Name: Pauline C. Beecroft, PhD, RN, FAAN
Current Position/Title: Nurse Researcher
Current Affiliation(s): Childrens Hospital Los Angeles
Area(s) of Specialization: Pediatrics, Parent/Child Research
Professional Education: PhD, University of Texas, Austin MN and BS, University of California, Los Angeles
Certification(s): None
What first motivated you to become a clinical nurse specialist?
I began working in the hospital setting and in 3 months was working as a charge nurse. I learned I did not enjoy this administrative perspective. I knew I wanted to stay clinically focused and remain at the bedside. I went back to school in a couple of years and selected the clinical nurse specialist (CNS) program because it fit my desire.
What were the professional or career issues you faced early in your career as a clinical nurse specialist?
I was working at University of California Los Angeles (UCLA) Medical Center. When the hospital was full, the pediatric nurses were floated off the unit or pediatric patients were assigned to other units. Adult nurses were assigned to pediatric patients, but they did not recognize pediatric issues or critical assessment findings, such as decreasing heart rates, from pediatric norms. I was somewhat of a "rebel rouser" and formed a committee of the pediatric nursing staff, and we began doing our own scheduling. We were able to document for administration the importance of not floating the pediatric staff. Based on this activity early in my career, I was placed on a professional practice committee and provided "a voice" for nursing.
What do you perceive as the key issues for clinical nurse specialist practice today?
1. Role recognition-we, as CNSs, are still fighting this one since the beginning of CNS roles. It is discouraging that even within nursing, nurses do not recognize the contributions of CNSs.
2. Unclear role boundaries-CNSs practice at a different level than staff nurses, but there remains much overlap in the roles. When the American Nurses Association (ANA) described the role components of the baccalaureate-prepared nurse compared with other educational preparation, it touted many of the same roles as the CNS subroles. This added to confusion in role recognition. People did not recognize the outcomes of CNS practice and very little was in print. The CNS's role contributions were somewhat invisible because their work focused often on "nursing in general," not as clearly task defined as the nurse practitioner role. We need to start with a clean slate. We need to start somewhere different and better define the role.
To date, what do you perceive as your greatest accomplishments as a clinical nurse specialist?
1. Personally, I believe it has been my commitment to maintain the integrity of the CNS role. Particularly educators and administrators push CNSs to go outside the role. This creates lack of clarity for the public and other nurses.
2. I believe it was establishing the first international journal for CNS practice. I was teaching CNS students in a joint appointment at California State University in the early 1980s. There was no literature about the role. I had to go to other journals to get information. My first idea was to write a book. I attended a CNS conference in Arizona and listened to the participants' questions. I realized these folks need a journal to write in and share their experiences and ideas in real time. It was serendipitous. Margo O'Neal, who was in publishing at Williams & Wilkins, was there, and so the journal was started. The journal provided a forum for me to share my own ideas, hopefully influencing, teaching, and assisting the work of colleagues. It has contributed to the writings of nursing and hopefully stimulated others to contribute to the profession.
3. It has also been teaching CNS students. "Having been there," I can help them to establish the role and share with them the benefits of my expertise.
What do you enjoy or value most about the role of a clinical nurse specialist?
The ability to move into unknown territory, establishing a new system to get everyone running up to par. There is nothing routine or boring. The CNS is faced with doing something about many different challenges.
What advice would you give a new clinical nurse specialist starting out in this role?
Find a mentor. It does not need to be a CNS but must be someone seasoned in nursing to get off to a good start. My mentor was Audrey Beatty, Director of Nursing at Childrens Hospital Los Angeles. It was my first job as a CNS and I was one of the first hired at the hospital. My mentor had a good perspective on nursing and valued the CNS role. She empowered me to face the challenges there. The pediatric intensive care unit (PICU) needed to upgrade its practice, and I had recently practiced in the PICU at UCLA. As my mentor, she provided support and made the effort, even when out on a limb, to promote the role. We practically turned over the entire staff to achieve our goal.
Find other CNSs to support and help you to stay true to the role.
Are there any other thoughts you would like to share with your clinical nurse specialist colleagues?
There are difficult times ahead for nursing, particularly with the nursing shortage. There will be insufficient role models for new nurses. We need to provide mentoring relationships. Those of us who are older and retiring will need to provide support. Nurses entering our profession do not become experts overnight. We must recognize the developmental progress of a nurse and help each one build his or her expertise. You cannot fool those you work for, those who will need your clinical expertise.
FIGURE