[jbird]

I'm a new CNS and just started a CNS role at a 100-bed community hospital in Nebraska. This hospital has never had a CNS and there is much confusion as to what my job will be from the staff nurses and managers. Staff and managers believe my job is to strictly educate, however as you all know that is not the case. I do have a job description, etc but I'm looking for any ideas on how to integrate a CNS within a hospital. Please help! Any suggestions would be wonderful. Thank you!

[WashYaHands]

That's a tough question without knowing the dynamic of the hospital staff and managers. Maybe meeting with each manager individually to find out some of the clinical challenges that exist in each dept. might provide you insight into what some of the clinical concerns are. For example, one manager might be challenged to decrease their fall rate. Another might have a high med error rate. Another might have a larger proportion of newer nurses. Another might be challenged with updating protcols, etc. Try to keep the conversations clinically focused as opposed to administrative challenges, such as staffing because you're a clinical nurse specialist, not administration. After you have a general idea of some of the clinical challenges, go to the staff and ask them questions about these topics (what are the needs of the staff to improve...decreasing falls, decreasing med errors, out-dated protocols, new nurse challenges. The staff may bring up other challenges that the managers didn't. Once you've assessed the clinical needs of the staff and managers, you can then develop a plan/plans to meet and/or improve these challenges. You may have to work on one plan at a time until you get used to everyone. Select one that is common to both staff and managers. Get the staff nurses involved in the planning and implementation process. Listen to their ideas and suggestions. It's important to build genuine relationships and include staff in the process. Before you begin to implement a plan for anything, map out how you are going to measure the outcomes so you can periodically report back to the mgmt and staff on how you and they are doing with the improvements.

A different approach might be to meet with the managers to introduce yourself, provide them with an overview of your roles as a CNS. Spend some time on the floor with nurses one-on-one so that they can get to know you. Ask them questions about their work, routines (like we have routines, ha!), what they think their educational needs are, what they like and dislike about their work. Get to know them on a professional level.

I'll give one example when I worked in rehab as a staff nurse...we experience a rather high turnover rate of new nurses due to our lack of a comprehensive new nurse orientation. Our leader staff nurses developed a new employee (nurse) orientation plan so that new nurses weren't just "thrown to the wolves" so to speak. We all sat down and developed a structured floor orientation program. After 6 months, our turnover rate decreased.

As far as the clinician role, you'll have to establish a rapport with the docs too.

Best wishes to you.

These are just suggestions. You'll have to assess the dynamic at the facility and ease your way into your roles.

[llg]

How long have you been at that job? My experience has been that it is always awkward at first as the new CNS establishes herself/himself in a new environment. Give it time. Use the basic nursing process ... assess what their needs are ... offer to help fulfill those needs ... offer to help resolve some of their problems, etc. If you do a good job, you will soon find that they come to you for help with other problems. Within 2 years, you will be overwhelmed with the amount of work you have to do and struggling with the need to say "no" sometimes when people come to you for help.

Your situation is a little more difficult than most because you have no experience with the role, no mentors within the same hospital, and a hospital that has no experience with the role. That's not a good set-up. But it can work out fine in the long run if you can stay focused on helping your colleagues with whatever their needs are and helping them to see you as a useful person to have around. Focus on being useful to them and you will soon find yourself with a strong relationship with them. Eventually, they may even see you as indispensable -- which is a great source of power. If you focus too much on trying to enact some textbook role description, you run the risk of being considered too focused on yourself and your own career fantasies -- and that can lead to resentment from people who don't have some of the same career advantages (education, salary, flexible hours, etc.) that you probably have in a CNS role.

The key is to portray that "it is not about you and what some expert says your role should be ... it is about the customers you serve (both patients and other nurses) and how you can help solve their problems." Then, as they begin to see you as capable, you can begin to market the special skills and talents that you would like to emphasize in your position.

llg -- who has had several CNS jobs in several settings over the years. I know what it is to be the new kid on the block.

[jbird]

I have been a House Supervisor at this hospital for almost a year, graduated with my MSN in August and just began the transition in September. I know the staff and managers very well and have a great repoire with them. My biggest challenge is the culture of negativity that exists in this organization. My boss, who is also the DON at this hospital has been there a year and is very respected. Together, with the managers, we have been planning ways to get the culture of negativity back on a positive track. Very tough as you may know. Another problem is that out of 5 managers of the acute care units, only two people have a BSN and one of those two just began at our facility this month. The other managers are AD/AS prepared and are lacking the education to understand what my CNS role is and how I will function. In our hospital the DON has a MSN and has almost completed her PhD and I am the the only other person with any type of advanced nursing education. It's a struggle! We both have awesome ideas and great challenges to face, but with lack of education from the managers and nursing staff, it's like pulling a train up a hill.

Your advice is wonderful! I recently surveyed the entire acute care nursing staff and managers asking the very same things you were recommending. But, I've only received 4 back from a group of 220 and I'm getting a little concerned. Many of the staff at this hospital have poor attitudes and are focused on coming to work for the pay check and then going home. There are a lot of "I don't care" attitudes which make my job even more challenging. Don't get me wrong, I love the challenge but getting past the negative culture is like walking into a wall. Much work on teambuilding needs to take place.

I appreciate your detailed response and I look forward to seeking your advice in the future. Thanks again!

Originally Posted by WashYaHands

That's a tough question without knowing the dynamic of the hospital staff and managers. Maybe meeting with each manager individually to find out some of the clinical challenges that exist in each dept. might provide you insight into what some of the clinical concerns are. For example, one manager might be challenged to decrease their fall rate. Another might have a high med error rate. Another might have a larger proportion of newer nurses. Another might be challenged with updating protcols, etc. Try to keep the conversations clinically focused as opposed to administrative challenges, such as staffing because you're a clinical nurse specialist, not administration. After you have a general idea of some of the clinical challenges, go to the staff and ask them questions about these topics (what are the needs of the staff to improve...decreasing falls, decreasing med errors, out-dated protocols, new nurse challenges. The staff may bring up other challenges that the managers didn't. Once you've assessed the clinical needs of the staff and managers, you can then develop a plan/plans to meet and/or improve these challenges. You may have to work on one plan at a time until you get used to everyone. Select one that is common to both staff and managers. Get the staff nurses involved in the planning and implementation process. Listen to their ideas and suggestions. It's important to build genuine relationships and include staff in the process. Before you begin to implement a plan for anything, map out how you are going to measure the outcomes so you can periodically report back to the mgmt and staff on how you and they are doing with the improvements.

A different approach might be to meet with the managers to introduce yourself, provide them with an overview of your roles as a CNS. Spend some time on the floor with nurses one-on-one so that they can get to know you. Ask them questions about their work, routines (like we have routines, ha!), what they think their educational needs are, what they like and dislike about their work. Get to know them on a professional level.

I'll give one example when I worked in rehab as a staff nurse...we experience a rather high turnover rate of new nurses due to our lack of a comprehensive new nurse orientation. Our leader staff nurses developed a new employee (nurse) orientation plan so that new nurses weren't just "thrown to the wolves" so to speak. We all sat down and developed a structured floor orientation program. After 6 months, our turnover rate decreased.

As far as the clinician role, you'll have to establish a rapport with the docs too.

Best wishes to you.

These are just suggestions. You'll have to assess the dynamic at the facility and ease your way into your roles.

[jbird]

Please read the post entitled Thank You So Much. I think this will help clarify some things about my position. Thank you also for such great advice. I appreciate your help.

Originally Posted by llg

How long have you been at that job? My experience has been that it is always awkward at first as the new CNS establishes herself/himself in a new environment. Give it time. Use the basic nursing process ... assess what their needs are ... offer to help fulfill those needs ... offer to help resolve some of their problems, etc. If you do a good job, you will soon find that they come to you for help with other problems. Within 2 years, you will be overwhelmed with the amount of work you have to do and struggling with the need to say "no" sometimes when people come to you for help.

Your situation is a little more difficult than most because you have no experience with the role, no mentors within the same hospital, and a hospital that has no experience with the role. That's not a good set-up. But it can work out fine in the long run if you can stay focused on helping your colleagues with whatever their needs are and helping them to see you as a useful person to have around. Focus on being useful to them and you will soon find yourself with a strong relationship with them. Eventually, they may even see you as indispensable -- which is a great source of power. If you focus too much on trying to enact some textbook role description, you run the risk of being considered too focused on yourself and your own career fantasies -- and that can lead to resentment from people who don't have some of the same career advantages (education, salary, flexible hours, etc.) that you probably have in a CNS role.

The key is to portray that "it is not about you and what some expert says your role should be ... it is about the customers you serve (both patients and other nurses) and how you can help solve their problems." Then, as they begin to see you as capable, you can begin to market the special skills and talents that you would like to emphasize in your position.

llg -- who has had several CNS jobs in several settings over the years. I know what it is to be the new kid on the block.