Implementing clinical nurse specialist (CNS) role designed for ambulatory setting in a cancer center in ItalyName : Dr. Anita Zeneli
Affliation : Professor
University : Istituto Scientifico Romagnolo Per Lo Studio E Per La Cura Dei Tumori IRST IRCCS
Country : Meldola, Italy
Introduction: Although there are several studies showing the impact that clinical nurse specialists (CNSs) have on patient outcomes and healthcare costs reduction, implementing this role in a healthcare organization is really challenging. As far as we know, there are not publications evaluating the CNS role implementation in a cancer context in Italy. Cancer treatments complexity, patient needs, and limited healthcare resources make mandatory the need to introduce advanced nursing practices into pathways. The aim of the study is to develop a CNS role model and associated metrics for outcome assessment to be implemented in a cancer center in Italy.
Material and Method: A focus group composed by manager, lead, research and experienced oncology nurses, studied the CNS role consulting documents developed by international scientific nursing associations, with particular focus on clinical studies providing evidence in CNS associated outcomes in onco-haematology context. We analyzed the organization for identifying care setting and diseases that need advanced nursing practice, were to implement the new role. Based on the communalities found among documents, on clinical, organizational and professional needs, we defined the role responsibility areas and the associated indicators for measuring its contribute.
Results: Differences among documents describing CNS roles are related to core competences, skills, certifications, academic education, settings and the most important regarding the outcomes to measure the impact that the CNS role has on the organizations. The CNS role model defined by our group will be implemented in ambulatory setting on eight of most representative cancer diseases treated in our center. We defined four working areas of responsibilities: quality and patient-centered care outcome; contribute to research and innovation; leadership for nursing and system efficiency. Associated indicators identified by us, were rates of: patients showing negative outcomes; patients with uncontrolled symptoms; prolonged intercycles among patients undergoing cancer treatments for complications, treatment compliance, patients accepting to participate on clinical trials, query related to clinical trial protocols , unappropriate admissions in oncology ward, education projects, clinical governance instruments developed , services improvement. Other indicators will be used to evaluate the new role implementation process.
Conclusions: We expect the new role will contribute in reducing the current gap in nursing practice with benefit in patient outcomes, research, nursing leadership and system efficiency.