In 2018 the role of clinical nurse specialist (CNS) was implemented in an ambulatory setting at our cancer research center in Italy. CNSs received specific training before taking on their new role. Although measuring the impact of CNSs is vital to support decision-making on the development and implementation of advanced nursing roles, the identification of indicators reflecting their impact on clinical practice remains one of the most challenging nursing research issues, mainly because of the complexity of the contributors who determine patient and organizational outcomes.
The study evaluated indicators measuring the implementation process and the impact of the CNS role one year after its introduction. Indicators for the former were: CNS interface mapping in disease pathways, participation rate of CNS in multidisciplinary team (MDT) meetings, and number of training hours/CNS on specific cancers. Indicators for the latter were: patient satisfaction with CNS (survey), compliance with priority criteria for waiting times for the first visit, total number of documented CNS-patient communications (i.e. first nursing interviews with new patients, phone interviews); and number of improvement projects to which CNSs contributed.
One year after CNS introduction, pathway mapping was 100%; MDT meeting participation 95%; training hours 40.5/CNS vs. defined standard of 30 hours. 83.2% of interviewed patients were very satisfied with CNSs. An average of 27 patient interviews and 126 phone interviews per month were performed. Improvements to the instruments used for patient agenda management were made, positively impacting compliance (+13%) with waiting time criteria.
CNSs were successfully introduced into all identified disease pathways and played an active role within the MDTs. Although there are data in literature indicating optimal CNS staffing for specific cancers, there are no previous Italian experiences that can be used for comparative purposes. We need to better clarify how disease characteristics and the number of new patients influence CNS staffing in our specific organizational care context, which obviously differs from that of other countries. Measuring CNS activities and outcomes would also help to optimize CNS core activities.
Clinical trial identification
Legal entity responsible for the study
Istituto Scientifico Romagnolo per lo Studio e per la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Has not received any funding.
All authors have declared no conflicts of interest.