NAME AND CREDENTIALS: Lianna Z. Ansryan, MSN, RN, CNS
CURRENT POSITION: CNS, Frailty Task Force
CURRENT AFFILIATION(S): Cedars-Sinai Medical Center
AREA(S) OF SPECIALIZATION: Cardiovascular
PROFESSIONAL EDUCATION: BSN-University of Southern California, 2004; MSN-Yale School of Nursing, 2007
CERTIFICATIONS: None
Lianna Ansryan, MSN, RN, CNS working as a progressive care clinical nurse specialist (CNS) at Torrence Memorial Medical Center in Torrence, California, was nominated by Angela Mankoff, MSNc, RN, CCRN, PHN, an acute care CNS student at California State University, Long Beach. California. Ms Mankoff describes her preceptor this way: "Precepting with her was challenging, liberating, motivating, and eye opening. I had not seen the CNS role so clearly defined in my previous clinicals as I did with her. To see the CNS function in all spheres of influence and not just as an "educator" was so refreshing compared with previous clinical experiences. Coming to her hospital, which was newly Magnet designated, "opened my eyes into how the CNS role is imperative in the success of organizations achieving and sustaining Magnet status." Ms Ansryan is dedicated to public and international health. She volunteers annually at a children's camp for those with heart disease, "Camp del Corazon," and does volunteer work on medical missions for cardiac surgery in both Haiti and Peru. Her nomination was supported by Barbara LeQuire, MSN, RNP, CNS, Vice President, Nursing Services, Torrence Memorial Medical Center, her CNS peers from Torrance Memorial Medical Center; Michael Millan, MSN, RN, CNS (a previous CNS student with her); and Lina Najib Kawar, PhD, RN, CNS, Assistant Professor, School of Nursing, California State University, Long Beach. The National Association of Clinical Nurse Specialists (NACNS) was honored to present the Preceptor of the Year award to her at the annual conference in Austin, Texas, March 2013.
This award was designed to nationally recognize an NACNS member for outstanding professional achievement as a CNS preceptor. The award acknowledges a CNS preceptor who has demonstrated commitment to teach, coach, and mentor CNS students to achieve CNS competencies as reflected in the NACNS Statement on CNS Practice and Education published in 2004.
You are obviously highly respected as a role model for CNS students, what do you feel are the most important skills or competencies to mentor for such students?
When I was given my first opportunity to precept a CNS student, I took a moment (after jumping up and down with excitement) to recall my experience as a CNS student and think about what I appreciated most among my preceptors. There were several characteristics that came to mind, and so in approaching my student I kept these in my forethoughts. A few of the skills that are crucial include the following:
* Be flexible. With graduate students as a preceptor, you must remember to take into consideration that your student is enrolled in school, is currently employed, and might have a family. In addition, you are working collaboratively with the university to accomplish the course objectives.
* Be passionate. Precepting is very exciting and rewarding, and at the same time, it can be challenging in many different aspects. Time constraints, different learning styles, skills sets, and so on can pose a challenge; thus, you really must be passionate both about your profession as a CNS and about precepting students.
* Provide feedback. While CNS students enter the program as a competent or expert clinician, they are a "novice" CNS; thus, continuous dialogue about the student's performance serves as reassurance and allows an opportunity to set/reset goals to help the student in achieving their objectives. During this time, you as the preceptor can also ask for the feedback on your teaching style and approach so that you may adjust if needed.
One of your personal skills mentioned by your nominees was challenging students to sharpen their critical thinking. What do you think are the best precepting methods to do this? What other most frequently used preceptor strategies do you use?
During one of my initial interactions with students, I ask students to list a few goals/objectives that they would like to accomplish during the rotation. I always ensure them that we will meet the objectives for the course, but I also want to know what their personal goals are. For example, a former student mentioned that they are absolutely afraid of teaching a class to a group of nurses, so we set this as one of the goals. During the clinical rotation, I shared with the student my unit staff's learning needs assessment for that year, and we identify the top 5 topics. From there, I asked the student to pick one topic that he found most interesting and research about it; I then asked him to summarize that into 25 PowerPoint slides. We took the set of slides and worked together to add learning objectives, and now we had a curriculum for a 30-minute presentation. I mentored the student to present this topic to the staff during a staff meeting, reassuring him that the staff is engaged during the meeting, and this is a topic that they have identified as a need. The staff meeting occurred toward the end of the student's clinical rotation, allowing him the time to build a rapport with the staff during the previous months; this made the environment very safe and comfortable.
To foster their critical thinking, I try to hold back from providing all the answers to their questions, rather I ask them to take a stab; however, I then share my perspectives as well. For example, if a situation arises where the CNS collaborates with the unit manager regarding practice concern of a staff, I ask the students how they would approach the situation.
Overall, I try to use open-ended questions such as to promote critical thinking:
* If you were the CNS, what would you do?
* What do you see as some of the potential barriers in a particular situation?
* Who would be your stakeholders for [horizontal ellipsis]?
* What can you bring to the table as a CNS?
* Is this an appropriate project for a CNS?
* Thinking about the CNS spheres, which sphere does a particular project fit under?
In your years of experience, is there one particular aspect of CNS practice that you think students struggle with the most and why?
The most common struggles that I have noticed among CNS students include understanding the relationship dynamics between a unit-based CNS, manager, and director especially when approaching unit-based projects. Another common one that I think at times we as CNSs struggle with is how to capture/measure our outcomes. Fortunately, one of my previous students decided that her project for the semester was to create a tool to capture CSN outcomes, and she would also use this in the future as a new-graduate CNS. She worked with our CNS group and quality department to create a tool, which she later submitted and was accepted for a poster presentation at the NACNS conference!
What successful learning activities do you use to help them in this area?
I find that the best way through these "struggles" are examples, sharing examples with students that come up during their rotation, also finding the appropriate learning opportunities for students that can help with these struggles; for example, attending a house-wide interdisciplinary falls committee that includes CNS, managers, directors, pharmacists, and the CNS student has the opportunity to see the role "in action" and understand the team dynamics.
What helped you the most in preparing for the role of a CNS?
Aside from the lectures, the best learning opportunities came from my preceptors who allowed me to step in their shoes as a CNS. I appreciated both the challenges and the level of autonomy as a CNS student. My CNS preceptors would trust me with a project and allow me to navigate through the system to successfully complete the project. At the same time, I am a firm believer that students need to be an active learner during the clinical rotation. As preceptors, we are skilled, knowledgeable, and ready to teach; however, a successful experience also requires a student who is engaged and seeks out learning opportunities.
What do you find you learn from the experience of precepting CNS students?
Precepting CNS students inspires me to continue doing the great work that we CNSs do; as you watch their enthusiasm and learn from their perspectives, it gives me ideas and keeps me engaged. I have also enjoyed the challenge of precepting students; as the preceptor, you are always adjusting your teaching style and approach for each student, so this helps me to self-reflect and continue to grow and improve as a preceptor; these experiences are very humbling. Precepting is definitely one of my joys as a CNS!
What has it meant to you to receive this award both personally and professionally?
I first learned about this award during the 2008 NACNS conference; attending as a new-graduate CNS, I remember telling myself that if I could ever receive one award as a nurse, I want this one! Precepting has always been a special part of my profession both as a staff nurse and as a CNS, and so when given the chance to precept, I welcome it with excitement. For me, it is the biggest professional accomplishment, and I was fortunate to be blessed with an amazing group of peers at Torrance Memorial and my previous students who nominated me for the honor.