I just returned from the Sigma Theta Tau 17th International Nursing Research Congress in Montreal, Quebec, Canada. The theme of the congress was the integration of evidence-based practice into day-to-day operations at the bedside. I did not go to the congress in my role as the President of NACNS but simply as a learner in an attempt to bring a jewel or two back to my place of work at the Portland VA Medical Center. I am pleased to report that I came back with more than one jewel.
I attended both days of preconferences and was thrilled to meet the directors of the Joanna Briggs Institute from Australia, Dr Alan Pearson, Mr Craig Lockwood, and Mr Zuben Florence. I also met Drs Bernadette Melnyk and Ellen Fineout-Overholt from the Arizona State University Center for Advancement of Evidence-Based Practice. In both instances, I heard strong support for the clinical nurse specialist (CNS) role in the implementation and integration of evidence-based practice at the bedside. From initial discussion of the evidence base to the descriptions of successfully changing practice of those who care directly for the patients in an effort to increase patient safety and quality, it was the CNS who stood out as the critical link. Little did I know that those 2 days were simply a precursor to the 3 days of the congress that followed.
Throughout the remaining 3 days of the actual congress itself, I attended many sessions that were being conducted by individuals who proudly identified themselves as CNSs at the beginning of their presentation or who revealed their educational preparation as the presentation progressed. They repeatedly and confidently demonstrated the skills necessary to weave together the system, the nurse, and the patient through the use of the evidence base, negotiation skills, and a desire for collegial collaboration. Consistently, I heard the message that the CNS was the one who held the key to successful implementation of the evidence base and the one who was making a significant contribution to the overall health of our patients in all facilities where they work.
This conference was not limited only to nurses from the United States. It was an international conference, and the countries represented there were as wide ranging as South Africa, India, Canada, and China. I had the distinct pleasure of dialoguing with CNSs from Canada and South Africa as well as those a little closer to home in Washington State. In every instance, they too remarked that the CNS role was dominant in providing the structure and support for successful implementation of a strong evidence-based practice environment.
The winds have changed. The need for the CNS is ever more evident as the cracks in the healthcare system have made themselves known. It is the CNS who can provide the much-needed "glue" that can bring our fractured healthcare systems together. The evidence exists all around us. As the expert nurses who connect the patient to the system, provide much needed support for the new graduates who are entering the workforce in record numbers, and bring the quality and safety initiatives of the Institute for Healthcare Improvement and Evidence-Based Practice to the patient, the CNS is key.
It is also evident that the CNS can be instrumental in bringing together a global healthcare perspective. Although educated in different systems, the key role of the CNS that was articulated by the many CNSs from different countries was the same. We are the "grey gorillas" who are holding the healthcare systems together.
It is the CNS who is mentoring the other disciplines on how to implement evidence-based practice. Our reach is not only to our nursing peers but also extends to our physician colleagues and transprofessional groups from all disciplines.
If you do not already know about the Joanna Briggs Institute for Evidence-Based Practice, find out about them. If you are not aware of the mentorship program for evidence-based practice from the Arizona State University program, find out about it. Increase the power of the tools you already have in your place of work. Increase your reach for provision of quality and safe care by not only your nursing peers but the other disciplinary groups you work with as well. Let them hear the grey gorillas roar on behalf of our patients.
NACNS UPDATES
Plan Now to Attend the 2007 NACNS Convention
Plan to spend your spring vacation in sunny Phoenix, Ariz. The 2007 NACNS convention will be held from February 28 to March 3. The convention will give you an excellent opportunity to recharge your batteries and network with CNSs from across the country. Watch for convention brochures to arrive soon.
News From Our Committees
Affiliate Advisory Committee
Projects that are currently underway:
1. Revision of the Affiliate section of the NACNS Web siteThere will be a resource page with information on becoming an affiliate, the American Nurses Credentialing Center continuing education process to obtain contact hours for your local education programs, Frequently Asked Questions, annual report form, and sample operating guidelines. In addition, there will be links to other important sites, such as the National Council of State Boards of Nursing, National League for Nursing, American Nurses Association, and others. Furthermore, a speakers' bureau section is under discussion. The Affiliate of the Year application will continue to be available-please consider applying. A template has been completed for affiliate leaders to submit information on their affiliate and have it posted. This will include identification of contact people, upcoming events, meetings, and ability to include a recent newsletter if applicable. It would be accessed by clicking on the name of the affiliate. Completion is expected by September. Thanks to Lisa Hopp, webmaster, for her assistance with this project.
2. Coaching/Mentoring programThis would be a volunteer service from one affiliate to another. If interested, the affiliate would identify the coach/mentor and include this person's contact information on the annual report. Please share any ideas you have for this program.
Annual Report (Reminder)
All affiliates are required to submit an annual report of the past year's activities. It is requested in January. Please plan ahead or keep a running tally of the information requested so that it will not be overly burdensome. The form will be on the affiliate section of the Web site for easy accessibility.
Membership on the Affiliate Advisory Committee
We would appreciate hearing from anyone who is interested in serving on this committee, especially if your affiliate is not currently represented. We will meet by conference call for 1 hour each month. Please contact the national office for more information about this committee and how to apply for membership.
Submitted by Cindy R. Balkstra, MS, APRN, BC; Chair, Affiliate Advisory Committee, [email protected].
News From Our Affiliates
California CNS Network
The California CNS Network Annual Conference in Palm Springs at Rancho Las Palmas Resort and Spa on November 4 is just around the corner. Our theme, "Safety and Quality," will be highlighted with presentations by dynamic CNS leaders including Beth Henneman, Pat Quigley, Trish Hunter, Diane Brown, and our own Bonnie de los Santos, Kathi Ellstrom, and Ann Mayo.
Garret Chan, Psychiatric CNS, has been working with a group of CNSs across the State of California, seeking to introduce a bill during the next legislative year to allow CNSs the option of obtaining furnishing (prescriptive) authority. This concept was brought up at the last California CNS Network meeting at the 2005 California CNS Conference in Palo Alto. The group, CNSs for Furnishing Authority, developed a white paper on the topic of providing sound reasons that CNSs should obtain furnishing authority to provide symptom management. They also developed a companion FAQ sheet on the topic. The CNSs for Furnishing Authority group is seeking the California CNS Network's endorsement of their white paper and FAQ sheet. They are focusing on the OPTION for CNSs to obtain a furnishing license through California's Board of Registered Nursing. Mr Chan, in particular, is focusing on many aspects of furnishing authority but significantly is calling attention to nursing's role in symptom management. Mr Chan believes that nurses have always been very active in nonpharmacologic and now pharmacologic interventions for symptoms. He has submitted the white paper and FAQ sheet to the California CNS Network's Board and received endorsement. He is now in the process of meeting with a California legislator to draft the proposed law. Mr Chan has been accepted to sit on NACNS's Practice Committee.
Submitted by Margaret, Talley, RN, CNS; Chair, California CNS Network.
South East Clinical Nurse Specialists, Georgia Affiliate
The South East Clinical Nurse Specialists, Georgia NACNS Affiliate, is hosting a state-wide meeting for CNSs on October 6, 2006 at Memorial Health University Medical Center, Savannah, Ga. All interested CNSs, CNS Students, and educators are invited to attend this important meeting. The goal of the meeting is to gather consensus and plan a strategy to submit a request to the Georgia Board of Nursing for Advanced Practice recognition for all CNSs in the State of Georgia. For further information, please call Marion Mann at (912) 350-7820 or e-mail at [email protected].
Submitted by Marion Mann, MSN, RN, CNS; President, South East Clinical Nurse Specialists.
Minnesota
Before winter arrives, the Minnesota affiliate to NACNS is quickly preparing for its October 6th all-day conference. Our conference with a theme "CNS Practice: Positively Influencing Patients, Nurses, and Organizations" mirrors the discussions held at the National 2006 NACNS conference. The goal of our affiliate conference is to discuss the influence of the CNS in all areas of practice through the following objectives:
* Define CNS success from an administration level.
* Discuss ways a CNS can exert influence in the 3 spheres of practice in the outpatient, inpatient, and home health settings.
* Describe how credentialing, privileging, and Joint Commission on Accreditation of Healthcare Organizations regulations are being addressed in your organization.
* Illustrate ways the behaviors of collaboration, mentoring, and coaching fall within the CNS sphere of influence.
* Summarize current issues regarding CNS practice, that is, the Doctor of Nursing Practice role, NCSBN draft paper, CNL role, and NACNS activities.
As our affiliate membership continues its growth with many CNS students joining to take advantage of collaboration and networking opportunities, we welcome additional members and all regional CNSs to our conference. Currently, we have approximately 143 members in our affiliate with 1 CNS representative on the Minnesota Board of Nursing and 1 member recently appointed as President of American Association of Critical-Care Nurses.
Along with our annual conference, we are working toward organizing a CNS collaboration session within our 2007 quarterly meetings. This collaboration session will provide a forum for each Minnesota institution to share interventions for dealing with identified issues that may be pertinent to all CNS roles. Discussion topics will be selected by a planning committee with representation from several institutions.
Finally, as an affiliate, we continue to dialogue with our state board of nursing representatives and Nursing Schools in regard to the direction and implementation of the Doctor of Nursing Practice. Our affiliate's collaborative position statement was forwarded to the Minnesota Board of Nursing and the board of NACNS this past Spring.
Submitted by Karen T. Warfield, CNS, MS, RN.
Montana Association of Clinical Nurse Specialists
The Montana Association of Clinical Nurse Specialists held their spring meeting via video conference accessible from Montana State University's nursing campuses in Bozeman, Billings, Great Falls, Helena, Missoula, and Kalispell. Invited guests included CNS, family nurse practitioner, and bachelor of science in nursing students, nursing educators, Montana State University Dean and Associate Dean for nursing, clinicians, and the Executive Director of the Montana Nurses' Association. The agenda included a robust discussion of the National Council of State Board of Nursing's Vision Paper and the development of an action plan to provide input on the article to the state and national nursing boards. Also on the agenda was a report from Montana State University faculty members (Linda Torma, Charlene Winters, Susan Luparell, Deanna Babb, and Dale Mayer) and CNS students (Rebecca Echeverri and Aven Strand) who presented or attended the national CNS conference held in Salt Lake City, Utah. The students commented that attending the conference helped them better understand the role of the CNS and provided an excellent opportunity for networking with CNSs from around the country. They highly recommended that CNS students be encouraged to attend the annual event. Based on the faculty and students' positive experiences at the conference, the members agreed to make the conference report a regular part of the spring meeting. At our fall meeting, we will continue to work on developing a chapter Web site, begin planning for the annual educational meeting, and develop our goals and activities for 2007.
Submitted by Charlene A. Winters, DNSc, APRN, BC, CNS.
Clarification of an Item From the March 2006 Issue of the NACNS Newsletter
In the Affiliate News section of the March 2006 NACNS newsletter, published in Volume 20, Number 2 of Clinical Nurse Specialist, the news item pertaining to the Delaware Valley Networking Group carried the heading of "Delaware." To clarify, the Delaware Valley Networking Group is not solely a Delaware affiliate. Instead, the affiliate represents the Delaware Valley region that includes Eastern Pennsylvania, New Jersey, and Delaware.
News From the Clinical Nurse Specialist Foundation
As a nonprofit organization founded by the NACNS, the CNS Foundation strives always to comply with the legal and regulatory requirements imposed on nonprofit organizations by federal and state law. One such federal law that impacts the function of the Foundation is the Sarbanes-Oxley Act (the "Act"). To ensure compliance, the Board has enacted 2 policies required by this law for nonprofit organizations.
Background-Sarbanes Oxley Act
The Sarbanes-Oxley law was enacted by Congress in response to the corporate scandals of Enron, Tyco, and other corporations, which eroded the public's trust in America's public corporate sector. The law principally applies to publicly traded corporations and requires them to adhere to governance standards that increase the board's oversight of financial transactions and auditing procedures of the corporation. However, 2 provisions of the Sarbanes-Oxley Act directly apply to nonprofit corporations also. These provisions call for the development of polices and procedures to protect whistle-blowers within the corporation and for document retention.
Whistle-blower Protection
The Sarbanes-Oxley Act provides protections for whistle-blowers (individuals who in good faith report suspected illegal behavior) and imposes criminal penalties for actions taken in retaliation against whistle-blowers. It is illegal for any corporation, including nonprofit corporations, to punish the whistle-blower in any manner.
Under the Act, an organization must develop procedures for handling employee or volunteer complaints including the establishment of a confidential and anonymous mechanism to encourage employees and volunteers to report any inappropriateness within the entity's financial management. No punishment for reporting problems-including firing, demotion, suspension, harassment, failure to consider the employee for promotion, or any other kind of discrimination-is allowed.
To comply with the Act, the NACNS Foundation has developed and adopted a formal process to deal with complaints and prevent retaliation via its Whistle-blower Protection Policy.
Document Destruction
The Act makes it a crime to alter, cover up, falsify, or destroy any document (or persuade someone else to do so) to prevent its use in an official proceeding (eg, federal investigation or bankruptcy proceedings). The Act turns intentional document destruction into a process that must be monitored, justified, and carefully administered.
To prevent such abuses, nonprofit organizations must maintain appropriate records about their operations such as financial records, significant contracts, and fund-raising obligations. These documents should be archived according to guidelines established by the organization.
The CNS Foundation has therefore enacted and adopted a written document retention and periodic destruction policy to guide its practices and to prevent accidental or innocent destruction. The CNS Foundation will continue to monitor its legal and regulatory requirements and implement additional measures as needed.
Submitted by Renee H. Martin, JD, MSN, CNS Foundation Board Member.
Member Recognition
Andrea C. Morris, MSN, RNC, CCRN, Neonatal Clinical Nurse Specialist at Citrus Valley Medical Center in West Covina, Calif, was accepted as a Mentor by the Sigma Theta Tau Leadership Academy. This is an 18-month commitment to a program Sigma Theta Tau calls "Nurses Investing in Maternal Child Health Leadership Academy." There are 21 Mentor-Mentee pairs from the United States and Canada in this Academy. Ms Morris is working with a mentee who is the Perinatal Educator at Redlands Community Hospital in California. The mentee is developing a perinatal education program that includes Labor and Delivery, Neonatal Intensive Care Unit, Post Partum the Emergency Department and Pediatrics. In addition to serving as a mentor, Ms Morris is on the editorial board for the "Newborn and Infant Reviews" journal.
Katherine Beam, a CNS at NorthBay Healthcare in California, presented research entitled "A Comparison of Patient Controlled Analgesia with Nurse Administered Oral Analgesia in the Management of Post-operative Pain" at the 17th International Nursing Research Congress Focusing on Evidence-Based Practice in Montreal, Quebec (July 19-July 22, 2006).
Bobbi Herron, MS, APRN, BC-CNS, was recently elected to sit on the Board of Directors for the American Association of Heart Failure Nurses. Her induction to the Board took place during the Association's Annual Meeting in South Beach Miami, from June 22 to 24, 2006. Ms Herron is a congestive heart failure CNS at St. Mary Medical Center in Hobart, Ind.
Jeffery Jones, MSN, CNS, BC, a psychiatric clinical nurse specialist from Ohio, recently opened with business partner and clinical nurse specialist, Sue Smith, MS, CNS, RNC, a new practice entitled "Pinnacle Mental Health Associates." Mr Jones specializes in treating adult attention deficit-hyperactivity and bipolar disorders. He and his associate also provide consultation, supervision, and training to organizations. Their practice is unusual in the state of Ohio because it is one of the few mental health practices that is run by nurses as opposed to psychiatrists.
Deborah Marks Conley, MSN, APRN, BC, CS, led Methodist Hospital of Omaha, Nebraska, in its recent successful effort to attain the John A. Hartford Foundation Institute for Geriatric Nursing at New York University College of Nursing NICHE (Nurses Improving Care for HealthSystem Elders) designation. Methodist Hospital is the only hospital in Nebraska to receive the NICHE designation, which acknowledges the hospital's commitment to gerontological nursing care. According to Ms Conley, the goals of the program are to achieve systematic nursing change that will benefit hospitalized older patients and increase awareness throughout the hospital of the special needs of elders. "At Methodist Hospital, approximately 40 percent of our patients are over age 65, which is true of nearly every hospital's census," Ms Conley said. "It only made sense to us that we put a special focus on how their needs differ from a younger patient's needs and how to best apply gerontological evidence-based care to them on an ongoing basis. Under the leadership of Dr Rebecca Reilly, Methodist Hospital in 2003 implemented an Acute Care for Elders (ACE) unit, which promoted NICHE concepts through a multidisciplinary geriatric team approach. Ms Conley also teaches a gerontological nursing certification examination preparation course through Nebraska Methodist College to prepare nurses to become nationally certified in gerontological nursing. "Four years ago at Methodist Hospital, there were no nurses certified in gerontological nursing. Today, we have more than 20," Ms Conley said. "The need for this nursing certification is really growing." Methodist Hospital now joins a network of distinguished hospitals that demonstrate dedication to improving the quality of care provided to older adults, Elizabeth Capezuti, PhD, RN, FAAN, codirector, Hartford Institute for Geriatric Nursing, said in the letter notifying Methodist of its designation.
News Briefs
American Nurses Credentialing Center Certification Exam Eligibility Deadline Drawing Near
A reminder to CNSs seeking initial American Nurses Credentialing Center (ANCC) certification as a Clinical Nurse Specialist. Last year, ANCC granted CNSs a 1-year extension to the January 1, 2006 deadline, requiring a minimum of 500 hours of faculty-supervised clinical practica experiences in order to be eligible to take the ANCC CNS examinations. The new deadline of January 1, 2007, is fast approaching, and after that time, graduates of programs with less than 500 clinical practica hours will not be eligible to sit for initial certification. If you want to take your initial certification examination before January 2007, and if your program did not have 500 faculty-supervised clinical practica hours, you can make up the additional hours postgraduation by working as a CNS. You will need to have your clinical supervisor, who must be board certified or eligible to be board certified, verify that during the year before applying for certification, you made up the difference between the number of supervised clinical practica hours in your CNS program and the 500-hour requirement. To verify the hours you worked, your clinical supervisor must complete and sign Part A of Form E-2, available on the ANCC Web site. After January 1, 2007, you will need to make up the additional hours through a faculty-supervised practicum experience by taking clinical courses that can be documented on a transcript. This change reflects the Commission on Collegiate Nursing Education Standards for Accreditation (Amended 2003) on curriculum development in which "the master's curriculum incorporates knowledge and skills identified in The Essentials of Master's Education for Advanced Practice Nursing (AACN, 1996)."
National Provider Identifier Deadline: May 23, 2007
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for healthcare providers. This identifier, called the National Provider Identifier (NPI), is a 10-digit number that will be used to identify healthcare providers to their healthcare partners, including all payers, in all HIPAA standard transactions. The NPI will replace the identifiers that are currently used in HIPAA standard transactions that are conducted with Medicare and with other health plans. All healthcare providers, as defined in 45 CFR 160.103, are eligible for NPIs. All those that are HIPAA-covered providers or those healthcare providers or suppliers who bill Medicare for services will need an NPI. The NPI compliance date is May 23, 2007. However, the Centers for Medicare and Medicaid Services recommend that healthcare providers obtain their NPI at least 6 months before this date to provide ample time to test the NPI and share it with healthcare partners, including payers, clearinghouses, vendors, and other providers. For more information and application instructions, visit the Health and Human Services Web site at http://www.cms.hhs.gov/apps/npi/01_overview.asp.
Recognition for Clinical Nurse Specialist: The Journal for Advanced Nursing Practice
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice was selected for coverage in Thomson Scientific products and services. Beginning with Volume 19, Issue 1, the journal will be indexed and abstracted in the following:
* Science Citation Index Expanded (also known as SciSearch)
* Social Sciences Citation Index
* Social Scisearch
* Current Contents/Social and Behavioral Sciences
* Journal Citation Reports/Social Sciences Edition
* Journal Citation Reports/Science Edition
Thomson Scientific is part of the Scientific & Healthcare market segment of the Thomson Corporation. The world's largest research institutions and major corporations use the services of Thomson Scientific for high-quality, cutting edge information. Examples of the available services include scientific journal literature, access to full-text documents, and extended search services. Inclusion in Thomson Scientific will greatly increase the exposure of Clinical Nurse Specialist to the scientific community and further communicate the important contributions of clinical nurse specialists.
Janet S. Fulton, PhD, RN, journal editor, is pleased with Thomson's decision to include Clinical Nurse Specialist in their index. "Many thanks to everyone who has given their talent and time to the journal" says Dr Fulton. "Thomson's decision reflects the work of the journal's associate editors, column editors, reviewers and authors." For more information on the journal, visit http://www.cns-journal.com.
Section Description
NACNS Statement on Clinical Nurse Specialist Practice and Education,Second Edition
This document articulates the core competencies requisite to CNS practice, outlines the outcomes of CNS practice, and provides direction to schools of nursing regarding the preparation of CNSs. Endorsed by the National League for Nursing and American Organization of Nurse Executives (AONE) as "a comprehensive reflection of the contemporary role that Clinical Nurse Specialists play in the delivery of quality nursing care," this updated version contains information for contemporary clinical nurse specialist practice and education. You can purchase your copy through the NACNS Office at a cost of $25 per copy for members of NACNS and $45 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.