Dr. Mary A. Hillanbrand, RN, DNP, CNOROctober 9, 2013

The Role of the Perioperative

Clinical Nurse Specialist

Dr. Mary A. Hillanbrand, is a perioperative Clinical Nurse Specialist on active duty in

the US Air Force currently assigned as an assistant professor and Deputy Program

Director in the Clinical Nurse Specialist program at the Uniformed Services University

in Bethesda, Maryland. Dr. Hillanbrand earned her Doctorate of Nursing Practice from

the University of Alabama, in Tuscaloosa, Alabama. Her capstone project “Identifying

Gaps in Perioperative Registered Nurses Knowledge of the Cleaning and

Decontamination Process for Surgical Instruments” provided the groundwork for the

development of educational interventions aimed at increasing knowledge of

recommended practices to improve practice and patient outcomes.

Dr. Hillanbrand has worked in the perioperative environment for over 30 years, which

includes more than 12 years as a certified surgical technician. Her field of interest is

the development of educational interventions to increase compliance with

recommended practice guidelines with a focus on improved patient outcomes.

Additionally, Dr. Hillanbrand is involved with promoting certification for all perioperative

team members including advanced practice nurses in the perioperative environment.

Dr. Mary A. Hillanbrand

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Dr. Mary A. Hillanbrand, RN, DNP, CNOR

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evaluation form.

• Discuss the history of the Clinical Nurse

Specialist

• Identify the four APRN roles within the

Regulatory Model

• Discuss the 5 domains of CNS practice

within the 3 spheres of influence

Objective

• Early 20th century “Nurse Specialist” was brought forward

• 1943 - Frances Reiter promoted the idea of a “nurse clinician”– A nurse with advanced knowledge, clinical

competence and commitment to providing high quality nursing care

– Recognized need for graduate education• Clinical Nurse Specialist (CNS)

– 1944 - NLNE’s Committee to Study Post-graduate Clinical Nursing Courses inception of the specialty

– 1949 - University of Minnesota National Conference of Director’s of Graduate Programs credited with genesis of the clinical-nurse specialty

History of CNS

(Towers, J, 2011)

APRN

POPULATION FOCI

APRN ROLES

APRN SPECIALTIES

Nurse

Anesthetist

Nurse

PractitionerClinical Nurse

Specialist

Nurse

Midwife

Family/

Individual

across lifespan

Adult/Gerontology Neonatal PediatricsWomen's

Health/ Gender-

related

Psychiatric

Mental Health

Lic

en

su

re o

ccu

rs a

t le

vels

of

Ro

le a

nd

Po

pu

lati

on

fo

ci

Focus of practice beyond role and population focus linked to health care needsExamples include but not limited to: acute care (perioperative, trauma, intensive care), oncology, older

adults, orthopedics, nephrology, palliative care

(APRN Consensus Work Group, 2008, p 9.)

Consensus Model for APRN Regulation

APRN Similarities

• Certification

• Prescriptive Authority **(NCSBN, 2013)

– 36 States authorize CNS Prescriptive Authority

• 13 States: Independent Authority

• 23 States: Not Independent Authority

• 15 States: No Prescriptive Authority

• Independent Practice** (NCSBN, 2013)

– 22 States: CNS Independent Practice

– 23 States: NP Independent Practice

**Defined by State Boards of Nursing Scope of Practice Acts

(National Council of State Boards of Nursing [NCSBN], 2013)

AORN Position Statement

“The APRN functioning in the perioperative setting

is a registered professional nurse who:– is competent in the use of specialized perioperative nursing

knowledge and skills in the care of patients and families

undergoing operative and other invasive procedures…;

– functions autonomously and collaboratively with the surgeon in

the preoperative and postoperative management of surgical

patients and their complex responses to the surgical process…;

– integrates clinical practice, education, research, management,

leadership, and consultation into a single but multifaceted role...;

– continually functions in a collegial relationship with nurses,

physicians, health care organizations, and systems to influence

care of the surgical patient.”(AORN, 2013, pp. 299-300)

• Unique role to integrate care across the continuum throughout the three spheres of influence– Patient

– Nurse

– System

• Improve patient outcomes and nursing care

• Create environments to empower nurses– Evidence-based practice

– Facilitate ethical decision making

• Responsible for diagnosis, treatment, and management of health and illness

• Health promotion

• Prevention of illness and risk behaviors

Clinical Nurse Specialist - CNS

(APRN Joint Dialogue Group, 2008)

Domain 1: Clinical Expert

• Complex surgical patients

• Surgical consults

– Differential diagnosis

– Metabolic needs

– Pain management

– Pharmacology

• Pre-op history and physical

– Treatment plans

Domain 2: Consultant

• Interdisciplinary and multidisciplinary

• Committee membership

– Expert resource for perioperative continuum

• Infection control

• Risk mitigation

• Root cause analysis

Domain 3: Education

• Nurses and staff– In-services

– Continuing education offerings

– Competency validation

• Patient/Family– Surgical expectations

– Pain management

– Post-operative management/wound care

• Community– Health promotion

Domain 4: Clinical Inquiry

• Evaluate current practice

• Patient safety initiatives

• Evidence-based practice

• Recommended practice guidelines

• Literature reviews

• Synthesize and disseminate research

finding

Domain 5: Manager/Leader

• Policy and procedure

• Organization

– Fiscal accountability

– Process improvement

– Risk management

– Patient safety

• Informatics

– Utilization

– Staffing

Professional Accountability

• Professional development

– Perioperative team members

– Continuing education

– Professional organizations

• Mentorship

• Certification

• Health policy and legislation

Final thoughts

• The perioperative CNS is an APRN who

provides care within the patient, nurse,

and organization spheres of influence

• The domains that define the CNS role are:

– Clinical expert

– Consultant

– Education

– Clinical inquiry

– Manager/leader

References

APRN Consensus Work Group & National Council of State Boards of Nursing APRN

Advisory Committee. (2008). Consensus model for APRN regulation: Licensure,

accreditation, certification & education. Retrieved from

https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Association of periOperative Registered Nurses. (2013). AORN Position Statement:

Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN

Journal, 97(3), 299-301.

National Council of State Boards of Nursing. (2013). APRNs in the U.S. Retrieved from

https://www.ncsbn.org/2567.htm

Towers, J. (2011). The evolution of advanced practice in nursing. In J. Stanley (Ed.)

Advanced practice nursing: Emphasizing common roles (pp.3-31). Philadelphia: F.A.

Davis Company.

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Take Your Career to the Next LevelGo for your CNS-CP Credential. Get there with AORN!

The Perioperative CNS Certification Exam Prep Course Includes:

• Two-day educational coaching event

• Three additional facilitated, interactive webinars and assignments

This course will provide advanced knowledge, review the core

competencies, and review the domains of nursing practice for the RN,

CNS in the specialty of perioperative practice.

Denver, CO | AORN HeadquartersJanuary 17-18

$450 includes all events

www.aorn/CNS-CPCourse