By Brenlee Coates
A growing number of nurses in Manitoba are taking their education further and getting master’s or doctoral degrees in nursing.
With these credentials, nurses can take on “advanced practice” roles, which often involve educational and leadership roles within the nursing community.
A 2012 summary stated that, in Canada, “The number of NPs (nurse practitioners) employed in nursing almost doubled between 2008 and 2012, from 1,626 to 3,157” (Regulated Nurses, 2012 – Summary Report).
These roles are visibly becoming more important to the healthcare system, and the support is welcomed by patients as well as fellow nurses who use the advanced practitioners as resources.
The growth of NP positions is in part due to legislation in the provinces and territories that emphasizes these advanced practice roles.
Clinical nurse specialist (CNS) is the other distinguished advanced practice nursing role in Canada. These specialists generally provide their expertise in consultation with nurses as well as help institute change in guidelines and protocols.
NPs spend more time on direct care, and are equipped to diagnose or order and interpret diagnostic tests, as well as prescribe medications or perform some procedures.
Kathleen Klaasen, clinical nurse specialist in home care, says the biggest distinction between clinical nurse specialists and nurse practitioners is the time they spend on direct care or behind the scenes.
She says as a CNS, she spends about “twenty to thirty per cent” of her time on direct client consultation, and “seventy to eighty per cent” on research, education, and policy development. For NPs, the opposite is true.
While Klaasen says she believes all clinical nurse specialists would agree that the best part of their jobs is the client involvement, the role requires someone passionate about pursuing leads and capable of instigating changes behind the scenes.
“They tend to be that high-energy person. That kind of inquisitive, ‘how do I make this better?’ person,” says Klaasen.
“It’s solution-focused – a lot of quality improvement. It’s identifying the issue and it’s trying to fix the issue… ‘How are we going to mesh reality and theory?’”
Because of the additional education requirements of the role, the advanced practice nurses tend to be really comfortable with conducting research, and writing and publishing their findings.
However, just as important is their clinical background.
“You have to have that clinical credibility,” says Klaasen.
Generally, she says, CNSs will bring about three to five years of expertise in a certain area of nursing to their roles, and often a specialty certification.
Once they’ve assumed the CNS role, they also do shadow shifts with nurses to make sure they maintain a clinical relevance and know “what it’s like to walk in their shoes,” says Klaasen.
Of course, CNSs in home care still do circulate the city to provide clinical consultation.
“We’re always on the road – we put in a lot of kilometres,” says Klaasen.
In home care, specifically, Klaasen and her colleague, Michelle Todoruk-Orchard, are the CNSs that tend to home care clients and provide support to their nurses and case coordinators.
“We cover the entire city,” says Klaasen. The two must extend their expertise to the approximately 400 home care nurses and their clients that operate in the city. “We’re a resource to nurses and we’ll make our assessments,” says Klaasen.
Klaasen is also currently involved in three studies, and teaches courses to university students. In addition, she is available as a mentor to students who take an interest in her position. She has approximately 21 years of experience in various areas of nursing, and has a specialty in gerontological (older-age) nursing.
When it comes to their role in supporting nurses, the CNSs do a lot of their own research as well as interpreting research that is out there. They’ll respond to nurses’ concerns and suggestions for change by looking into what solutions may be available.
“There’s an expectation to be involved with a lot of leadership and local, regional, and national committees,” says Klaasen. “A lot of what we do is networking,” she says, adding they will use their contacts in other provinces to see what the results of their research was to determine best practices.
“You’re expected to be sort of a generalist and know about a lot of things. Sometimes you feel like a jack of all trades but a master of none,” jokes Klaasen.
A huge part of Klaasen and Todoruk-Orchard’s focus is on keeping people living in the community for as long as possible.
They work with pediatric and young adult clients, as well, though the majority of their clients are a mature age.
Recent changes have included providing more complex interventions at home so that the clients may remain in their homes longer.
Nurses that have a flair for research and enjoy teaching or affecting change may be inclined to this type of nursing.
“Every day is a different day,” says Klaasen. “It’s a fun job because we get to work alongside clients and families. We’re also then working with staff and working with leaders and changing policies.”