Healthcare Industry Needs More Specialist Nurses

By Zulkiple Ibrahim This is the second of three articles on the issues and challenges faced by those working as nurses in the healthcare industry. The following is on the role of the Specialist Nurse, in conjunction with the celebration of World Nurses Day on May 12. KUALA LUMPUR, May 9 (Bernama) -- Siew Bee (not her real name) has a five-year-old son who had contracted a bacterial lung infection when he was two years old. After a long hospital stay, doctors decided that the boy could go home, but he needed to have an 'oxygen concentrator' machine as well as an oxygen tank to use at home. Siew Bee was fortunate because the hospital had a Clinical Nurse Specialist (CNS) for respiratory disorders who helped her to arrange things. "I was fortunate as when the doctors discharged my boy, I had a CNS to help me. The CNS liaised with the supplier for the oxygen tank and oxygen concentrator machine. "She (the CNS) also liaised with the hospital's social worker to assist in the acquisition of these two machines. They are both expensive, but with the CNS's assistance, the hospital helped me to obtain these two machines that were crucial for my son's recovery at home," Siew Bee informed this writer here recently. Siew Bee added that the presence of the CNS had been of great help as the doctors cannot be burdened with tasks other than the treatment of patients. CLINICAL NURSE SPECIALIST To many in society, a Clinical Nurse Specialist (CNS) is no different from those who carry out general nursing duties and patient care. However, in the professional nursing fraternity, a CNS is an advanced practice nurse who has completed a specialised graduate degree programme or obtained a master's degree to become an expert in a particular field of nursing. The CNS is an advanced practice nurse whose care is focused on a specific patient population. A CNS can specialise in certain types of diseases, including endocrine diseases such as diabetes as well as respiratory and cardiovascular diseases. A CNS can work in many different medical environments such as an operating theatres, emergency rooms or critical care wards. She may also focus on a variety of procedures such as surgical procedures. Since there are many nurses in the profession, why do we need a CNS? This question was posed by this writer to a CNS who wished to be known as Freeda Hanum. OPTIMISE PATIENT CARE According to Freeda, a CNS acts as a common thread in that all CNS have the skills and knowledge to provide not only diagnosis and treatment to patients but also expert consultation to other nurses to improve healthcare delivery. She said a CNS can be based in any aspect of nursing practice, such as population (pediatrics), settings (emergency care or surgery), disease (cancer/oncology), type of care (psychiatric or rehabilitation) and type of problem (wounds or pain). "A CNS works with the nursing staff to optimise patient care, which may involve consulting with doctors, analysing treatment alternatives and educating nursing staff on new procedures. "She also fosters teamwork among healthcare staff and decides how best to allocate resources and staff within a hospital ward," Freeda pointed out. Freeda also said that the CNS can examine patients to evaluate their specific health issues and develop specialised care plans based on these evaluations, apart from educating patients and their families on how best to manage their conditions. She added that CNS generally divide their time between patient care, research, teaching, consulting and management. IMPROVING PATIENT SATISFACTION According to Freeda, a CNS can help to improve patient satisfaction, apart from reducing medical complications. "The CNS can be versatile. CNS training equips nurses with in-depth knowledge and expertise in their respective field, preparing them for leadership and teaching roles in a wide variety of healthcare settings. "Although the CNS role develops in the hospital setting, a CNS can now work in a wide variety of healthcare settings, from clinics to long-term care facilities," she added. KEY ROLE Another CNS, Ng Ai Lee, observed that the CNS plays a key role in the management of patient care. "They work closely with doctors and other members of the multidisciplinary team. They also educate and support patients, relatives and caregivers," Ng remarked. Ng said that a CNS has knowledge regarding the physical, psychological and social effects of a specific condition that a patient is experiencing, adding that most specialist nurses are hospital-based and have access to patients' medical records. "Some will visit patients in their own homes following discharge from hospital. Some hospitals employ nurse specialists for cardiac, respiratory, oncology, neurology as well as renal medicine and others," she explained. According to Ng, the CNS's report can provide details of the patient’s diagnosis, brief medical history, clinical examination findings, medication, treatment plan and response, variability of the condition, disabling effects and prognosis. "However, in people who have more than one medical condition, the CNS may not be able to provide detailed information outside their own area of expertise or be able to comment on multiple disabilities," Ng added. Statistics indicate that although there are more than 80,000 State Registered Nurses (SCN) working in the country’s public and private sectors at present, less than 500 of these are CNS. -- BERNAMA