Implementing a Clinical Nurse Specialist on Night Shift

Purpose:

First, the role of the CNS on night shift is intended to offer the staff working at night similar access to educational opportunities to those working during the day. This provides consistent, evidence-based, holistic, patient-centered care by having similar resources available during all shifts.

Significance:

The night shift staff is predominantly comprised of newer nurses. This fact causes increased stress and potential for errors. The CNS helps to support the staff thereby decreasing errors and improving patient outcomes. The staff has embraced this new role not only clinically, but educationally.

Strategy and Implementation:

The night shift CNS rounds throughout the entire hospital, visiting each unit and crossing all service lines. This establishes a rapport with staff and ecourages questions. The CNS is able to help in all areas of the health system. By being visual on the nursing units the CNS can provide real-time answers and consultations. One-on-one education is paramount for the newer staff because they can ask questions in a non-threatening environment. The CNS is also able to identify and support new nurses who have just completed their orientation and are now providing care independently. These new staff members are encouraged to utilize the CNS in order to help them transition from the novice to expert role. Another use for the CNS is responding to rapid response team calls. The floor nurse and patient receive immediate assistance and the ICU nurses do not have to leave their patients to answer the call. The CNS is able to stay on the floor with the rapid response team as long as necessary.

Evaluation:

Prior to the inception of the night shift CNS, 90% of staff felt minimally supported. Currently 86% of the same staff reports being more informed and supported. There are over 280 educational sessions and 340 assistance calls annually. The CNS has more than 200 patients resuscitated at night.

Implications for Practice:

By utilizing a CNS in order to initiate early interventions, there has been a reduction in sentinel events at night. Also, providing staff education during their regular work hours fosters a sense of caring and convenience. A night shift CNS is an innovative way to aid practice and education needs.