Specialty Nursing & Diverse Roles

A staff Registered Nurse (RN)/Registered Practical Nurse (RPN) work as an integral member of the interdisciplinary team and is responsible for delivering patient-centred care.

Staff nurses work throughout Niagara Health in many different practice environments where they demonstrate the following competencies:

• Establishing therapeutic relationships
• Administering and monitoring therapeutic interventions
• Monitoring and effectively managing complex and rapidly changing clinical situations
• Teaching-coaching activities with patients/families
• Monitoring and ensuring the quality of healthcare practices
• Providing care grounded in evidence-based practice

Registered Nurse First Assists (RFNAs) function interdependently with the surgeon and apply the knowledge, skill and judgement necessary to assist the surgeon in performing a safe operation that yields optimal results for the patient.

RFNAs demonstrate the following competencies in the provision of direct patient care using the nursing process preoperatively, intra-operatively and postoperatively:

Pre-operative:

• Work collaboratively with the patient and perioperative team to ensure an accurate preoperative assessment
• Communicate identified issues to the team
• Educate patients and their families while offering emotional support

Intra-operative:

• Collaborate with the surgical team to develop, coordinate and implement a perioperative plan of care unique to individual patient needs
• Maintain dignity of the patient while assuming the responsibility of patient advocate
• Use expanded knowledge of surgical anatomy, physiology and operative techniques
• Employ intra-operative techniques of exposure, retraction, suturing, hemostasis, and other forms of tissue handling

Post-operative:

• Assist in the safe delivery of the patient to Post Anesthetic Recovery
• Consult with members of the health care team to enhance recovery
• Participate as needed in discharge planning and post-operative teaching

At Niagara Health Nurse Practitioners (NPs) work within collaborative teams to provide care to defined patient populations in areas such as cardiology, medicine, nephrology, mental health and addictions, emergency, complex care and palliative care.

NPs integrate their extensive knowledge of advanced nursing practice to deliver high quality patient-centred care that optimizes outcomes. NPs work within a scope of practice that includes comprehensive health assessment, ordering and interpreting diagnostics, prescribing of pharmaceutical agents, and performing procedures.

NP competencies build and expand on the competencies required of a registered nurse and include:

• Professional role, responsibility and accountability
• Health assessment and diagnosis
• Therapeutic management
• Health promotion and prevention of illness and injury

Clinical Nurse Specialists (CNS) hold either a master’s or doctoral degree in nursing and have expertise in a clinical nursing specialty. At Niagara Health, CNSs work to promote excellence in patient care in mental health and addictions.

The CNS uses advanced knowledge, skill and judgment to provide care and demonstrates the following competencies:

• Conducting comprehensive in-depth assessments
• Developing, implementing, evaluating and revising plans of care in collaboration with the interprofessional team to enhance patient safety, accessibility and experience
• Fostering an organizational culture of learning, quality and safety through preceptorship, role, modeling, mentorship and coaching of nurses and other members of the care team and students

Leading the development and implementation of:

• Standards of nursing practice
• Practice guidelines
• Education strategies
• Quality management
• Research initiatives

Clinical Nurse Educators have roles in all program areas at Niagara Health where they teach, guide, support and evaluate staff learning to maximize individual potential and support the development of expertise and confidence in care abilities.

Clinical Nurse Educators demonstrate the competencies of:

• Developing, implementing, and facilitating learning activities that enhance nursing practice
• Supporting nurses in engaging in reflective practice and ongoing learning
• Role modeling expertise and leadership qualities
• Providing professional and educational advice to committees and teams

The Clinical Manager provides overall leadership and direction to interprofessional teams at the unit level to ensure the delivery of safe, effective, efficient and high quality care.

The key areas of accountability for the Clinical Manager are:

• Staff development and professional practice
• Resource utilization
• Customer and staff satisfaction
• Engagement of interprofessional resources
• Developing innovative, team-oriented strategies for day-to-day operations