Clinical Nurse Specialists on the Night Shift. 2020

Erica Fischer-Cartlidge, and Elizabeth Arenas, and Linda Ogbuagu, and Carla Remondini, and Jane Murphy
Author Affiliations: Nurse Leader of Evidence-Based Practice (Dr Fischer-Cartlidge) and Clinical Nurse Specialists (Mss Arenas, Ogbuagu, Remondini, and Murphy), Division of Evidence-Based Practice, Memorial Sloan Kettering Cancer Center, New York.

BACKGROUND Night-shift nurses care for complex and acutely ill patients but are frequently more junior compared with day shift. They often have less access to support resources such as educators and clinical nurse specialists (CNSs). This article describes the addition of night CNS positions, their roles, and associated outcomes. METHODS The night CNSs were implemented to perform a highly flexible set of activities including proactive rounding on high-risk patients and medications; code/rapid response support; education; nursing practice/policy reinforcement; providing psychosocial support to nurses, patients, and families; and responding to consults. To capture work effort at night and truly define the role of the night CNS, a shared consultation log was created. RESULTS Between October 2017 to April 2019, 6053 CNS encounters were captured in 24 different categories. The top 5 reasons for consultation included policy/procedure education or change, education/in-service, nursing practice review/reinforcement, medication/blood administration, and clinical assist. Five hundred sixty-nine rapid response/codes have been responded to. There was also a 17% increase in event reporting on the night shift. Outcomes have continued to support additional budgeted positions for the nights and weekends. CONCLUSIONS Night CNS expertise and knowledge are vital to offsetting novice nurse deficits in advanced assessment, which is paramount to patient outcomes. They provide support with on-the-spot education and empower individual development. Organizations should strongly consider implementation of this role or, if that is not possible, consider flexible scheduling into evening hours to support night staff.

UI MeSH Term Description Entries
D009720 Nurse Clinicians Registered nurses who hold Master's degrees in nursing with an emphasis in clinical nursing and who function independently in coordinating plans for patient care. Clinical Nurse Specialists,Clinical Nurse Specialist,Nurse Specialist, Clinical,Nurse Specialists, Clinical,Specialist, Clinical Nurse,Specialists, Clinical Nurse,Clinician, Nurse,Clinicians, Nurse,Nurse Clinician
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000073577 Shift Work Schedule Job schedule in which working hours deviate from the standard hours (e.g., evening shift, night shift or rotating shift). Night Shift Work,Rotating Shift Work,Schedule, Shift Work,Schedules, Shift Work,Shift Work, Night,Shift Work, Rotating,Work Schedule, Shift
D015403 Nursing Evaluation Research Research carried out by nurses that uses interviews, data collection, observation, surveys, etc., to evaluate nursing, health, clinical, and nursing education programs and curricula, and which also demonstrates the value of such evaluation. Evaluation Research, Nursing,Nursing Program Evaluation,Program Evaluation, Nursing,Research, Nursing Evaluation,Evaluation Studies, Nursing,Evaluation, Nursing Program,Evaluation Researchs, Nursing,Evaluation Study, Nursing,Evaluations, Nursing Program,Nursing Evaluation Researchs,Nursing Evaluation Studies,Nursing Evaluation Study,Nursing Program Evaluations,Program Evaluations, Nursing,Researchs, Nursing Evaluation,Studies, Nursing Evaluation,Study, Nursing Evaluation
D024802 Nurse's Role The expected function of a member of the nursing profession. Nurse's Scope of Practice,Nurses Role,Nurses' Role,Nurse Role,Nurse Scope, Practice,Nurse's Roles,Nurses Roles,Nurses Scope, Practice,Nurses' Roles,Practice Nurse's Scope,Practice Nurse's Scopes,Role, Nurse's,Role, Nurses,Role, Nurses',Roles, Nurse's,Roles, Nurses,Roles, Nurses'

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