Registed Nurses' Association of Ontario

Advancing the Clinical Nurse Specialist Role at Thunder Bay Regional Health Sciences Centre

Chad Johnson
Thunder Bay Regional Health Sciences Centre

Thunder Bay Regional Health Sciences Centre (TBRHSC) is a 395-bed, academic health sciences centre in Northwestern Ontario. In 2013, TBRHSC underwent organizational restructuring into a program management model. As a result of the restructuring, clinical educator positions were decentralized from the Staff Education Department and positions were changed to clinical nurse specialist (CNS) positions for various clinical areas. With the change in title, CNS positions at TBRHSC were and are continuing to be shaped by expectations of stakeholders, healthcare providers, and nurses working in the role resulting in wide variations in how CNS roles are interpreted and used. Lack of role clarity and inconsistent expectations contribute to challenges such as role conflict, role overload, and variable stakeholder acceptance of the CNS role at TBRHSC. The overall goal of this fellowship was to gain the skills and knowledge to develop and implement the Canadian Nurses Association (CNA) Pan-Canadian Competencies for the CNS at TBRHSC.

I accomplished this goal by participating in the following learning activities:

  • Gain a comprehensive understanding of the CNS role as defined by the CNA. I read and reviewed numerous documents (e.g., position statements, webinars, etc.) on the CNS role in Canada. This information provided the background and future direction of the CNS role in Canada. A literature review was completed to gain insight on the CNS role implementation in Canada. Attending the Canadian Association of Advanced Practice Nurses (CAAPN) conference in Winnipeg, Manitoba provided an opportunity to network with novice to expert CNSs throughout Canada. In addition, the conference highlighted the need for continued development of the CNS role across Canada and the need for role clarity.
  • Gain knowledge and skill to develop and implement the CNA Pan-Canadian Competencies for the CNS. The fellowship allowed opportunity to site visit and job shadow with a mentor in Toronto, Ontario. This learning provided an opportunity to assess how the CNS role functioned in a well established model, utilizing specialized skills, influencing and improving the quality of patient care and improving health outcomes. I was able to take what I learned from the site visits and educate and discuss with TBRHSC’s director of nursing, director of academics, CNSs, and interprofessional educators on the role of the CNS. In addition, this information was used to compare the CNS role at TBRHSC, the mentor’s organization, and the CNA’s core competencies. This served as a foundation to evaluate the current role at TBRHSC and how to move forward in implementing the CNA’s core competencies. An orientation package was developed that will be used for all new CNS’s; the orientation package provides education on the CNS role, the CNA’s core competencies, and provides tools to assist the novice CNS with role development. A meeting with CNSs and director of nursing practice took place to provide education on the CNA’s core competencies and allowed for discussion on the further advancement the CNS role at TBRHSC. A productivity tool was introduced and adopted by the group as a strategy to group work into themes within each core competency. In addition, work that does not “fit” into a core competency will be tracked to determine reallocation to the appropriate individual.
  • Develop a performance appraisal tool that demonstrates and evaluates the core competencies. A performance appraisal tool was developed based on the revised job description created during the fellowship. The performance evaluation tool will be completed by the director of nursing and the program/service director. Performance is evaluated based on the core competencies. The performance evaluation tool was presented to the clinical managers and directors and the manager of Human Resources and will go-live on April 1, 2016.