title: Outcomes of Clinical Nurse Specialist Role Transformation to Population-Focused Model.
abstract: OBJECTIVE
  In 2010, our comprehensive cancer center developed a professional practice model where the clinical nurse specialist role was transformed to proactively plan and facilitate evidence-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum.
  
  
  BACKGROUND
  Prior to this transition, practice was unit based, focused on nursing staff education, skills, and competencies, and practice varied widely based on the needs of the unit. This lack of role consistency resulted in decreased autonomy and collaboration and frustration with not consistently impacting positive outcomes.
  
  
  METHODS
  Nursing leadership worked with the clinical nurse specialists to develop and transition to a population-focused model. Some responsibilities in the unit-based model were retained, whereas others were transitioned to different roles. The reporting structure was centralized, and the role was realigned to focus on a specific patient population encompassing care from diagnosis throughout survivorship.
  
  
  RESULTS
  Baseline job satisfaction data were collected prior to the transition and repeated at 6 and 12 months, then 2, 3, and 4 years after implementation. Over time, there was significant improvement in participation in decision making, support of leadership, and positive contributions to patients and staff, resulting in improved nursing-sensitive patient outcomes, an increase in evidence-based practice initiatives and nursing research projects, and substantial professional growth of clinical staff.
  
  
  CONCLUSIONS
  With this practice model, clinical nurse specialists consistently and proactively plan and facilitate evidence-based best practice in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory. Results of outcome measurement report job satisfaction at an all-time high. Significant impact is demonstrated for patients and families, the nursing staff, and the organization.
  
  
  CONCLUSIONS
  Healthcare organizations should evaluate current roles and practice models for opportunities to incorporate innovations that will result in improved patient care and satisfaction.
authors.affiliation: Author Affiliations: Clinical Nurse Specialist (Ms Catania) and Associate Chief Nursing Officer (Ms Tippett), The Ohio State University-Comprehensive Cancer Center, James Cancer Hospital & Solove Research Institute, Columbus.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Catania
authors.forename: Jamie Ezekielian
authors.initials: JE
authors.lastname: Tippett
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration; D003299:Cooperative Behavior; D055317:Evidence-Based Practice / Q000458:organization & administration; D005500:Follow-Up Studies; D006801:Humans; D007588:Job Satisfaction; D016294:Models, Nursing; D017146:Models, Organizational; D009720:Nurse Clinicians / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role; D015403:Nursing Evaluation Research