I was a Clinical Nurse Specialist, responsible for the clinical practice and competence of every nurse on the unit.

My work over the past 10-20 years includes the following:

• When a nurse wasn’t meeting the standards of care, I was expected to evaluate the deficiencies, re-teach when necessary, and collaborate with the unit manager as to whether a nurse should be counseled or released from her/his position.
• It was up to me to identify acceptable, adequate, and stellar practice standards among the nurses.
• I was expected to onboard new nurses who were directly out of college. Sometimes that involved going to the patient’s bedside and actually performing the procedure or standing back while the novice performed something for the first time.
• I was expected to bring new practice to the nurses and instruct them in new areas of practice, including new research.

As a CNS, my favorite element is the variability of every day! Every day is different. Typically I would arrive early and pull the unit census report, review those patients who were not there yesterday. These could be new neurosurgical patients or new admissions with neurological conditions, e.g. stroke, meningitis, encephalitis, or new brain injuries. Depending on their seriousness, I would independently round on these patients and discuss the upcoming day with the nurse.

My job was to have an awareness of every patient on the unit, all 30+ patients in various stages of healing. It was up to me to be sure the nurse was confident and competent to meet the needs of the most complicated and to assist the nurse who was unsure. Because of the behavior component to patients with illness or injury to their brains, I would check in on those who had shown problems with anger or other behavior problems to make sure everyone was coping well, including the families.

On occasion, I would arrange family conferences for those who were expected to pass away within the coming week by involving our hospice team. I would also check in with the new graduate nurses to be sure they are capable to meet the needs of their patients, which sometimes meant working with complicated equipment like lumbar drains or external ventricular devices when making a mistake could be a serious consequence to the well-being of patients. In other words, I was responsible for the competent clinical practice of all the nurses on the unit.

Pros

There are many! I’m seen by the nurses as their clinical expert on the floor. They valued my presence and depended on my opinion. I was always made to feel important and needed by these nurses. I was very involved with ensuring quality efforts for our patients. If the patient and family had a good hospital experience, I knew it was in part due to the influence I had on each, individual nurse’s professionalism, skill, and communication approach. I carried a pager day and night, not because I was tasked to do this, I chose to do it. The night shift nurses needed my presence, too. They knew I was only a phone call away. The residents, some seasoned, some green, knew they could count on my expert advice – day and night. They often expressed their gratitude to me.

Cons

Well, there were very few. I love being a CNS. There were times I would have liked more support from my administrators. It was rare for me to have difficulties, but when I did, they were not always ready with a good solution. I also noticed when awards were handed out, often the Clinical Nurse Specialists were on the awards committee and selection committees, but rarely on the receiving end. I got my “awards” from the nurses who expressed their gratitude every day.

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