THE CHANGING LANDSCAPE OF CREDENTIALING
The landscape for advanced practice registered nurses' (APRNs') credentialing is on the cusp of change. For some of us, it is like standing on a rocky coast watching the turmoil of the rushing seas. How do we-as clinical nurse specialists (CNSs)-make sense of the sea of change in legislation, accreditation, certification, and education?
The focal point of the change is the APRN Consensus Model being promoted by the National Council of State Boards of Nursing. This document is the result of years of collaboration between national nursing membership and credentialing organizations. The effort is intended to ease the challenge for APRNs to practice across state boundaries and to recognize the contribution that APRNs can make to healthcare delivery. In order to experience the benefits of this model, we must navigate a sea of change. The CNS role will be greatly impacted by the changes and will position the CNS to be a significant contributor to healthcare delivery.
The question facing us is: How can we weather the changes to get there? There are 2 currents of change that many of us are feeling the impact of. We understand that approximately 19 states will be pursuing the APRN Consensus Model in their state legislatures this session. Some of these states will be successful, and it will be essential that CNSs in those states make sure they are part of this process. The Legislative & Regulatory Committee of the National Association of Clinical Nurse Specialists (NACNS) has worked hard this year to develop a legislative tool kit that is available on the NACNS Web site for you to use in these efforts. It is most important that the language in the APRN Consensus Model that provides a grandfathering provision for previously recognized CNSs be included as well as language that defines the CNS as one of the APRN roles. Clinical nurse specialists will need to carefully follow the work of their state boards of nursing and follow any state legislation to make sure their state law reflects optimal language for CNS practice.
In an effort to prepare for a future that is driven by the APRN Consensus Model, certification bodies have announced plans to implement changes to their eligibility requirements for their examinations. You may have seen the recent statements from AACN and ANCC regarding certification. We have all heard the adage, "timing is everything." The dance between the promotion of the APRN Consensus Model and the changes to certifying examinations is one that demonstrates the challenges in orchestrating national change. It appears that the certifying bodies are moving forward with the changes, based on the APRN Consensus Model, to their examinations that will go into effect in 2013, but we have no guarantee that APRN Consensus Model will be adopted on this same time frame.
So, how can we weather this storm of change? First, it is important that if you currently hold a certification as an advance practice nurse, you need to continue to maintain that certification. If you do not renew/keep your certification current, you will need to comply with the new eligibility requirements for certification. This may mean returning back to school for a postgraduate certificate that would incorporate the new educational eligibility requirements for the new certification examinations.
This is true in my case. I graduated from graduate school in 1999; at that time, I needed only 250 clinical hours in school. For certification, the eligibility requirements at that time were an additional 250 hours, then sit for certification. Unfortunately there were no CNS positions at the time I graduated, and I started to teach at a local community college. While continuing on in my career, I took an administrative position as an assistant vice president of a cardiovascular service line. In this role, my educational preparation as a CNS and my specialty focus served me well in building a new service line, opening an open heart program and coronary intervention program. As I continued in my career, I was promoted to the chief nursing officer position. Several years later, I found myself back at the bedside as a CNS in critical care in 2009. When inquiring about certification in 2011, I was not eligible for the adult health CNS and CCNS.
Many of you may have received a letter and/or e-mail notification from AACN or AANC regarding the changes to the eligibility requirements for certification as a CNS. There are several concerns I have with these changes occurring now. There is no nationally recognized population-based examination or other system of certification for the CNS at this time, acknowledging that this will take time to develop and go through the process of being a psychometrically sound examination. In addition, there is a need for CNS graduate programs to be modified so that specialty is emphasized within role and population. I have heard of many nursing programs that are developing postgraduate programs to assist CNSs in getting the required educational preparation. Where does experience leave us? What is going to happen when a CNS is told he/she will need to also have additional clinical hour requirements in order to be certified?
You need to know that NACNS is committed to removing certification and regulatory barriers for CNSs and will continue to work on addressing these issues and concerns of its members. I urge you if you have not taken the time to look at the changes to the certification requirements, now is the time to dive in. And again, if you are currently certified, do not let this lapse, or you may find yourself in a position where you will no longer be eligible to sit for a certification examination.
NEWS FROM OUR AFFILIATES
California Association of Clinical Nurse Specialists
Once again, the California Association of Clinical Nurse Specialists was recognized as the Affiliate of the Year. Incoming president Cecelia Gray accepted the award at the 2012 National Association of Clinical Nurse Specialist Conference held in Chicago in March. Congratulations to all our members for making this possible.
Dr Katie Beam, DNP, RN, ACNS-BC, CWS, a CNS at Woodland Healthcare, has been appointed as adjunct faculty at both California State University Stanislaus and California State University Sacramento. As adjunct faculty, she is teaching the Advance Pathophysiology coursework in the master's programs of both universities. Dr Beam also passed the National Board Certification examination for the Certified Wound Specialist (CWS) and is now a diplomate of the American Board of Wound Management. The CWS is the most prestigious and rigorous certification in wound care and demonstrates a distinct and specialized expertise in this area of practice. There are only about 3000 CWS practitioners in the United States including physicians.
Submitted by: Margaret Talley, PhD, RN, CNS, CWCN-AP
Central Ohio Clinical Nurse Specialist Association
The Columbus, Ohio, chapter of the National Association of Clinical Nurse Specialists (NACNS) was formally given affiliate status in April 2011. The Central Ohio Clinical Nurse Specialist Association (COCNSA) was a collaborative effort between Mt Carmel School of Nursing, whose clinical nurse specialist (CNS) students formed the chapter as a student project, and the Ohio State University Medical Center, whose CNSs were also working on forming a chapter at the same time as the Mt Carmel students. When the 2 groups heard about each other from the national organization, they came together to establish a chapter. COCNSA is sponsoring its second annual education conference, has enrolled 50 members, and will soon have a publication by its members.
COCNSA goals were to
(1) increase local and regional visibility and influence of the CNSs. The strategies for meeting this goal included establishing a chapter, applying for affiliation status, and encouraging members to join NACNS. The first 2 strategies were accomplished last year, and we continue to encourage membership in NACNS.
(2) promote and advocate for the CNS role within the central Ohio healthcare community. We met this goal by hosting a seminar to advocate for CNS positions, encouraging and promoting membership in the local chapter to increase support and mentorship, and having established CNSs assist with mentorship of CNS students.
(3) assist the NACNS in advancing the practice of the CNS. All of these were accomplished within the first 6 months of the chapter's establishment.
The COCNSA chapter continues to further the advancement of the CNS through electronic newsletters, educational seminars, and a Web site and will seek to establish scholarships for future CNS students.
Submitted by: Sunny Rai, MS, RN, ACNS, CIOCNS President
Illinois Branch Clinical Nurse Specialist
The Illinois Branch Clinical Nurse Specialists is a new affiliate of the National Association of Clinical Nurse Specialists (NACNS). The affiliate is led by Cristin Rassi, APN, ACNS-BC, CNRN, as chair and Mary Webb, APN, ACNS-BC, as cochair. Both are practicing clinical nurse specialists (CNSs): Cristin practices across the continuum of care in neuroscience, specifically in neurosurgery and Mary is a hospital, system-based CNS. In addition, Diane Ryzner, APN, CNS, CCRN, OCNS-C, an orthopedic CNS, is the CNS representative to the Illinois State Advanced Practice Nurses organization. Illinois Branch Clinical Nurse Specialists has 26 members who also hold dual membership in Illinois State Advanced Practice Nurses. We are excited to start an affiliation with NACNS and hope to recruit more CNSs to join NACNS. We recognize that the multifaceted roles of the CNS are extremely valuable and will make a huge contribution to Accountable Care Organizations. The CNS has its own unique issues. We are fortunate in Illinois that the CNS role has title protection and is recognized as an advanced practice nurse. As a new affiliate, we plan to network within our state of Illinois and at the national level. We need to advocate for one another, especially as the Advanced Practice Registered Nurse Consensus Model unfolds. We look forward to the 2012 Annual NACNS Conference in our windy city of Chicago, Illinois.
Submitted by: Cristin Rassi, APN, ACNS-BC, CNRN
Military Virtual Affiliate
The Military Virtual Affiliate welcomes new cochair, MAJ Lisel Gates, US Army. MAJ Gates is an adult health clinical nurse specialist, who is currently stationed at Evans Army Community Hospital in Fort Carson, Colorado. She has been a member of the Military Virtual Affiliate since 2009 and has greatly contributed to the continued growth of our affiliate.
LTC Gayla W. D. Wilson, chief nurse, currently stationed at US Army Health Center Grafenwoehr, Germany, presented at the LTC Juanita Warman Conference on "Navigating the Multi-generational Workforce." As a TeamSTEPPS trainer, she has taught more than 70 medical personnel to enhance communication and the team approach to patient care.
Submitted by: LCDR Tina M. Cox, MSN, MSM, CNS-BC, RNC
Northeast Alliance of NACNS
The Northeast Alliance continues to meet regularly. Any clinical nurse specialist (CNS) in Maine, New Hampshire, Vermont, and/or Massachusetts is welcome to join and may be interested in joining us by a virtual meeting or teleconferencing. At this time, the membership is low, and we do not have membership dues in order to encourage communication, collaboration, and idea sharing. If you would like to join our group, please e-mail the chair, Anne-Marie Hardman, at [email protected].
In September, we explored ideas on outcome monitoring to include core measures, clinical practice changes, and how to measure those outcomes. Members discussed their particular clinical practice changes and outcome measurements of practices such as delirium assessment, clinical institute withdrawal assessment, and fall prevention. Grant writing was discussed with information shared from a workshop attended by a few members. Other CNS members have had experience with grant writing and discussed resources. Resources available through the Maine Health System were also mentioned.
The major topic of discussion was the Maine Board of Nursing activities to adopt the Advanced Practice Registered Nurse (APRN) Consensus Model. The board of nursing has developed an APRN panel to review the current chapter on APRN practice. The board discussed legislative changes and is planning a formal bill proposal in September 2012 to allow CNS and Certified Registered Nurse Anesthetist prescriptive authority (currently, these 2 roles do not prescribe in Maine). The bill will also propose adoption of the consensus model with the doctorate requirement for new APRN roles. An APRN in practice prior to this bill will be grandfathered into practice as an advanced practice nurse.
Submitted by: Anne-Marie Hardman, MSN, ACNS-BC, OCN
Philadelphia Area Affiliate of Clinical Nurse Specialists
Fourteen founding members joined to form the Philadelphia area affiliate in November 2011. We have presented a program that highlighted reports from the National Association of Clinical Nurse Specialists membership liaison (Eileen Gallagher, MSN, RN, ACNS-BC) and education committee liaison (Donna Callahan, PhD, RN, GCNS-BC, CNE). Thirty participants discussed the National Association of Clinical Nurse Specialists Johanna Briggs member benefit and the use of evidenced-based practice to guide patient outcomes. Plans are underway for a spring program. The group is led by Colleen Quinn, MSN, RN, ACNS-BC, CEN, from Philadelphia and Mary Brennan, MSN, RN, from Langhorne, Pennsylvania.
Submitted by: Colleen Quinn, MSN, RN, ACNS-BC, CEN
Veterans Affairs Virtual Affiliate
Janette Elliott and Mary Thomas, both CNSs at the Palo Alto, California, Veterans Affairs Medical Center, recently published in the following article: "Thomas ML, Elliott JE, Rao SM, Fahey KF, Paul SM, Miaskowski C. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum. 2012;39(1):39-49."
Kathleen L. Dunn, SCI CNS, at the San Diego Veterans Affairs Medical Center, presented a full-day workshop on Spinal Cord Injury Nursing at the Rehabilitation Institute of Oregon, in Portland on February 9 and 10, 2012. She provided the same workshop twice in order to reach as many nursing staff as possible.
Submitted by: Kathleen L. Dunn, MS, RN, CRRN, CNS-BC
Wisconsin Association of Clinical Nurse Specialist
The Wisconsin Association of Clinical Nurse Specialist (WIACNS) started the year by focusing on the Institute of Medicine's Future of Nursing: Leading Change, Advancing Health (2011) report as an educational topic at our general meetings. To enhance affiliate knowledge and engagement to change healthcare policy at state and national levels, future educational sessions will focus on understanding the political arena. In addition, Suzanne Purvis, NACNS board member, will provide critical insight into how the role of the CNS can be impacted by membership on key organizational and national boards. WIACNS will hold its annual conference entitled, "CNS Leaders: Transforming Health Care," in October 2012.
Two WIACNS members are representing the affiliate in the current legislative arena in the ongoing process to secure title protection in Wisconsin for advanced practice nurses.
In February 2012, 4 WIACNS members were awarded financial support based on a new "point system," which recognizes CNS activity and outcomes in the 3 spheres of influence. The funds were granted to support attendance to the NACNS 2012 Conference in Chicago. In addition, it is the custom of this affiliate to support the president's or president-elect's attendance at the national conference. For the past 2 years WIACNS members have been awarded national recognition. Sharron Coffie, president-elect, was recognized with the 2011 Preceptor of the Year Award and Stephenie Cerns, current president, was recognized as the 2012 CNS of the Year. The WIACNS affiliate has been awarded the Silver award by the NACNS for its scholarship donation.
The 2012 Affiliate Vision statement seeks to strengthen partnerships, community involvement, and leader development program and increase WIACNS membership participation. The current WIACNS officers include Stephenie Cerns, president (Froedtert Hospital); Sharron Coffie, president-elect (Froedtert Hospital); Julie Darmody, past president (University of Wisconsin-Milwaukee); Jan Ancon, treasurer (Wheaton Franciscan Healthcare); Brenda Larkin, past-treasurer (Aurora Health Care); Barbara Mangiafico, secretary (ProHealth Care). To learn more about WIACNS, visit our Web site (http://www.wiacns.org).
Submitted by: Stephenie Cerns, MSN, RN, ACNS-BC, RN-BC, CHPN, President, and Sharron Coffie, MS, RN, CNS-BC President-Elect
MEMBERS NEWS
Ann M. Mayo, DNSc, RN, FAAN, and professor at the Hahn School of Nursing & Health Science at the University of San Diego, received 2 regional awards. She was awarded the 2011 Best Practice-Excellence in Nursing Research, Association of California Nurse Leaders Recognition Award, and the 2011 American Nurses Association California JoAnne Powell Award for Research. Please join us in congratulating Dr Mayo.
Pam Bellefeuille of the California Association of Clinical Nurse Specialists was promoted to full clinical professor at the University of California, San Francisco, School of Nursing. Pam teaches in the Masters Entry Program in Nursing that takes students with nonnursing baccalaureate degrees and prepares them as advanced practice nurses. Pam has 3 to 4 CNS students doing clinical teaching practica each quarter.
Jeffrey Jones, DNP, PMHCNS, BC, LNC, and member of NACNS, is the editor, along with Joyce Fitzpatrick and Vickie L. Rogers, of a new undergraduate textbook, Psychiatric-Mental Health Nursing: Interpersonal Approach (2012), published by Springer. If you teach undergraduate students, you should check it out.
CNS Foundation News
The CNS Foundation Board of Trustees is deeply grateful to the 11 NACNS affiliates that contributed items for our 2012 silent auction at the NACNS annual conference in March. Through the generous support of these NACNS affiliates, the silent auction raised funds to enhance our scholarship program:
Alaska Clinical Nurse Specialist Association
Central Indiana Association of Clinical Nurse Specialists
Illinois Branch Clinical Nurse Specialist Representatives
Michigan Association of Clinical Nurse Specialists
Northeast Ohio Clinical Nurse Specialists
Oklahoma Association of Clinical Nurse Specialists
Oregon Council of Clinical Nurse Specialists
Philadelphia Area Affiliate of Clinical Nurse Specialists
Veterans Affairs Virtual Affiliate
Virginia Association of Clinical Nurse Specialists
WIACNS (Wisconsin Association of CNSs)
Sincere thanks also to the NACNS Board of Directors and NACNS interim Executive Director Melinda Ray for donations of items for our silent auction. Your participation with the foundation in fundraising and your support are important to our success! For more information about these and all the foundation's activities, please see the foundation's Web site CNS-Foundation.org.
NACNS 2013 CONFERENCE-SAVE THE DATE
The 2013 National Association of Clinical Nurse Specialists' conference will be held in San Antonio, Texas, on March 7 to 9 at the Hyatt Regency. Come prepared for a historical and cultural immersion experience. The weather is generally mild (60s-70s) and sunny in March. The Hyatt Regency overlooks the Alamo and is located on San Antonio's fabulous Riverwalk. San Antonio blends American and Mexican history and offers unique diversity. There are many boutiques, artist shops, and historical sites within walking distance, so bring walking shoes. The Call for Abstracts will be distributed soon-consider submitting an abstract for 2013.
CALL FOR NEWS ITEMS
If you have information you want to share about yourself, your NACNS or affiliate peers, please send the news item to Ethan Gray at [email protected]. News items for the 2012 September/October issue are due by June 28, 2012.