Clinical nurse specialists (CNSS) is in a good position to participate in the transformation of health care as defined by the Institute of medicine, called by the patient protection and affordable care Act of 2010. CNSS practice their expertise through population-based care in three constituencies (patient/family and nurses/other professionals, systems). However, challenges during the educational process as well as the implementation in practice that the barriers for optimization of the role, denying and take full advantage of the potential CNSS. This article highlights some of the issues and provides solutions to mitigate these difficulties.
Citation: foster, J., Flanders, S.(31 May 2014) "challenges in central nervous system of practice and education" OJIN: online journal of issues in nursing folder. 19, issue 2, manuscript 1.
DOI: 10.3912/OJIN. Vol19No02Man01
Keywords: Clinical nurse specialists and nurse practitioner clinical specialist, Clinical nurse specialist education and Clinical nurse specialists and nurse specialist challenges of clinical care Healthcare
CNSS employ seven core competencies in practice: the direct care and consultation and leadership systems, collaboration, training, research, and ethical decisions. Clinical nurse specialists (CNSS) are advanced practice nurses bring specialized knowledge to set up practice. They work in three areas of influence, CNSS facilitate quality results for individual patients and patient populations, and support and guidance to nurses, driving innovative changes that strengthen the health care system to meet the needs of Patients and families, and communities. CNSS employ seven core competencies in practice: the direct care and consultation and leadership systems, collaboration, training, research, and ethical decision making (NACNS, 2010). The same role complexity creates challenges in the educational preparation of the CNSS. Find a room in the curriculum to address all seven competencies, demand into three spheres of influence, and treat complex diseases and other health problems can be a problem. Moreover, the lack of standardization in educational preparation, organization, and even advanced recognition practice throughout Dole challenged educators central nervous system development and sustainability education device Central nervous system. Additional inquiries include enough faculty and clinical counsellors and clinical practice settings, and material resources, funding sources for students. There are a number of recent initiatives lend the possibility to find solutions to some of these issues; however, they can also create a new set of problems. This article will address a consensus model for APRN regulation, the IOM report, guidelines for educational CNS.
Concurrency model for APRN regulation
Advanced nursing practice defines lace model (APRN) and identifies four roles: Clinical nurse specialist (CNS), certified nurse (CNP), certified registered nurse anesthesia (Crna), certified nurse midwife (CNM). Consensus model for APRN regulation: licensure, accreditation, certification and education (lace model), is a product of the APRN consensus work group and the National Council of State boards of nursing (2008), finalized and released In 2008, with the goal of full implementation by 2015. Advanced nursing practice defines model lace (APRN) and identifies four roles: Clinical nurse specialist (CNS), certified nurse (CNP), certified registered nurse anesthesia (Crna), certified midwife (CNM For women). And educated in both roles in at least one patient population focus: family/individual through the ages, adult gerontological, neonatal, Pediatrics, women's health/related type Gender, mental mental health across the lifespan (APRN consensus work group/National Council of State boards of nursing APRN Advisory Committee, 2008).
Advanced education is based on pre setup license for RNS and occurs at the level of the role of population, then prepare the individual for initial certification. Educational program requirements lace form and adopt the program accordingly. APRNs may specialize; however, the license cannot be exclusively within the focus of specialization. And educated in the central nervous system and a certificate to practice across a range of wellness, acute care. Will education theme and recognition, and management will be on specialized professional organizations (APRN consensus work group/National Council of State boards of nursing APRN Advisory Committee, 2008).
Another tenet of lace stereoscopic adult population called Gerontology. This includes young adult from the old, and the frail elderly. These three changes (concentration of population, focus after ratification, and wellness care acute) is the most exciting of the CNSS, who, it is clear from the title, always exercised with the selected specialization in focus Sometimes, what is now a population. For example, the central nervous system and critical care for adults include little practice in "wellness" and may not be setup in hospice care. Both had central nervous system education programs and certification exams to undergo profound revision as a result to add content and specialty content solution. American Association of critical care nurses, for example, has changed the name of the CCNS exam adults for ACCNS-AG and add items that cover acute care and wellness articles dealing with elder care (American Association of critical care nurses, 2013). For institutions that only specialized programs offered to the central nervous system such as palliative care or gerontology, these changes can go further to end the program.
Despite the difficulties faced by the lace model can generate, one of the main benefits is that it provides for unification of educational requirements and certificates recognizing APRN in all States. All APRN roles, and this is of particular value to the CNSS because in many States, higher education is not a prerequisite and CNSS have no recognition of advanced practice. That form lace this step helps along the process changes in these countries, which will be good for education and practice the central nervous system.
The IOM report
... CNSS can "easily" transition from master's level of preparation in the National Planning Department program, as approved by the International Organization for migration report. Another influential document "report of the International Organization for migration". The Institute of medicine in partnership with the Robert Wood Johnson Foundation first released in 2010 summary report entitled the future of Nursing: leading change, health promotion, followed by full publication in 2011 describing barriers Without practice of the nursing profession that hinder the ability to meet the objectives of the 2010 patient protection and affordable care Act and changes in nursing should happen to the country's health care needs (IOM, 2011). Four key messages emerged with eight corresponding recommendations. He was one of the messages related to education central nervous nurses must achieve higher levels of education and training through improved educational system promotes a smooth academic progress (Organization IOM, 2011). This goes along with the standardization of educational programmes as stipulated by the APRN consensus model, which requires at this time at least a Masters degree. However, the American Association of colleges of nursing (AACN) document in 2004, doctoral proposal of nursing practice (DNP), the entry level Setup for CNSS and other effective 2015 APRNs (AACN, 2004). Consensus model for APRN curriculum requires a course in advanced pathophysiology, assessment of advanced material, advanced Therapeutics ("the three PS") and most of the National Planning Department programs are even Now post master, CNSS can "easily" move of masters level setting in national planning department program, as approved by the International Organization for migration report.
For nurses to achieve higher levels of education, whether master or the National Planning Department, required more nursing college. With a looming shortage of faculty is likely to worsen as seasoned faculty members retire, a sufficient number of faculty members is a problem for everyone, not just the nursing education programs The central nervous system. In 2012, AACN survey results reported on vacant faculty positions. Nursing schools 662 respond (78.9%), there was 1, 181 vacancies, most of which are required or prefer a doctoral degree (7.6% vacancy rate). For two companies set 1) limited range of PhD nurses ready (32.9%) and 2) weak competitive salaries (27.6%) (AACN, 2012). Recommendation 5 of the IOM report calls for doubling the number of nurses with PhD 2020 (IOM, 2011, p. 281). The report goes on to say that private funding agencies and federal funds should be used to expand programs and provide accelerated curricula to reach that goal. Because the wages in the service sector (hospitals) are higher than those paid in academia, offering competitive interest packages to recruit and retain faculty members will help to build a cadre of members Qualified faculty. This allows to teach nurses to become CNSS as well as attract CNSS faculty posts.
Example of the APRN Fellowship is NET Smart neurological vascular education and training in the management of acute stroke and reperfusion treatment programme. Recommendation 3 of the report of the International Organization for migration promotes residency programs for nurses nurse after completing advanced degree programs prelicensure when moving to a new area of clinical practice (organisation IOM 2011, p 280). Some take issue with stay long to prepare advanced practice RNS, considering the long Fellowship is more convenient, which somewhat parallels the process of medical education: completion of College of Medicine (College of Nursing)-(graduate with at least 500 post BAC clinical hours)-Fellowship. Putting semantics aside, the academic programs are designed to prepare the CNSS to perform advanced practice level beginners. Opportunity to advance through the residency program/Fellowship also meet development expert doctor with one of the core competencies to practice central nervous system which is direct care (force CNS national task efficiency, 2010). The main purpose of the International Organization for migration of this recommendation is to improve nurse retention rates and improve patient outcomes. Survival rates to baccalaureate nurses ready/newly licensed, however, improved patient outcomes under the leadership of the central nervous system is consistent with the practice of the central nervous system. An example is the smart NET APRN Fellowship, education and training in the field of neural vascular management of acute stroke and reperfusion treatment programme, a graduate fellowship APRN aims to teach recognition and management of stroke Acute stroke (Alexandrov, et al, 2009). A comprehensive program consists of 14 units using an online platform with 24/7 availability covering epidemiology, pathophysiology, neuro-imaging, and management including pumped and accompanying treatment, complications, Emergency systems and centres of stroke stroke unit. In addition to the content of didatic, asking colleagues to contract with a local doctor, preferably a neurologist for clinical training and education. Competency validation occurs at the conclusion of each unit before progressing to another. After completion of 14 units, colleagues meet 80 hours of supervised clinical time site with faculty program and stroke team (Alexandrov, et al, 2009). In addition to compliance with the recommendations of the International Organization for migration, this program meets the APRN consensus model by providing postgraduate education specialization. In addition to increase knowledge of stroke that participants, patient outcome included early in the program smart NET increase of 7% in the management of thrombosis and stroke Entity certificate (Alexandrov, et al, 2009), achieving a key principle of the IOM recommendation 3 which creates opportunities to improve patient outcomes.
Another recommendation of the report of the International Organization for migration is "expanding opportunities for nurses to diffuse cooperative improvement efforts and leadership" (IOM, 2011, PG 279). Drive systems are the core competencies of the CNSS and as such is an integral part of education central nervous system. Thompson and Nelson Martin (2011) describe the process of teaching leadership program in the central nervous system at the University of Colorado through the development and implementation of the change project which includes another core competency (using) Research. Through a series of three sessions, students identify a problem/issue, and research and evaluation of literature, theoretical approach, designing educational materials, measuring tools, test tools, and the like. At the end of the program the central nervous system, and the students made a presentation poster highlights the results achieved under the leadership of the project (Thomson Nelson Martin 2011). Not all central nervous system software required to implement the project, but may be degree requirements merely proposing the idea. Just a suggestion draft can be a disservice to the student central nervous system after graduation because during clinical, talented students can spend more time "after" of "leading". So full circle project, on the other hand, provides opportunities for students of the central nervous system to see the effect of their projects while preparing them to be competent in the leadership regimes.
Guidelines for the Clinical nurse specialist education
With the growth of online master's programs, and student workers can achieve the central nervous system has become very competitive as "local" and "remote" students seeking a limited number of individuals. In 2004, and release guidelines for the Clinical nurse specialist education (NACNS, 2004A). And incorporated relevant recommendations to the organization/administration, curriculum, clinical resources, and evaluation of programmes in the publication. Seven items compose the Organization/doc management accreditation addresses program definition, qualifications of faculty members. Curricular requirements outlined in the guidelines are the most restrictive, insert commissioned by central nervous system-specific educational content and a minimum of 500 hours of clinical. Clinical resources directories recommends education central nervous system include 1:6 or 8 Faculty: student ratio 1: proportion of students and qualified Preceptor, clinical trials that ensure students Achieving competencies as outlined in the statement of NACNS on practice: 1 or 2 Preceptor (NACNS, 2004b). This aspect of the guidelines could afford a bigger challenge. May be few CNSS practice available to students and/or exercising in institutions that limited medical services, with little opportunity for students of the central nervous system to meet a multitude of specialized services or even Challenging patients. Given the diversity of understanding and leveraging role in tuning practice, CNSS who may work as teachers hospital versus solid clinical experience application systems leaders and improve results with the application of research findings. This confusion is compounded by another role. The assets that promote education and develop the core competencies of the central nervous system and include classroom and simulation, information technology support, and resource library. Spread of the nurses also may be unintelligible and need hospital administrators role to do the "work of the central nervous system." With the growth of online master's programs, and student workers can achieve the central nervous system has become very competitive as "local" and "remote" students seeking a limited number of individuals.
Other assets that promote education and develop the core competencies of the central nervous system and include classroom and simulation, information technology support, library resources, to name a few. The contrast between the universities in these resources can hinder students central nervous system "and incorporate core competencies.
Set up a strong workforce of CNSS holds many challenges. Diverse role and competencies of faculty shortages, changing educational requirements, and scarce resources are some of the issues. It was a well thought out solutions to address some of these challenges, but the continuing work by the central nervous system, educators, policy makers, legislators and regulators are necessary to provide preparation for CNSS The growing health needs of Americans
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