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All nurses need special training

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VOL: 98, ISSUE: 11, PAGE NO: 33

Sally Gooch, MSc, BA, RGN, RHV

I read with interest the view that clinical nurse specialists (CNSs) deskill other nurses ('General nurses are special too', March 7, p20).

I read with interest the view that clinical nurse specialists (CNSs) deskill other nurses ('General nurses are special too', March 7, p20).

This is probably because the growth in the number of CNS posts has coincided with 10-15 years of clinical nurses' skills not keeping pace with patients' needs.

This means there are a large number of under-skilled nurses, even in core clinical procedures like passing nasogastric tubes, cannulation and verifying expected death.

Competency frameworks and effective appraisal and recruitment now help to plug these deficits, but we need an enormous commitment from the NHS. Managers (including nurses) have viewed training as a luxury nurses engage in at their own expense in their own time. And they aren't expected to put their learning into practice.

Despite recent falls in nurse vacancies, the greatest threat to The NHS Plan's delivery is not having the right professional with the right skills doing the right job.

If the NHS doesn't quickly invest in training its existing workforce, through clinical skills coaching and practice-based clinical leadership programmes, it will continue to use expensive practitioners to carry out work nurses could do.

CNS posts have grown fast, and these specialists have enabled patients' care and treatment to be better coordinated.

Where these posts can go wrong is in creating caseloads, which can sound the death knell for the effective CNS. Caring for patients, there is no time to develop patient-centred services, evidence-based practice, or skill-sharing with colleagues.

However, a CNS working with patients with rare conditions can be useful in case management. For example, generalists can't be expected to be expert in the rare blood dyscrasias or rare cancers.

These patients may need the CNS to coordinate their complex care packages. But the average nurse should be able to manage diabetes, asthma or dementia competently, given the access there now is to clinical guidelines and care pathways.

CNSs need to provide frameworks and tools within which generalists can practise safely and confidently, and can offer consultancy, coaching, teaching and patient education.

Doing this means CNSs are rarely engaged in useful clinical research or audit. Without the clinical governance skill set they will struggle to quality assure the clinical practice of others. Also, most nurses (including CNSs) lack writing and presentation skills, which are essential to disseminate practice effectively.

CNSs aren't the reason why general nurses are under-skilled. Some within both groups are under-performing.

CNS posts are expensive and a precious resource, so ensuring value for money warrants regular review. Closing the skills gap is everyone's business and CNSs have a special contribution to make.

Patients need CNSs. They also need droves of competent practitioners, with their care managed by a lead clinician.

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