MAR 2021 ISSUE 47

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Clinical Excellence

Opportunities and Challenges for Clinical Nurse Specialists (CNS)

Mr Alan Wong | Former General Manager (Nursing), The University of Hong Kong - Shenzhen Hospital

Ms Cai Xinliang | Head Nurse, The University of Hong Kong - Shenzhen Hospital

Ms Zhan Jie | Registered Nurse, The University of Hong Kong - Shenzhen Hospital

Introduction

The clinical nurse specialist (CNS), also called the clinical nursing expert, refers to the advanced clinical nursing practitioner formed and developed during nursing professionalisation. CNS also indicates a registered nurse with expert nursing techniques and solid knowledge in a specialised area of nursing who is certified by an accredited agency after completing the CNS education programme and a sufficient period of clinical nursing practice which included 28,600 nurses, 68% of the total 1,2. However, due to lack of unified CNS standards and systematised training, career access, accreditation, management and usage in China, there are significant differences among CNSs’ core competencies. Some can hardly keep their competitive edge; others, because of poor remuneration and career advancement opportunities, choose to leave their positions, resulting in both human resource waste and a shortage of expertise.

Background

It is clearly proposed in both the National Nursing Career Development Plan (2016-2020) and the Nursing Career Development Plan of Guangdong Province (2016-2020) to develop the CNS, intensify related training, improve the level of specialty nursing services, and to explore of the creation of CNS positions, continuously improve nurses’ remunerations, and provide corresponding conditions for effective deployment of CNSs 3,4.

Hospital beds and registered nurses in Guangdong Province and Shenzhen City by the end of 2018 are shown in Table 1 5 .

Table 1. Hospital Beds and Registered Nurses in Guangdong Province & Shenzhen City in 2018

Beds Available (No.) Registered Nurses (Person) Registered Nurses per 1,000 Population (Person)
2015 2018 2015 2018 2015 2018
Guangdong Province 436,000 517,000 254,000 335,000 2.35 2.95
Shenzhen City 34,000 43,000 34,000 40,300 2.88 3.09

Current Status of CNS

Some developed countries such as the United States, Canada, Australia, and the United Kingdom have developed a mature system for CNS training, accreditation, and deployment 6 . Since the early 1990s, Hong Kong has established CNS teams. Nowadays, there are about 3,000 advanced practice nurses (APNs). A set of relatively mature standards and specifications for the accreditation of CNSs are available 7 . Studies have shown that the CNSs can not only benefit patients by improving their condition and prognosis but can also reduce their economic stress 8-10.

In Mainland China, the CNS system has been developing for more than ten years from the 11th to the 13th Five-Year Plan, and has made remarkable achievements. Nursing care provided by CNSs covers more than 20 fields, including ICU, emergency, wound/stoma care, surgery, geriatrics, oncology, and organ transplantation. However, current CNS training and deployment remain unstandardised, unsystematic, and unclear, which negatively influences CNS training quality and their enthusiasm for work6 . The problems mainly include:

Thus it is clear that there is an urgent need to establish a standardised training system and professionalised management, to systematically develop a CNS post, unify CNS management organisation, to create and improve the relevant management systems 11.

Opportunities and Prospects

It is stated in the Opinions of the CPC Central Committee and the State Council on Supporting Shenzhen in Building a Pioneering Demonstration Zone for Socialism with Chinese Characteristics issued in July 2019 that GBA construction will aim to further the process of reform and opening-up for the Qianhai Shenzhen-Hong Kong Modern Service Industry Cooperation Zone, and to continuously improve Hong Kong and Macao’s degree of openness with institutional innovation as the core 12. In the Third Session of the 13th National People's Congress (NPC), held in May 2020, NPC and CPPCC members including Li Xiuhua, Liu Yucun, Song Jing and Hu Meiying proposed to promulgate the Nurse Law, to establish a code for nursing accredited by the National Natural Science Foundation of China (NSFC), thus strengthening the structuring of the nursing discipline and improving their remuneration.

As a pioneer for medical reform in Mainland China, the HKU Shenzhen Hospital has continuously explored a new mode of public hospital management since our establishment eight years ago. This mode has four key aspects: “Running, Managing, Practicing, and Consulting”.

We have been gradually come to be recognised by the general public. In 2019, we ranked first in Shenzhen for nursing satisfaction and won the “Shenzhen Mayor Quality Awards - Gold Award (Social)”. We have made remarkable achievements with respect to nursing. On September 12, 2019, we won the Asian Hospital Management Award – Nursing Excellence.

CNS’s training and development requires support from national policies and the protection by laws. Our hospital intends to learn from maturely developed foreign experience in specialist nursing, the "CNSs to Hong Kong" training mode, and the first GBA CNS qualification accreditation framework. We aim to implement a training and deployment mode suitable for GBA nurses’ development and clinical practice in China, to take full advantage of CNS skills by refining the fields for their future development, to attend to ongoing training and continuous development of CNSs, to establish and improve the CNS management system and post-management systems, to strengthen CNS professionalised management and rationally build the CNS post, to develop and implement salary standards for CNS, and thereby to promote the advancement of specialist nursing quality in the GBA.

References

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