CNS career path strengthened

 

New classifications and a more simplified, state-wide selection criteria provide a more attractive and rewarding clinical career path.

NSWNA Public Health System members recently voted overwhelmingly to accept the Government’s offer to introduce new nursing and midwifery career path options that provide new clinical categories and significant pay rises for the nurses and midwives in those positions.

Two new classifications, Clinical Nurse/Midwife Specialist Grade 1 and Clinical Nurse/Midwife Specialist Grade 2, have been created in the Public Health System Nurses’ and Midwives’ (State) Award.

According to NSWNA Assistant General Secretary Judith Kiejda, the new CN/MS Grade 1 position provides a more clearly defined role than previously and the new CN/MS Grade 2 classification delivers an excellent advanced practice role.

‘The CN/MS Grade 2 position forms a better bridge between the CN/MS and CN/MC or nurse practitioner classifications,’ she said.

The new classifications resulted from a review of the CN/MS classifications, which was part of the previous 2005-2008 Public Health System wages and conditions agreement.

The NSW Government has provided a funding mechanism equal to 25% of the current CN/MS population.

‘There are currently 4,500 CNSs, and CMSs, in NSW. Many of these specialist nurses will be eligible for the Grade 2 positions,’ said Judith.

‘This is an exciting career development opportunity enabling experienced nurses to further pursue a clinical career path.

‘We encourage experienced nurses, who have relevant post-registration qualifications and experience, to apply for these positions.’

Judith said another major breakthrough was the streamlining of criteria to achieve CN/MS grade. ‘There will now be consistent state-wide requirements for CNS positions and local criterions will be banned.

‘Previously, the CNS eligibility criteria was developed locally, hospital by hospital, and was left to the discretion of individual managers – sometimes requiring up to 150 qualifying points. This was a big deterrent to nurses and midwives.

‘The new criteria developed by the NSWNA and NSW Health makes it much fairer and easier to apply.

‘NSW’s 4,500 CN/MSs were also required to satisfy often excessive annual criteria proving they were contributing to the development of clinical practice in their ward or service in order to keep their CNS grade. Often nurses are forced to do this work in their own time.

‘The new state-wide approach is fairer and more consistent. It removes a major disincentive to nurses and midwives pursuing and retaining a clinical nurse specialist status and will encourage many to stay in the clinical stream,’ said Judith.

Grade 2 CNS provides exciting clinical challenge

’I have extensive experience in recovery room nursing. Apart from working in Australia, I have worked in the United States, the Channel Islands, and in the United Kingdom, where I ran a Recovery Unit. Building on this experience, I now work as my hospital’s only Acute Pain Nurse, where my classification is Registered Nurse (8th year thereafter). The new Grade 2 CNS position provides an excellent opportunity for RNs to specialise. The Grade 2 position finally acknowledges the qualifications and skills of experienced nurses. I’m looking forward to applying. It will be an exciting challenge.

’It has annoyed me that, until now, I had to complete an application package at Greater Western Area Health Service (GWAHS) which was 31 pages long to gain CNS status. I would rather spend time either doing my job or attending to my University studies than complete such a tedious document. This only re-emphasised to me that experienced nurses are greatly undervalued.’
Sue Latham, RN, Dubbo Base Hospital

New state-wide CNS criteria fairer
‘There are huge benefits to simplifying the CNS criteria and creating the new Grade 2 classification. Nurses can have over-expectations of each other and some managers imposed a very onerous process on their colleagues. The state-wide criteria means there is fairness and consistency. Previously, Liverpool had the most onerous criteria in NSW. There were too many hoops to jump through. You needed to submit your CV, a recent performance appraisal, a supporting letter from your manager. Then every year you had to undertake a project that proved you were responsible for quality improvements on your ward. It certainly made people very anxious and deterred people from applying from CNS positions. It’s not surprising we do not have enough CNSs.

’These changes are a strong move to keep experienced nurses at the bedside.’
Brian Grant, CNS, Liverpool Hospital

See page 44 for a definition of the new CNS Grade 2, and the process for applying for the Grade 2 positions.

Definition of the new CNS/CMS Grade 2 positions

According to the Public Health System Nurses’ and Midwives’ (State) Award:

Clinical Nurse/Midwife Specialist (CN/MS) Grade 1 means:

a Registered Nurse/Midwife who applies a high level of clinical nursing knowledge, experience and skills in providing complex nursing/midwifery care directed towards a specific area of practice, a defined population or defined service area, with minimum direct supervision.’

To qualify for a CN/MS Grade 1 position nurses must satisfy the following minimum criteria:

  • Relevant post-registration qualifications and at least 12 months’ experience working in the relevant clinical area of their post-registration qualification; or four years post-registration experience, including three years experience in the relevant specialist field.
  • A CN/MS Grade 1 is distinguished from an 8th Year Registered Nurse/Midwife by being required to satisfy the following criteria:

a) Actively contributes to the development of clinical practice in the ward/unit/service
b) Acts as a resource and mentor to others in relation to clinical practice
c) Actively contributes to their own professional development.

The Public Health System Nurses’ and Midwives’ (State) Award states:

Clinical Nurse/Midwife Specialist (CN/MS) Grade 2 means:

a Registered Nurse/Midwife appointed to a position classified as such with relevant post-registration qualifications and at least three years’ experience working in the clinical area of their specified post-graduate qualification.

The CN/MS Grade 2 classification encompasses the CN/MS Grade 1 role criteria and is distinguished from a CN/MS Grade 1 by the following additional role characteristics:

  • Exercises extended autonomy of decision making;
  • Exercises professional knowledge and judgment in providing complex care requiring advanced clinical skills and undertakes one of the following roles:
    • leadership in the development of nursing specialty clinical practice and service delivery in the ward/unit/service; or
    • specialist clinical practice across a small or medium-sized health facility/sector/service; or
    • primary case management of a complete episode of care; or
    • primary case management of a continuum of specialty care involving both inpatient and community-based services; or
    • an authorised extended role within the scope of Registered Nurse/Midwifery practice.

Assessment of a registered nurse appointed to a CN/MS Grade 2 position should be undertaken at the unit/clinical service level and the functions which the nurse/midwife will undertake in performing the CN/MS Grade 2 role should be agreed between the nurse/midwife and the Nursing/Midwifery Unit Manager as part of the annual appraisal process, taking into account the strengths of the individual, the clinical/operational needs of the unit and the reasonable workloads provisions.

Process for implementing new CN/MS Grade 2

CN/MS Grade 2 positions will be identified in two phases.
Phase 1
The first phase in identifying CN/MS Grade 2 positions will proceed as follows:

  1. Directors of Nursing (DoN) and Health Service Nurse Managers will identify positions for potential classification as CN/MS Grade 2 with reference to the Award criteria and this Policy Directive – and submit them to the Area DoN for consideration (in a form determined by the Nursing and Midwifery Office (NaMO)).
  2. The Area DoN will review submissions with reference to the Award criteria, this Policy Directive and internal consistency – and submit the positions identified for potential classification as CN/MS Grade 2 to NaMO (in a form determined by NaMO).
  3. NaMO will consolidate the submissions and supporting documentation sufficient to facilitate a review process.
  4. NaMO, together with Workplace Relations and Management, will conduct a review process with the Area DoNs, to determine those positions to be classified as CN/MS Grade 2. The focus of this step is to ensure consistency in application and implementation of the criteria.
  5. The outcomes from the preceding step will be provided to the NSW Nurses’ Association for information and concurrence with the process.
  6. Area DoNs will circulate a list of those positions considered for classification as CN/MS Grade 2, identifying those that will be classified as CN/MS Grade 2 and those which will not. At the same time Area DoNs will consult with the NSW Nurses’ Association at the local level in accordance with local custom and practice.
  7. Area Health Services will proceed to fill the positions identified as CN/MS Grade 2.

Concurrent with proceeding to fill the positions identified in the last step of Phase 1, Phase 2 will proceed as follows:

  1. Nurses who substantively occupy a position which they believe meets the Award criteria, but which has not been considered as a CN/MS Grade 2, will have the opportunity to submit that position for consideration by the Area DoN.
  2. Area DoNs will forward such submissions to NaMo with comments as to whether or not it is supported and why (in a form determined by NaMO). NaMO will consolidate the submissions and supporting documentation sufficient to facilitate a review process.
  3. NaMO, together with Workplace Relations and Management, will conduct a review process with the Area DoNs and consider the submissions to determine any to be classified as CN/MS Grade 2. The focus of this step is to ensure consistency in application and implementation of the criteria.
  4. The outcomes from the preceding step will be provided to the NSW Nurses’ Association for information and concurrence with the process.
  5. Area DoNs will circulate a list of those positions that will be classified as CN/MS Grade 2. At the same time Area DoNs will consult with the Association at the local level in accordance with local custom and practice.
  6. Area Health Services will proceed to fill the positions identified as CN/MS Grade 2.

Timeline for implementing new CN/MS Grade 2

  1. Phase 1: All positions identified as CN/MS Grade 2 filled by 30 January 2009. If a position identified to be a CN/MS Grade 2 position has not been filled by 30 January 2009, where there is a substantive occupant of the existing position, they will be temporarily appointed to the CNS Grade 2 position until such time as it is permanently filled.
  2. Phase 2: all positions identified as CN/MS Grade 2 filled by 9 April 2009. If a position identified to be a CN/MS Grade 2 position has not been filled by 9 April 2009 where there is a substantive occupant of the existing position they will be temporarily appointed to the CNS Grade 2 position until such time as it is permanently filled.

The transition arrangements will end on 9 April 2009 after which CN/MS Grade 2 positions will be created and filled in accordance with standard practice and processes.