The Clinical Nurse Specialist (CNS) is the clinical leader for a program or area of nursing practice within Michigan Medicine. The advanced knowledge and skills required for this role include clinical expertise in a focus area, evidence-based practice, collaboration, consultation, education, mentoring, and change leadership. These are essential to advance the practice of nursing and the professional development of nurses. The specialized knowledge and skills are used within three major areas of focus: patient/family, nurses and nursing practice, and the organization/system. The CNS and the Clinical Nursing Director are partners in leading the nursing clinical practice area. The CNS coordinates and guides clinical activities/projects of nurses within a practice area. The CNS is accountable for collaborating with members of the health care team to design, implement, and measure safe, cost-effective, evidence-based care strategies. The CNS is responsible for maintaining current professional knowledge and competencies and contributing to the advancement of the practice of nursing at the unit/system, local, state and/or national and international level.

CHARACTERISTIC DUTIES AND RESPONSIBILITIES

• Direct Patient Care  
• Serves as a reliable source of information on the latest evidence supporting cost-effective, safe nursing practices.
• Collaborates with the multidisciplinary team using the nursing process to integrate the nursing perspective into a comprehensive plan of care for the patient/family.
• Identifies and prioritizes nursing care needs for a select population of patients/families. This includes synthesis of assessment data, advanced knowledge, experience to pose problems amenable to advanced interventions.
• Conducts comprehensive, holistic wellness and illness assessments using established or innovative evidence-based techniques, tools, and methods.
• Initiates and plans care conferences or programs for individual patients or populations of patients. Calls for interdisciplinary care conferences when barriers or LOS protraction are evident or predicted.
• Assists the team and individual nurses to establish working goals and targets, and measures to be assessed and documented as evidence of progress in plan of care. Establishes intervention families within standards of care that are best united for best effects.
• Designs and evaluates innovative educational programs for patients, families, and groups.
• Establishes methods to evaluate and document nursing interventions at the individual, unit, cluster and professional practice model level.
• Evaluates the impact of nursing interventions on fiscal and human resources including establishing average and variance economics of plans of care for major populations and targeted conditions.

Nursing/Nursing Practice

• Collaborates with others to resolve issues related to patient care, communication, policies, and resources.
• Creates and revises nursing policies, protocols and procedures using evidence-based information to achieve outcomes for indicators that are nurse-sensitive.
• Identifies facilitators and addresses barriers that affect patient outcomes.
• Leads clinical practice and quality improvement initiatives for a unit or a program.
• Collaborates with nurses to develop practice environments that support shared decision-making.
• Assists the staff in developing critical thinking and clinical judgment through formal rounds, informal and daily habits in bedside consultation, activity and procedural progression likely in plan of day and plan of stay.
• Creates a nursing care environment that stimulates continuous self-learning, reflective practice, feeling of ownership and demonstration of responsibility and accountability.
• Collaborates with Educational Nurse Specialists, Educational Nurse Coordinators and others on content and operational design of orientation, clinical competency, and other clinical educational program development.
• Mentors nurses to acquire new skills, develop their careers and effectively incorporate evidence into practice. Assists with the specific development of portfolios that demonstrate navigational way to achieve mastery in daily care activities, reading and literature reviews.
• Models advanced communication and therapeutic interventions in interviews, evaluation, patient- family assessments and high performance team conversation within urgent and planned care conferences.
• Provides input for staff evaluation.
• Provides formal and informal education for nurses and other health professionals and health professional students.
• Leads in the conduct and utilization of nursing research as well as evaluation of daily work process mapping required to insert the evidence and remove activities of less value.
• Analyzes data from quality reports, incidents, consultations and care conferences to present trends and patterns indicative of substantial quality improvement initiatives and requirements for education and mentorship.

Organization/System Leadership

• Consults with other units and health care professionals to improve care.
• Leads/assists institutional groups to enhance the clinical practice of nurses and improve patient outcomes.
• Develops, pilots, evaluates, and incorporates innovative models of practice across the continuum of care.
• Designs and evaluates programs and initiatives that are congruent with the organization's strategic plans, regulatory agency requirements, and nursing standards. Includes data from readmissions, claims, incidents, and daily habit to frame doable improvements.
• Identifies, collects, and analyzes data that serve as a basis for program design and outcome measurement.
• Participates in need identification, selection and evaluation of products and equipment.
• Advances nursing practice through participation in professional organizations, publications, and presentations.
• Models high performance team development in daily habits of rounds, grand rounds, huddle reports, and care conferences. Participates in the development of prioritization schema for production targets in planned and unplanned admissions based on system priorities and population needs.

SUPERVISION RECEIVED

Direction is received from an Associate Chief Nursing Officer (ACNO) or designated official.

SUPERVISION EXERCISED

Functional supervision is exercised over Clinical Nurses, LPN's, Allied Health, Service/Maintenance and other support staff.

• Completion of an accredited graduate-level Clinical Nurse Specialist Program. 
• Master’s degree in nursing with a clinical focus is required.
• Adult-Gerontology CNS certification recognized by NCSBN or Master’s degree in nursing with an adult clinical focus is required
• Current RN licensure to practice nursing and current CNS specialty licensure in the State of Michigan is required.
• Recent experience in assessing, treating and evaluating patients typically cared for in a cardiovascular intensive care unit, in a tertiary healthcare environment, including the use of devices (as applicable) and pharmaceutical treatment modalities is required.

• Previous experience and demonstrated ability to interact with all levels of internal and external personnel in an academic, tertiary care healthcare environment is desired.
• Ability to function independently and as a team member is desired.
• Demonstrated ability to consistently, and positively, contribute to a group/unit work setting is desired.
• Demonstrated ability to consistently work collaboratively with the manager and leadership team is desired.
• Excellent written and verbal skills as evidenced by positive feedback through references and/or evaluations are desired.
• High level of self-motivation to stay current in a rapidly changing environment is desired.
• Three (3) or more years designing, and collaborating with, the implementation of competency and education activities for nursing staff including competency programs, orientation, staff and professional development is desired.
• Strong teaching skills as evidenced by the ability to demonstrate a teachable moment, as well as, develop class content, and staff and patient education materials is desired.
• Demonstrated ability to innovatively lead complex change projects, particularly those focused on raising patient care to the highest standards, in an academic, tertiary care environment is desired.
• Demonstrated analytical skills necessary to gather and collate data to present recommendations for solutions to identified problems is desired.
• Demonstrated ability to apply evidence-based clinical knowledge into the patient care setting via protocols, standards, and outcomes measurement is desired.
• Demonstrated knowledge of, and experience with, the Continuous Quality Improvement process, including recent experience implementing keystone quality improvement initiatives is desired.
• Previous experience as principle or co-investigator on a research project(s) is desired. 
• Experience in implementation of service initiatives at the unit level is desired.
• Demonstrated professional writing experience and being published in professional periodicals is desired.
• Eligible for appointment with the School of Nursing is desired.
• Competence with basic computer functions is desired.