optimización de la atención sanitaria en una unidad de gestión clínica de atención primaria mediante una experiencia innovadora. Proyecto ganador del VI Premio Esteve. Área de Enfermería / Optimizing clinical management in a health care unit: an innovative experience

El aumento significativo de las indicaciones de la anticoagulación hace que el número de pacientes que precisan de seguimiento y control en AP crezca cada día, situación que requiere por parte de los gestores adecuar las agendas de los profesionales -médicos y enfermeras- a esta necesidad creciente. La prescripción colaborativa enfermera se está desarrollando en Andalucía. Esta actividad permitiría en nuestra Unidad de Gestión Clínica optimizar los tiempos dedicados al seguimiento de pacientes anticoagulados. La determinación y dosificación de los pacientes por parte de la enfermera supone menores tiempo de dedicación a esta actividad por parte del médico de familia y que oriente su actividad a otras tareas, como aumentar el número de citas disponibles o el tiempo que dedica actualmente a las mismas, atender las urgencias del centro, entre otras. Se realiza un estudio piloto diseñando un ensayo clínico (EC) para determinar la viabilidad del proyecto e implementar esta práctica. Se realiza el seguimiento de 146 pacientes asignados de manera aleatoria al grupo experimental y control y durante 4 meses y medio. Se midió el gasto en el consumo de tiras, coste en tiempo del servicio, valores de INR, tiempo en rango terapéutico y de dedicación a la consulta. Los resultados, con significación estadística contrastada, indican que, cuando la enfermera dosifica y sigue al paciente, los pacientes están más tiempo en rango terapéutico, el número de visitas es menor y el gasto en tiras se reduce (AU)

The increase of anticoagulation drug therapy indications translates into a rise of patients, which need primary healthcare monitoring and control. Managers have to adjust health professionals' timetables -of doctors and nurses to adapt them to the increasing demand. Collaborative nurse prescription is being tested in Andalusia. Implementing this development would allow our clinical management unit to optimize the amount of time dedicated to monitor patients taking anticoagulation drug therapy. When nurses monitor patients and determine anticoagulant drug therapy dosage, the amount of time that general practitioners dedicate to this group of patients is reduced, increasing their time for other duties such as: augmenting the amount of available medical appointments, providing better attention during the appointments, and increasing their availability to respond to emergencies within the unit, among others. We ran a pilot study designing a clinical trial to establish the viability of the project. We monitored 146 patients randomly assigned patients, both to the control and experimental group during four and a half months. We evaluated the expenditure of test strips, the cost of service time, INR values, the time of therapeutic range and consultations. Results showed a statistical significant difference: when nurses dose and monitor patients, patients have more time of therapeutic range, the number of visits declines, and the expenditure of test strips is reduced (AU)

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

PURPOSE: The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. DESCRIPTION OF THE PROJECT: The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. OUTCOME: On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. CONCLUSIONS: Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Clinical nurse specialist regulation: the Maryland experience.

High-quality care will continue to be a driver in the evolution of today's health care environment. Ensuring effective, cost-conscious, quality care is the core of clinical nurse specialist (CNS) practice. The CNS practice varies by state, depending on each state's Nurse Practice Act. Some states have separate scopes of practice for CNSs, including prescriptive authority, whereas some states do not recognize CNS practice as different from the practice of the registered nurse. The journey to state recognition and title protection for the CNS role in the state of Maryland is described.

Liability of physicians supervising nonphysician clinicians.

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.