COVID-19 Pandemic: Clinical Nurse Specialist Practice Supporting Preparedness in the Spheres of Impact.

PURPOSE/OBJECTIVES: The goal of this article is to describe how a high-functioning clinical nurse specialist (CNS) team rapidly responded to the needs of the patients, nursing staff, and organization as a whole to address the coronavirus disease 2019 (COVID-19) crisis. DESCRIPTION OF THE PROJECT: Using the advanced practice knowledge and skills, each CNS moved effortlessly between the 3 spheres of influence, patient, nursing, and organization, to address the unique needs of the COVID-positive patient, as well as the routinely ill who still needed care during a pandemic. In addition to observing and addressing opportunities at the bedside, the CNS team was essential in the development of plans of care, crisis care standards, and a structure for critical care cross-training. OUTCOMES: Five themes essential to success were identified: a common motivation and goal, collaboration, the importance of communication in utilizing established groups to create rapid change, power of influence, and the availability of a vast number of resources including professional nursing roles. CONCLUSION: Using the expertise of a specially trained team of CNSs, an effective plan was established to ensure safe, optimal care during the COVID-19 pandemic and effectively support frontline nurses.

Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU.

INTRODUCTION: Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU). METHODS: We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared. RESULTS: Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period (P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65). CONCLUSIONS: Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.