Purpose/Objectives: Generative artificial intelligence (GenAI), as a new technology and innovation in practice, is here. The purpose of this paper is to introduce general principles for using GenAI to enhance the workflow of the clinical nurse specialist.Description: This technology is rapidly advancing and influencing practice, education, communication, and workflow for nurses and clinical nurse specialists. Understanding how to optimize GenAI, including developing strong prompts to improve outputs, is shared.Outcome: A hypothetical example of a clinical error is used to demonstrate ways in which GenAI can be used to search the literature, create a Situation, Background, Assessment, and Recommendation (SBAR) document and a competency tool is presented.Conclusions: GenAI is a useful tool supporting the workflow of clinical nurse specialists in all practice settings. Understanding the nuances of using AI inclusive of the importance of human, expert oversight by the clinical nurse specialist, can build stronger nursing and healthcare systems resources and optimize patient outcomes.
Aims: To explore how operating room nurses (ORNs) make clinical decisions during surgical wound closure, a delegated act for which they are legally authorized but often constrained in practice.Materials and Methods: A qualitative exploratory-descriptive study was conducted with 14 ORNs working in public and private surgical facilities in northern France. Individual semistructured interviews were carried out between February 2025 and March 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's reflexive thematic analysis. COREQ guidelines informed reporting.Results: Six themes were identified. ORNs primarily developed wound closure skills through experiential learning rather than formal training. Their autonomy was conditional, shaped by institutional protocols, surgeon expectations, and hierarchical dynamics. Trust and familiarity within surgical teams determined whether nurses could take initiative or adapt closure techniques. Institutional factors-such as operating room turnover and prioritization of surgical residents-limited opportunities for nurse-led closure. Many ORNs reported low recognition of their role, leading to professional invisibility. Despite these constraints, some ORNs demonstrated patient-centered reasoning, adapting closure methods to individual characteristics when possible.Conclusion: ORN decision-making during wound closure reflects a persistent tension between legal authorization and limited enacted autonomy. Enhancing nurse-led closure practices requires clearer protocols, improved interprofessional recognition, and educational strategies that integrate both technical and judgment-based competencies.
Purpose/Objectives: To deliver evidence-based, high-quality end-of-life care through a collaborative initiative led by geriatric and palliative clinical nurse specialists in partnership with an interdisciplinary team and hospital administration. Description: After identifying inconsistent end-of-life care within an academic medical center, geriatric and palliative clinical nurse specialists synthesized best practices to develop a “comfort care” initiative. Operating across the 3 clinical nurse specialists’ spheres of influence, the team collaborated with administrative and interdisciplinary stakeholders to pilot the model on a specialized geriatrics unit. Outcomes: Implementation led to consistent use of individualized care plans, accurate pain assessments, and timely execution of EOL orders. In the designated unit, nurses achieved compliance rates of 80% to 100%, significantly outperforming other system settings. This successful pilot served as a catalyst for system-wide improvements, including the standardization of evidence-based nursing care plans, comfort care code status protocols, and end-of-life order sets throughout the hospital system. Conclusions: This project demonstrates that clinical nurse specialists-led interdisciplinary collaboration can drive sustained, significant improvements in end-of-life care quality and system-wide practice standardization.
