Press Room

Clinical Nurse Specialists Well-Positioned to Do More to Address Malnutrition in Hospitalized Adult Patients

New Report Offers Model to Better Prepare Clinical Nurse Specialists to Help These Vulnerable Patients

Malnutrition among hospitalized patients is a pervasive problem in our country. It affects 20 to 50 percent of hospitalized adult patients and the costs of treating malnutrition are estimated to be more than $11 billion per year. A lack of proper nutrition can cause muscle wasting, loss of functional ability and increased rates of hospital-acquired conditions like falls, pressure injuries and infections—all which can lead to increased morbidity and mortality, longer hospital stays and higher rates of readmission.

A new report, issued by the National Association of Clinical Nurse Specialists (NACNS) and sponsored by Abbott Nutrition Health Institute, finds that clinical nurse specialists (CNSs) are well-positioned to intervene and reduce malnutrition in hospitalized adult patients, but many have limited knowledge of, and experience using, nutritional assessment and interventions. There are more than 72,000 CNSs, a group of advance practice registered nurses, across the United States working in hospitals and other health care settings.

Released today, Malnutrition in Hospitalized Adult Patients: The Role of the Clinical Nurse Specialist, was produced by the NACNS Malnutrition Task Force. It includes a literature review, an online survey of CNSs, and a new malnutrition conceptual model for CNS practice. The report notes that CNSs are qualified to: directly assess, prevent and treat malnutrition; educate and collaborate with nurses at the bedside and in other disciplines; collaborate with nutrition professionals and implement system-level interventions across hospitals and health systems to ensure that at-risk adult patients are screened, identified and treated for suboptimal nutritional states.

But in the survey, NACNS found that just half of its members (50 percent) reported they received education on nutrition beyond an undergraduate course and three in five NACNS members (59 percent) indicated they have basic, or less than basic, knowledge related to nutritional status or the nutritional needs of hospitalized patients.

“Clinical nurse specialists are an untapped resource for hospitals and health systems looking to cut rates of malnutrition and reduce the costs and complications resulting from it,” said Susan Smith, Chair of the NACNS Malnutrition Task Force and Adult Clinical Nurse Specialist for Critical Care at Baylor University Medical Center, Dallas, Texas. “CNSs should utilize their full scope of practice and work across the care continuum to promote optimal nutrition for hospitalized patients and intervene when necessary. Decreasing the risk of developing or continuing malnutrition will not only make a difference to patients, it also will reduce rates of readmission and infection and thereby reduce healthcare costs.”

The report recommends that CNSs use their full scope of practice, including prescriptive authority, to identify and treat hospitalized adult patients who are experiencing malnutrition or at risk for it. They can:

  • ensure comprehensive screening and assessment is done on all patients;
  • intervene by ordering evidence based nutrition therapy, as needed;
  • mentor and educate bedside nurses on best practices related to nutrition screening and care;
  • consult with and engage interprofessional health care teams to prioritize optimal nutrition in patient care management;
  • influence organizational change by communicating the issue of malnutrition in the hospital setting with executive leadership; and
  • address nutrition-related gaps within the system, including but not limited to organizational policies, procedures and programs.

But in order to do so, more education and training is needed for CNS, the report says. It recommends that NACNS work to develop: nutrition-related resources, nutrition education webinars, stronger nutrition content in curricula, relationships with nutrition groups, and explore and document the cost/benefit of nutrition intervention for patients.

To accompany the report, the Malnutrition Task Force developed a conceptual model for clinical nurse specialists to use when advocating for a systems-level malnutrition identification, prevention and treatment program. The model identifies the variables associated with malnutrition and describes processes for recognizing, intervening and evaluating systems to reduce rates of malnutrition.

Members of the NACNS Malnutrition Task Force, who authored the report, are:

  • Susan Smith, DNP, APRN, ACNS-BC (Chair), Baylor University Medical Center;
  • Tracy B. Chamblee, PhD, APRN, PCNS-BC; Children’s Health Dallas;
  • Karie Falder-Saeed, MSN, RN, PCNS-BC, VA-BC, Children’s Health Dallas;
  • Kelly Haight MSN, APRN, ACNS-BC, PCCN, Cleveland Clinic;
  • Melanie Horbal Shuster, PhD, CNS-BC, CNSC, CRNP, Allegheny Health Network;
  • Mary J. Waldo, PhD, RN, GCNS-BC, CPHQ, Providence Health & Services; and
  • Hea Lan Yoon, RN, MSN, AOCNS, VA Greater Los Angeles Healthcare System.

Abbott Nutrition Health Institute sponsored the work of NACNS’s Malnutrition Task Force.

Download the full report and conceptual model here.


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