CNS Education and Practice: Essential for Embedding Evidence in Nursing Practice

Lisa Hopp, PhD, RN, School of Nursing, Purdue University Calumet, Hammond, IN, USA and Susan K. B. Jones, MS, RN, CNS, APN, Nursing Research and Evidence-Based Practice, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA.

    Implementation of evidence is one of the most difficult aspects of the evidence-based practice (EBP) cycle. Systematic reviews suggest that multifaceted interventions are the most powerful methods to get evidence into practice. These interventions are typical of clinical nurse specialist (CNS) practice including interactive teaching methods, clinical prompts, educational outreach, and audit and feedback. We will argue that CNSs are ideally suited to get evidence into practice through their influence of patients, families, nurses, and systems. We will discuss two case studies, one related to CNS education and one related to CNS practice.
    In the first case study, we will detail the curricular elements of a CNS program designed to build graduates’ evidence-based practice (EBP) knowledge and skills. Specifically, we will describe a year-long clinical implementation project where students craft a question based on the diagnosis of a practice problem, search and critically analyze relevant evidence, design, implement and evaluate the intervention. We will detail exemplary projects and the graduates' reflections on these projects 6 months post graduation.
    In the second case, we will discuss a CNS-led program of evidence implementation and how the ethos of the organization has begun to evolve from tacit acceptance of traditional practice towards a reflective, questioning culture of evidence. The program aims to link current policy and practice to evidence and to produce economic benefit to the organization. The CNS facilitates a group of direct care nurses by helping them to refine clinical questions, assess the available literature, design interventions, and evaluate outcomes of the practice changes. In addition, she helps the group develop research questions when the evidence is missing. Because of her collaborative role, she enables a multidisciplinary approach to practice. As the evidence-based practice movement gains momentum, the CNS is well prepared and critical to embed evidence into nursing practice.

Learning Objective #1: discuss curricular and teaching strategies to prepare clinical nurse specialists (CNSs) for EBP.
Learning Objective #2: describe how CNSs can advance nursing practice and generate economic benefit through implementation of the EBP process.