Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy and six ambulatory sites.

Job Summary

The Clinical Nurse Specialist (CNS) is an advanced practice nurse who utilizes advanced knowledge and clinical expertise in providing primary and/or specialized health care services to individuals, families, groups and communities across the health-illness continuum. Diagnostic reasoning, advanced therapeutic interventions and education are key elements in the direct provision of care using a collaborative model. The clinical nurse specialist is directly accountable for making clinical judgments using independent and interdependent decision-making skills. The clinical nurse specialist 's primary focus is on the provision of direct and indirect patient care in managing the health care needs of the identified client population(s). The clinical nurse specialist provides care to a specific patient population using advanced skills in physical exam, nursing diagnosis and nursing interventions. The clinical nurse specialist also functions as a consultant, educator, researcher, resource and role model for patient, families, community, nursing personnel and other health care providers. The clinical nurse specialist evaluates the quality of care rendered; analyzes and promotes system changes to enhance quality of care and organizational effectiveness/efficiency; conducts/utilizes research to promote health and improve health care delivery. The clinical nurse specialist assumes responsibility for own professional development. The clinical nurse specialist may not prescribe medications or medical interventions, but may order nursing interventions. The clinical nurse specialist may take verbal orders from a physician, which must be co-signed by the physician within 24 hours.

A. PRACTICE

Assesses the health status of patients through eliciting comprehensive health histories, performing physical exams and analyzing data to formulate appropriate diagnoses. Develops prioritized, comprehensive problem list and prioritizes/initiates nursing interventions. Consistently collects patient data, which is prioritized according to the patient's immediate condition or needs. dentifies expected patient outcomes and develops appropriate plan of care to manage patients' health problems, promotes health maintenance and prioritize multiple patient needs. The plan of care is developed in collaboration with the patient, family and other health care professionals. The plan of care is documented and specifies specific nursing interventions to attain expected outcomes which are individualized, consistent with goals of care, cost-effective, reflective of current scientific knowledge and which anticipate and address the continuing needs of the patient. Implements interventions identified in the interdisciplinary plan of care. Interventions may include a variety of therapeutic interventions, providing patient/family education and counseling, and initiating health care and community referrals. Evaluates and documents patient progress toward the attainment of expected outcomes utilizing interdisciplinary collaboration, appropriate quality indicators and multiple sources of data, including the patients' assessment of progress. Coordinates and facilitates continuity of care that crosses institutional and organizational boundaries, as required. Acts as a patient/family advocate to ensure health care services are delivered in an ethical and culturally sensitive manner.

B. CONSULTATION

Acts as a consultant to patients, families, the community, nursing staff, medical staff and other health care providers by providing clinical expertise. Promotes the integration of a nursing perspective in planning, policy making and problem-solving. Provides consultation to various agencies and groups (i.e., government, planning groups, health institutions, community groups, policy makers, organizational leaders, teaching institutions and other educational groups/agencies).

C. EDUCATION

1. Assesses the knowledge, skills and ability of the nursing staff to provide quality patient care. Provides education opportunities to develop and enhance performance, problem-solving and critical thinking skills of nursing staff.

2. Designs, implements, coordinates and evaluates materials and programs for clients, health care professionals and the community, based on identified needs.

3. Educates nursing staff and other health care providers in the development, implementation and evaluation of teaching strategies for patients/families.

4. Instructs patients/families/caregivers about medical condition, management, follow-up care, medications, illness prevention, health promotion, coping strategies. The intent is to increase knowledge and the ability to manage the illness and maximize coping strategies for patients, families/caregivers.

COMPLIANCE STATEMENT Supports the standards set forth in the DMC Code of Conduct by creating an atmosphere of commitment to legal and ethical standards, and as directed, implementing external and internal audit recommendations. Monitors activities to ensure compliance with applicable laws, regulations JCAHO requirements, and DMC policies and procedures.

1. Registered nurse licensure to practice in the state of Michigan.

2. Master's degree in nursing (i.e., a clinical-based degree).

3. Two years clinical experience as a professional nurse.

4. National certification in advanced practice nursing specialty is required, where available, within 6 months of employment for all clinical nurse specialists hired after December 31, 2003, except where eligibility requirements for certification exceed 6 months of clinical practice. Failure to achieve certification, if available, will result in termination.

LEGAL SCOPE OF PRACTICE

1. In the state of Michigan, clinical nurse specialists have the scope of practice of a Registered Nurse.

2. According to Michigan law, clinical nurse specialists have delegated authority to prescribe non-controlled substances. A clinical nurse specialist may take direct verbal orders from a licensed physician and will write the verbal order in the patients medical record. The physician must co-sign the verbal order within 24 hours. Example: v.o. Dr. Alex Jones/Mary Smith R.N.

3. Clinical nurse specialists may perform medical procedures under the direct supervision of a licensed physician upon:

a. Initial training in performance of specific procedure, which shall include appropriate didactic instruction and demonstration of clinical competence in performing the procedure.

b. Documentation of ongoing clinical competence in performance of specific procedure.

4. Clinical nurse specialists may perform a nursing assessment and physical examination, but may not bill for these services as a physician service.