CNS in PICU/NICU

[MGMR]

Hey all,

Just wondering what your experiences have been with clinical nurse specialists working in your PICU/PCICU/NICU. We currently do not use any in my PCICU, but the NICU just hired a neonatal CNS and the job seems very interesting - possibly something I'd like to pursue.

What have your experiences been like? What were their job responsibilities? Did they still take patient assignments from time to time? How much hands on patient care did they perform (inserting lines, dressing changes, etc.)?

[NotReady4PrimeTime, RN]

My experience with CNS activity on our unit (combined PCICU/PICU) has been that they did very little hands-on patient care... as in none. I've never seen one take an assignment once they've been elevated to CNS status, or even cover breaks. (Our most recent one actually told me she would NOT touch my patient or take responsibility for any care but would draw up my meds or transcribe my orders to help me out. We've had at least 5 different people in the role over my tenure there but currently do not have one. The first two took on wound care as their main focus, but we now have a dedicated pediatric wound care NP, so that role is no longer included in the job description. They also were the main overseers of family-centered care and coordination of care for long-stay patients. Our most recent CNS was heavily involved in quality improvement activities such as infection control, oral care, changes to medication administration practices, and analysis of incident reports, especially medication errors. They all attended many meetings. There was little affection for them among the front-line staff because their presence at your bedside usually meant a lecture about something, the tone of which was usually meant to make the bedside nurse feel inferior. Not my idea of a desirable career move... but that's just me.

[MGMR]

Hm, that's a real shame. And definitely not the role I envision myself doing in the future. The neonatal CNS in our hospital's NICU does a lot more patient care at the bedside. She helps insert lines in babies who are difficult sticks, helps to change aspects of the unit that are not streamlined and are frustrating for nurses, and does a lot of education for the staff. For example, ECMO is becoming much bigger at our hospital - previously all patients on ECMO, neonatal or not, would be housed in the PICU or PCICU. But she has created protocols and education sessions so that the NICU staff can house their own patients requiring ECMO.

These are just a few things that I could see myself doing as a CNS in the PCICU. The CNS roles that you're describing sound like my own personal nightmare though, which makes me a bit worried.

[NotReady4PrimeTime, RN]

It might not be a good idea to spread your ECMO capacity into the NICU unless the neonatal cardiac surgical patients go back there from the OR. It takes a minimum number of runs a year to maintain skills that might not be met. Not one of the 5 CNSs our unit has had in my time there have been ECMOlogists (although one of them took the specialist training, the most recent one didn't have the unit-based education for bedside care of the ECMO patient but had a Master's degree) and they didn't have any involvement with those patients other than superficially. Line insertions are done by our transport nurses (PIVs), our residents and fellows, or sometimes the intensivist if it's really difficult. PICCs are placed under fluoro by an interventional radiologist. The roles you describe would be more expected from an NP at my workplace.

[NicuGal, MSN, RN]

Our CNS in both PICU and NICU are very involved in quality, hospital standards/policies, preceptorship, research. They will pitch in when they can, but they sit on so many committees they really don't have time for patient care.