Clinical Nurse Specialists: A Voice to Lead

When 2020 was designated the Year of the Nurse and Midwife, no one ever considered it would become the year that a global pandemic showed the world how important nurses are to the public’s health and wellbeing.  Nurses everywhere were called upon to serve by either directly caring for persons with COVID-19 or by supporting families, communities, and health systems as everything shifted in response.  Clinical nurse specialists are educated with unique knowledge and skills for impacting three intersecting domains:  direct care, nurses and nursing practice, and health systems and organizations.  As expert clinicians who interpret core practice competencies into specialty populations and settings, CNSs were able to interpret pandemic-generated needs for nursing care at the clinical, nursing personnel, and system level. 

The 2021, the United States’ National Association of Clinical Nurse Specialists Annual Conference, held virtually, showcased many clinical nurse specialist responses to the pandemic.  In the direct clinical care domain, examples included clinical nurse specialists assuming responsibilities as care providers, shift coordinators, managers, and resource nurses.  Clinical nurse specialists introduced new technologies such as remote tele-monitoring, secure chat messaging, and upgrades to electronic health records.  They revised clinical procedures for improved tracheostomy care and prone positioning.  Clinical nurse specialists led teams in developing new COVID-19 intubation checklists and resuscitation standards.  In the nursing practice domain, examples of clinical nurse specialist responses included creating educational programs to transition general practice nurses to COVID-19 focused intensive care responsibilities.  Clinical nurse specialists helped design staffing models to address complex COVID-19 care needs while continuing to deliver care to persons with other serious, urgent medical problems.  They organized virtual clinical rounds and web conferences for interprofessional team collaboration.  And clinical nurse specialists supported nurses and other staff members by listening, encouraging, and being present when no words could be found.  In the system domain, clinical nurse specialists coordinated training hospital staff for new responsibilities such as safety officers, messengers, and transporters, emphasizing proper safety precaution procedures using virtual technology, small group presentations, and YouTube tutorials.  They created personal protective equipment protocols and collaborated with biocontainment experts to assure safe disposal of contaminated equipment. A recurring theme through many of the conference presentations was the clinical nurse specialist’s central role in facilitating communication to and from administration and front-line workers.

The pandemic challenged health care providers and systems.  It also highlighted the unique knowledge and skill of the clinical nurse specialist and how the everyday work of this advanced practice role is essential to meeting the demands of the healthcare environment.  The ability to work in three integrated domains (spheres of impact)  was especially critical in the pandemic crisis.

The International Council of Nurses theme for Nurse’s Day is ‘A Voice to Lead’; the sub-theme is ‘A Vision for Future Healthcare’.  A voice without a vision is noise.  A vision with no voice is a mirage.  I am pleased to have opportunity to reflect on how clinical nurse specialists demonstrated both vision and voice in a trying time, and invite my colleagues to celebrate this advanced practice role! 

*Header image copyright: Bruno Lavi - IND2021 photo contest winner

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Janet S. Fulton PhD, RN, ACNS-BC, ANEF, FCNS, FAAN

Centennial Endowed Professor in Innovation in Nursing Education, Indiana University School of Nursing

Available at the 2021 11th ICN/APN virtual Conference (Aug 29 - Sept 1) learn more. Sponsored by Springer.