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7 lessons learned from the COVID-19 pandemic

By Sean Reed PhD, APN, ACNS-BC, ACHPN

Clinical nurse specialists share experiences on how the pandemic and social distancing are highlighting the CNS role.

The “new normal” resulting from the COVID-19 pandemic has altered the way America’s 89,000 clinical nurse specialists (CNSs) do their jobs. For example, how do CNSs perform all the tasks they have been trained to do while maintaining six feet of social distance? What information should be communicated to staff?

Four CNSs and National Association of Clinical Nurse Specialists (NACNS) members recently shared their experiences learned over the past months about how to maintain social distance while taking on new responsibilities and still be effective. Their insights go beyond wearing masks, keeping social distance, and washing hands.

Communications

1. Worry only about what you can control.

It’s an ever-changing environment, with new COVID-19 information arriving daily, frequently resulting in new healthcare policies. Early in the pandemic, the Centers for Disease Control and Prevention (CDC) changed recommendations regularly, and CNSs were responsible for disseminated them across many organizations.

“It could get exhausting with the constant changes in policy and protocol. We had no control over CDC announcements, so we just rolled with it and worked to keep everyone current,” said Julie DeVaney, CNS at UC San Diego Health. “We had daily announcements, over-communicated information, and held what we called a ‘Daily Engagement.’ The Daily Engagement was a formal, daily conversation with our leadership and the clinical CNSs so we could disseminate any new information.”

2. Overcommunicate.

Take the time to critically look at news and other information being released. Because COVID-19 is constantly evolving and new study results are being reported regularly, there is a real need to be vigilant about the types of information being shared. Learning to overcommunicate accurate information takes time and is essential.

“Initially, we dedicated a lot of time for conversations and supporting staff, trying to be sure they had accurate information; keeping them updated,” said Pat Rosier MS, RN, ACNS-BC, a surgical CNS at Berkshire Medical Center in Pittsfield, Massachusetts. “We answered questions like, ‘What was our guidance?’ and ‘What was the personal protective equipment [PPE] to use?’ So, you’re always trying to be sure the [nurses] have the accurate information. And then internally, what were our plans for which units would care for which types of patients? So, we spent, and continue to spend, time keeping staff up-to-date, calming them down, and sometimes we just listen. Listening is a form of communication.”

3. Know where and how the staff is getting their information.

Understand where and how nurses obtained new information. According to Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, CCRN, FCCM, FCNS, who is CNS, acute medicine service line quality and safety and sepsis leader/coordinator at ChristianaCare in Newark, Delaware, it’s important to first locate the news sources used by staff and then check to see if the sources are credible. If the sources aren’t accurate, speak up and inform the staff, and provide sources that are credible. This will enable CNSs to prevent the spread of misinformation before it starts.

CNS Leadership

4. Persuade with evidence.

As leaders, CNSs need to communicate evidence-based information thoughtfully to staff without simply reacting to whatever new information is presented. They need to use their skill and knowledge to persuade—and back up with evidence—recommended actions. The confidence that evidence brings to new information can reduce the levels of uncertainty nurses often experience working on the frontlines of the pandemic.

“The biggest challenge CNSs had to manage was the staff’s fear,” said Seckel. “Our code words for staff were ‘fluid and flexible’ because what was common practice for COVID-19 today could change next week due to new research. We didn’t want to react before we considered the situation with other experts and leaders, so we put the right information out.”

Messaging becomes exquisitely important in this environment. Rapidly and constantly changing information makes people more fearful. It’s important for the CNS to lead and persuade by taking the time with staff and explaining the evidence.

5. Insist on a seat at the leadership table.

The pandemic led to healthcare operational leaders and clinical leaders working together more closely and communicating more as a team. It’s important to not separate operational and clinical activities from each other and to make sure everyone is working toward the same objectives. This can only happen when CNSs play a leadership role.

“Clinical leadership is imperative in a situation like this. CNSs definitely need to be a voice at the table,” said Matthew Beier MS, RN, CNS-BC, CNOR, director of advanced practice nursing at Children’s Hospital of Wisconsin in Milwaukee. “Decisions should not be made strictly from an operational perspective. Clinical leadership through a CNS, and clinical educator is absolutely 100% needed in a situation like this. We need to make our voices heard and advocate for the clinical needs of the organization, not just the operational needs.”

6. Train, train, train.

All training is welcome but, in particular, pandemic surge training had the unexpected benefit of calming nurses’ nerves and creating an even more collegial environment. DeVaney helped train more than 300 nurses to manage a surge that required moving toward a team-nursing model at UC San Diego Health. DeVaney believes that the pandemic has been enlightening in that it forced her team to learn new ways of getting the job done better.

“The surge training helped calm nerves because it provided a clear idea of what may be expected of nurses,” said DeVaney. “They realized it wasn’t going to be as scary as they thought. Training is helpful in that it sets expectations and helps staff maintain focus.”

Patient Visitation

7. Maintain social distance but be socially inclusive.

Social distancing between family and patient—restricting access—is the hardest part of the job. It’s wonderful when the patients are awake and alert and want to talk to their family using various media platforms. At the same time, it’s difficult to watch patients with COVID-19 having to FaceTime family members. There is no physical contact with the family. The lack of intimacy can be incredibly sad and heart wrenching.

Nurses can become emotionally drained in this environment. These situations require a lot of discussion with staff in the form of providing care for the caregivers.

8. Master technology and use it.

“Our infection prevention team has been involved from the very beginning dictating a lot of our practices when it comes to entering patient rooms,” said Beier. “We definitely rapidly ramped up our telehealth capabilities doing a lot of work with the nurses using telehealth right on the patient care unit. Specifically, with patients who were positive early on in the crisis, we allowed nurses to stay out of the patient room, only entering for critical needs or necessary assessments and interventions. Other conversing and interactions are done by iPad and other similar devices.”

Necessity as the mother of invention has been visible in many adaptive behaviors, especially when it comes to using technology and bundling care to facilitate patient visits. During the pandemic, CNSs are helping lead efforts to improvise communications channels. All the CNSs interviewed highlighted the importance of technology to help family members communicate with their loved ones in the hospital. From acting as an intermediary between the patient and family on a mobile phone to using Facetime and iPads, CNSs have helped institute a number of communications solutions for their patients. This was especially true in instances where family members were unfamiliar with technology.

Resurgence of the CNS

Maintaining social distance while performing the role of a CNS during a pandemic—aptly categorized as a “roller coaster ride”—is challenging, yet CNSs everywhere have stepped up to lead practice changes needed. CNSs around the country are successfully modifying and strengthening their communications, taking on more leadership roles, and adapting existing systems and procedures for this new normal. Processes like the lessons learned and shared in this article have helped save lives, comforted patients, supported nurses and sparked a growing resurgence of the CNS role in organizations across the country.

Sean Reed is president of the National Association of Clinical Nurse Specialists.


Access to CMS Call Recordings, Transcripts and Podcasts

CMS has been hosting regular calls with a variety of clinicians, hospitals, other facilities, and states in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, we are happy to share that you can access recordings of the calls along with transcripts on the following link: www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. We will continue to host calls and share information through our list serves and media.


National Association of Clinical Nurse Specialists Honors Six Distinguished Advanced Practice Registered Nurses

National Awards Recognizes Clinical Nurse Specialists for Outstanding Achievement and Contributions Advancing the Profession

 

RESTON, VA – March 25, 2020 – The National Association of Clinical Nurse Specialists (NACNS) unveiled its 2020 award winners at its 25th Annual Conference last week. The six award winners were honored for their professional achievement and contributions to advancing the clinical nurse specialists (CNS) profession.  NACNS is the only national organization representing thousands of CNSs and dedicated to advancing the practice and education of CNSs.   Award winners were selected to receive the honors by their professional nursing peers.

 

“The unique expertise and consistent value these six clinical nurse specialists have contributed to health care significantly advance the CNS profession by differentiating the CNS skill-set from that of other advanced practice registered nurses,” said Sean M. Reed, PhD, APN, ACNS-BC, ACHPN, NACNS President. “Their contributions across a broad range of health care settings and specialties are leading to improved patient outcomes as well as greater support for CNS professional development programs.”

 

The NACNS’ Annual Award Program recognizes significant achievements and contributions from individual members and affiliates for raising the profile of the CNS, fostering research and improving practice, educational opportunities and service.

 

About The National Association of Clinical Nurse Specialists 2020 Award Winners

For a description of each award winner’s achievements and contributions click here.

 

Clinical Nurse Specialist (CNS) Of The Year Award honors a CNS for outstanding professional achievement demonstrating exemplary practice in patient care, nursing and health care delivery systems.

  • Award Winner: Kathy M. Williams, MSN, RN-BC, APRN, AHCNS-BC, Adult Health Clinical Nurse Specialist/Master Clinician, U.S. Air Force, Eglin Air Force Base, Florida

 

CNS Educator of the Year Award recognizes an NACNS member for outstanding professional achievement as a CNS educator and acknowledges his/her commitment to excellence and innovation.

  • Award Winner: Gayle M. Timmerman, , RN, CNS, FNP, FAAN, Associate Professor and Associate Dean for Academic Affairs, University of Texas at Austin, School of Nursing,

 

CNS Evidence-based Practice/Quality Improvement of the Year Award is bestowed annually on a NACNS member who has successfully implemented evidence-based practice and quality improvement changes that had a significant impact on nursing practice and patient and family outcomes.

  • Award Winner: Erica A. Fischer-Cartlidge, DNP, CNS, CBCN, AOCNS, Nurse Leader, Evidence-based Practice, Memorial Sloan Kettering Cancer Center, New York

 

Susan B. Davidson Service Award recognizes extraordinary service to NACNS.

  • Award Winner: Susan B. Fowler, PhD, RN, CNRN, FAHA, Nurse Scientist, Orlando Health, Orlando, Florida

 

Brenda Lyon Leadership Award distinguishes an individual who has demonstrated exemplary leadership in service to NACNS.

  • Award Winner: Susan Dresser, PhD, RN APRN-CNS, CCRN FCNS, Clinical Assistant Professor and Director, Adult-Gerontology CNS Program, University of Oklahoma Fran and Earl Ziegler College of Nursing, Oklahoma City, Oklahoma.

 

President’s Award recognizes an individual or entity for extraordinary service and contributions to NACNS and the accomplishment of its mission.

  • Award Winner: Anne E. Hysong, MSN, APRN, CCNS, ACNS-BC, FCNS, Critical Care Clinical Nurse Specialist, Northside Hospital, Duluth, Ga

 

About The National Association of Clinical Nurse Specialists

The National Association of Clinical Nurse Specialists (NACNS) is the only national association representing the clinical nurse specialist (CNS). CNSs are the most versatile advanced practice registered nurses and work in a variety of health care specialties to ensure delivery of high-quality, evidence-based, patient-centered care. As leaders in the acute, post-acute, and ambulatory health care settings, CNSs impact direct patient care, nurses and nursing practice, and organizations and systems to optimize care and drive outstanding clinical outcomes. NACNS is dedicated to advancing CNS practice and education and removing unnecessary and limiting regulatory barriers, while assuring public access to quality CNS services. For more information or to join NACNS click here


2020 Annual Conference Programming Canceled for March 13

Dear NACNS Annual Conference Attendees,

As you know the NACNS Board has been closely monitoring the situation with the COVID-19 virus. This evening, Indiana Governor Eric Holcomb banned non-essential gatherings of more than 250 people. Given this, we are cancelling our programming for tomorrow, March 13. We apologize for the inconvenience and appreciate your understanding during this ever-changing situation.

Despite challenging circumstances, our CNS family pulled together to make this event a success. . Volunteers filled-in for what would have been cancelled sessions, attendees exhibited patience and understanding through it all, and our resilient conference planning committee made sure everything ran like clockwork. The strength of character required to be a CNS was clearly evident this week.

Thank you everyone for being here. Safe travels home. Let’s meet in New Orleans next year to celebrate the resurgence of the CNS!

The NACNS Board of Directors


Improved Sleep in the Hospital

Improving sleep in the hospital leads to significant decrease in delirium:

A CNS-led project Abbott Northwestern Clinical Nurse Specialists, Liz Kozub and Autumn Gode, led an evidence based practice initiative to improve sleep and reduce the delirium in 2017. Delirium is sudden confusion that develops over a short period of time and it is known that up to 30% of patients in the hospital will have delirium. Some reasons a person may develop delirium include pain, lack of activity, certain medications, lack of sleep, and older age. The main purpose of this project was to prevent complications such as delirium and improve satisfaction of the hospital stay.

The sleep promotion initiative to reduce the frequency of delirium on two hospital units was created to allow for a period of uninterrupted sleep. The program consisted of reducing noise and interruptions during the overnight period. Patients are offered a sleep menu with a variety of options to increase their comfort at night. The project was carried out on a surgical spine and medical oncology unit. The results were astonishing, with significant decrease (40% reduction) in delirium. In addition, patients reported more satisfaction with their hospital stay.

Read more here.


Brenda Lyon Research Grant Awardees!

The Clinical Nurse Specialist Institute would like to congratulate two NACNS members in receipt of research grant funding from monies provided through a charitable donation by Brenda Lyon:

  • Mary Pat Johnston, MS, RN, AOCN, Clinical Nurse Specialist, Oncology, at the University of Wisconsin Cancer Center at ProHealth for her research study titled ‘Cancer Survivor Empowerment through Patient-Reported Outcomes’ and
  • Morgan Yordy, DNP, ACNS-BC, RN-BC at Auburn University School of Nursing for her research study titled ‘Improving Health Outcomes by Incorporating Animal Assisted Therapy in the K-12 School Setting.’

Read more about the Clinical Nurse Specialist Institute here.



ANA Announces 2020: Year of the Nurse

In honor of the 200th anniversary of Florence Nightingale, the American Nurses Association has announced that 2020 will be honored as the Year of the Nurse and Midwife. The ANA plans to celebrate 2020 by “engaging with nurses, thought leaders and consumers in a variety of ways that promote nursing excellence, infuse leadership and foster innovation.” This initiative includes expanding National Nurses Week from May 6-12 to the entire month of May.

NACNS supports this initiative to elevate nurses and applauds the ANA for this celebration.

Read more here:

ANA Website: Year of the Nurse 2020

Nursing World News

 


2021 Federal Budget Cuts Key Programs that will not meet the Nation’s Growing Demand for Nursing Workforce and Research

NACNS is a member of the Nursing Community Coalition(NCC).  Below is a quick summary of the issue.

Yesterday, President Trump released his FY 2021 budget, A Budget for America’s Future. This $4.8 trillion budgetary blueprint includes many cuts to key programs of interest to the NCC, including:

  • Elimination of all Title VIII Nursing Workforce Development Programs, except the Nurse Corps;
  • A reduction of $5.5 million to Nurse Corps funding for a total of $83.135 million;
  • Nearly $3 billion cut to the National Institutes of Health;
  • Reduction in National Institute of Nursing Research for a total of $156.804 million.

In response to these deep cuts, the Nursing Community Coalition released a statement that can be found here. For additional background on this budget framework, visit:


NACNS Member Input Needed for CMS!

Calling All NACNS Members!

Please take advantage of this opportunity to voice your concerns regarding challenges for CNS practice and advocating for full practice authority.

The Centers for Medicare & Medicaid Services (CMS) is seeking additional input and recommendations regarding elimination of specific Medicare regulations that require more stringent supervision than existing state scope of practice laws, or that limit health professionals from practicing at the top of their license.

Click here to read more on the CMS Initiative.

Click here to read more on the President’s Executive Order (EO) #13890

 

Please send your recommendations to PatientsOverPaperwork@cms.hhs.gov with the phrase “Scope of Practice” in the subject line by January 17, 2020.