Discover what it takes to be a Perioperative Clinical Nurse Specialist. This presentation is from AORN's webinar which describes the role of the perioperative CNS, RN. Receive 0.5 contact hours by registering for the webinar replay and successfully completing the evaluation. The webinar is available at http://bit.ly/1aROqKI. Interested in obtaining the new CNS-CP nursing credential? Learn valuable test-taking strategies and more through a CNS-CP Certification Exam Preparation Course: http://bit.ly/GQ5Yy0.

1. The Role of the Perioperative
Clinical Nurse Specialist
Dr. Mary A. Hillanbrand, RN, DNP, CNOR
October 9, 2013

2. Dr. Mary A. Hillanbrand
Dr. Mary A. Hillanbrand, is a perioperative Clinical Nurse Specialist on active duty in
the US Air Force currently assigned as an assistant professor and Deputy Program
Director in the Clinical Nurse Specialist program at the Uniformed Services University
in Bethesda, Maryland. Dr. Hillanbrand earned her Doctorate of Nursing Practice from
the University of Alabama, in Tuscaloosa, Alabama. Her capstone project “Identifying
Gaps in Perioperative Registered Nurses Knowledge of the Cleaning and
Decontamination Process for Surgical Instruments” provided the groundwork for the
development of educational interventions aimed at increasing knowledge of
recommended practices to improve practice and patient outcomes.
Dr. Hillanbrand has worked in the perioperative environment for over 30 years, which
includes more than 12 years as a certified surgical technician. Her field of interest is
the development of educational interventions to increase compliance with
recommended practice guidelines with a focus on improved patient outcomes.
Additionally, Dr. Hillanbrand is involved with promoting certification for all perioperative
team members including advanced practice nurses in the perioperative environment.

3. Disclosure Information
Speaker:
Dr. Mary A. Hillanbrand, RN, DNP, CNOR
Disclose No Conflict
Planning Committee:
AORN Nurse Educator
Ellice Mellinger, MS, BSN, RN, CNOR
Disclose No Conflict
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4. Objective
• Discuss the history of the Clinical Nurse
Specialist
• Identify the four APRN roles within the
Regulatory Model
• Discuss the 5 domains of CNS practice
within the 3 spheres of influence

5. History of CNS
• Early 20th century “Nurse Specialist” was brought
forward
• 1943 - Frances Reiter promoted the idea of a “nurse
clinician”
– A nurse with advanced knowledge, clinical
competence and commitment to providing high quality
nursing care
– Recognized need for graduate education
• Clinical Nurse Specialist (CNS)
– 1944 - NLNE’s Committee to Study Post-graduate
Clinical Nursing Courses inception of the specialty
– 1949 - University of Minnesota National Conference
of Director’s of Graduate Programs credited with
genesis of the clinical-nurse specialty
(Towers, J, 2011)

6. APRN

7. Consensus Model for APRN Regulation
APRN SPECIALTIES
Licensure occurs at levels of
Role and Population foci
Focus of practice beyond role and population focus linked to health care needs
Examples include but not limited to: acute care (perioperative, trauma, intensive care), oncology, older
adults, orthopedics, nephrology, palliative care
POPULATION FOCI
Family/
Individual
across lifespan
Adult/Gerontology
Neonatal
Pediatrics
Women's
Health/ Genderrelated
Psychiatric
Mental Health
APRN ROLES
Nurse
Anesthetist
Nurse
Practitioner
Clinical Nurse
Specialist
Nurse
Midwife
(APRN Consensus Work Group, 2008, p 9.)

8. APRN Similarities
• Certification
• Prescriptive Authority **(NCSBN, 2013)
– 36 States authorize CNS Prescriptive Authority
• 13 States: Independent Authority
• 23 States: Not Independent Authority
• 15 States: No Prescriptive Authority
• Independent Practice** (NCSBN, 2013)
– 22 States: CNS Independent Practice
– 23 States: NP Independent Practice
**Defined by State Boards of Nursing Scope of Practice Acts
(National Council of State Boards of Nursing [NCSBN], 2013)

9. AORN Position Statement
“The APRN functioning in the perioperative setting
is a registered professional nurse who:
– is competent in the use of specialized perioperative nursing
knowledge and skills in the care of patients and families
undergoing operative and other invasive procedures…;
– functions autonomously and collaboratively with the surgeon in
the preoperative and postoperative management of surgical
patients and their complex responses to the surgical process…;
– integrates clinical practice, education, research, management,
leadership, and consultation into a single but multifaceted role...;
– continually functions in a collegial relationship with nurses,
physicians, health care organizations, and systems to influence
care of the surgical patient.”
(AORN, 2013, pp. 299-300)

10. Clinical Nurse Specialist - CNS
• Unique role to integrate care across the continuum throughout
the three spheres of influence
– Patient
– Nurse
– System
• Improve patient outcomes and nursing care
• Create environments to empower nurses
– Evidence-based practice
– Facilitate ethical decision making
• Responsible for diagnosis, treatment, and management of
health and illness
• Health promotion
• Prevention of illness and risk behaviors
(APRN Joint Dialogue Group, 2008)

11. Domain 1: Clinical Expert
• Complex surgical patients
• Surgical consults
– Differential diagnosis
– Metabolic needs
– Pain management
– Pharmacology
• Pre-op history and physical
– Treatment plans

12. Domain 2: Consultant
• Interdisciplinary and multidisciplinary
• Committee membership
– Expert resource for perioperative continuum
• Infection control
• Risk mitigation
• Root cause analysis

13. Domain 3: Education
• Nurses and staff
– In-services
– Continuing education offerings
– Competency validation
• Patient/Family
– Surgical expectations
– Pain management
– Post-operative management/wound care
• Community
– Health promotion

14. Domain 4: Clinical Inquiry
•
•
•
•
•
•
Evaluate current practice
Patient safety initiatives
Evidence-based practice
Recommended practice guidelines
Literature reviews
Synthesize and disseminate research
finding

15. Domain 5: Manager/Leader
• Policy and procedure
• Organization
– Fiscal accountability
– Process improvement
– Risk management
– Patient safety
• Informatics
– Utilization
– Staffing

16. Professional Accountability
• Professional development
– Perioperative team members
– Continuing education
– Professional organizations
• Mentorship
• Certification
• Health policy and legislation

17. Final thoughts
• The perioperative CNS is an APRN who
provides care within the patient, nurse,
and organization spheres of influence
• The domains that define the CNS role are:
– Clinical expert
– Consultant
– Education
– Clinical inquiry
– Manager/leader

18. References
APRN Consensus Work Group & National Council of State Boards of Nursing APRN
Advisory Committee. (2008). Consensus model for APRN regulation: Licensure,
accreditation, certification & education. Retrieved from
https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
Association of periOperative Registered Nurses. (2013). AORN Position Statement:
Advanced Practice Registered Nurse Practicing in the Perioperative Setting. AORN
Journal, 97(3), 299-301.
National Council of State Boards of Nursing. (2013). APRNs in the U.S. Retrieved from
https://www.ncsbn.org/2567.htm
Towers, J. (2011). The evolution of advanced practice in nursing. In J. Stanley (Ed.)
Advanced practice nursing: Emphasizing common roles (pp.3-31). Philadelphia: F.A.
Davis Company.
All pictures in this presentation were obtained from public domain on Google images at
https://www.google.com/imghp?hl=en&tab=ii

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22. Take Your Career to the Next Level
Go for your CNS-CP Credential. Get there with AORN!
The Perioperative CNS Certification Exam Prep Course Includes:
• Two-day educational coaching event
• Three additional facilitated, interactive webinars and assignments
This course will provide advanced knowledge, review the core
competencies, and review the domains of nursing practice for the RN,
CNS in the specialty of perioperative practice.
Denver, CO | AORN Headquarters
January 17-18
$450 includes all events
www.aorn/CNS-CPCourse