NAME: Lisa Gorski, MS, RN, HHCNS-BC, CRNI, FAAN
CURRENT POSITION: Clinical nurse specialist
CURRENT AFFILIATION(S): Wheaton Franciscan Home Health & Hospice
AREA(S) OF SPECIALIZATION: Home care
PROFESSIONAL EDUCATION: MS, BSN, University of Wisconsin-Milwaukee College of Nursing
CERTIFICATIONS: HHCNS-BC, CRNI
What first motivated you to become a clinical nurse specialist?
From the very beginning of my nursing career, my passion has been about providing and promoting the best possible patient care. As a new graduate on a surgical unit and later as a critical care nurse, I witnessed much variation in care practices; I was always asking questions and reviewing the literature to understand the best approaches to care. I worked to promote consistency in certain practices on my units, for example, our practices in preoperative teaching. I started graduate school 1 year after receiving my BSN, knowing that I wanted to become a clinical nurse specialist (CNS).
What, if any, professional or career issues did you face early in your career as a CNS? What helped you address them?
I transitioned from being a critical care nurse educator to a home care nurse as I completed graduate school. In less than a year of working in home care, I was given the position as a CNS. One of the challenges was growing my expertise in home care at the same time as formulating and developing my role as a CNS. My critical care background contributed tremendously to my confidence and expertise in assessment and patient care, but I lacked certain experiences-for example, managing patients with long-term illnesses, dealing with barriers to patient and family self-care management, and working closely with family caregivers. My focus in graduate school was chronic illness, which complemented my acute care skills, helping me to understand the challenges and trajectory of chronic illness. Another issue, which all of us as CNSs face, was the need to explain and justify the CNS role as many coworkers were unfamiliar with the title. There were 2 other CNS positions created at the same time as my position, and the 3 of us really supported each other in addressing such challenges and growing our roles.
What do you perceive are the key issues for CNS practice today?
As CNSs, we must continue to promote the importance of our role and articulate our role within the health care system. In the world of home care, there are relatively few CNSs. In fact, the American Nurses Credentialing Center no longer offers the certification examination for the home care specialty because there were not enough home care CNSs taking the exam. Yet, the complexity of the patients managed in the home setting demands high-level nursing care. Home care was recently cited as the "best place for health care" in a position paper by The Joint Commission (http://www.jointcommission.org/assets/1/18/Home_Care_position_paper_4_5_11.pdf) However, we face many challenges in home care including growing numbers of older chronically ill patients, more regulations, less reimbursement, more technology, and higher expectations for implementation of evidence-based practices and positive clinical outcomes. Although home care research is growing and expanding, there are continued needs to identify best clinical practices and to effectively and efficiently implement technology solutions. I believe more CNSs are needed to address these issues in home care. Increasingly, CNSs in all settings, acute, long-term care, outpatient, and home care settings, will work together to effectively transition patients across clinical settings.
To date, what do you perceive as your greatest accomplishments as a CNS?
As a new home care CNS, one of the first "assignments" I was given was to develop a home infusion therapy program. This was in the late 1980s when home care was growing at a rapid pace, and it was the beginning of "high-tech" home care. I developed the program, educated the nursing staff, and managed many patients myself. I learned so much about the importance of, and strategies for, patient education in home care and the challenges that some patients face, being dependent on long-term infusion therapies. I became involved with the local chapter of the Infusion Nurses Society (INS) and ultimately the national INS, serving as President from 2007 to 2008. I identified a need for education for home care nurses across the country and ended up writing 3 successive books on the topic of home infusion therapy and many journal articles. This led to numerous occasions to speak to home care nurses about the issues, the challenges, and best practices. It also led to further opportunities to work with INS and my dedicated INS colleagues, most recently serving as chairperson for the 2011 Standards Committee. So I would say my ability to influence and educate home care nurses about home infusion practices is my greatest accomplishment, and that work continues. My CNS work led to important honors such as being inducted as a fellow in the American Academy of Nursing in 2006 and most recently being given the CNS of the Year award by NACNS. This award is especially meaningful, being recognized by my extremely talented CNS peers, for my work.
What do you enjoy or value most about the role of a CNS?
I think what I enjoy the most is the challenge of confronting many clinical issues, the variety of the role, and the ability to work within the spheres of influence. While I have emphasized my work in home infusion, I also deal with many other issues in my day-to-day CNS work. I continue to manage a small caseload of patients. I work with our nursing and other home care staff in improving and implementing evidence-based practices and also within the larger health care system. I have an active institutional review board-approved research study. I have been leading our home care team in the development of a palliative care program. There is always a new challenge, and the work is always interesting.
What advice would you give a new CNS starting out in this role?
Being a CNS presents an exciting opportunity to work within an organization to improve patient care. You need to be open-minded, identify opportunities for patient care improvement, and understand the organization's people and their roles. Join appropriate committees that involve patient care, and offer to take on leadership opportunities within them. Look at the challenges you encounter (and there will be many!) as opportunities. It is important to have a CNS support network-whether this is available within your organization or outside it. I believe that becoming involved in the National Association of Clinical Nurse Specialists, your local chapter, and other nursing organizations pertinent to your specialty is essential. For many years, I have been the only CNS in my home care organization. Connecting with other CNSs in the local community keeps me challenged and motivated.