Outgoing President's Message
As I reflect upon this past year as your president, it is hard to believe that the time has gone by so quickly. This past year we have been very busy with growth of our membership. Other activities included participating in several national forums that addressed the regulation of advanced practice, developing competencies for the doctorally prepared clinical nurse specialist (CNS), and working with the American Nurses Credentialing Center to develop a core competency examination. I said in my opening comments that this work takes a village; I have at times felt like the village idiot with all there is to do, but thankfully I have, you have, a great village with depth and understanding on the issues. I thank each of you for your part in helping my year as president to be successful. Your incoming president, Dr Sue Sendelbach, has been on our board for several years. She is a critical care/cardiovascular CNS in Minnesota and holds a part-time appointment with a school of nursing. Sue will bring clinical savvy along with academic excellence to her perspectives on advanced practice and the role of the CNS.
Clinical nurse specialists exert tremendous influence upon care delivery processes leading to high-quality clinical and financial outcomes. I am an expert in critical care nursing and bring a strong clinical presence to the patients I support. For example, I may be called to see a complex patient, or to work with a family on end-of-life issues. Direct patient interactions such as these will always be the hallmark of CNS practice and influence. Clinical nurse specialist influence also permeates throughout the department and indeed the healthcare system. For example, CNSs create an environment where staff can practice excellence in a safe and enjoyable manner. Clinical nurse specialists also build infrastructure for safe, quality care delivery that is not person dependent. The ability to do so is a large measure of our success, and the healthcare delivery system depends on it. Let me give you a simple example. I know that the head of the bed is elevated on all of the patients receiving mechanical ventilation in all 7 of the critical care units that I support. I can assure you of this even though I am not able to visit all 7 units on a daily basis. How do I know? The staff understands the importance of the practice. We have achieved this understanding through education and testing. We have also collected the data on head-of-bed elevation and shared it with the staff. They see the linkage between the process measure o{\mrow{}}f head elevation and the outcome measure of ventilator pneumonia. Staff can see that the change in their practice makes a difference in the patients' outcome and they now own the practice, holding each other accountable. These behaviors are now embedded in their value system. I know that the head of the bed is elevated whether I am in the building or not because we have worked diligently on these process elements, as well as staff empowerment and accountability. Even though I may not touch the patient at all, I know that the impact of my work, the creation of this infrastructure for clinical excellence, is strong and our clinical outcomes reflect this.
What is behind the push for Magnet hospitals to have CNSs? It is not because we are taking care of each and every patient with our advanced knowledge and skills. It is because we create reliable, evidence-based robust processes for care delivery. If this means we also decrease the cost of care delivery, then this is all the better. Clinical nurse specialists achieve these types of results through our system wide influence. By bringing in new equipment and getting multiple disciplines and departments working together toward the same goal, we can drastically reduce harm, costs, and resource utilization while at the same time achieving significant improvements in clinical quality.
In summary, we are clinical experts, but the services we deliver and the impact of our work are so much more. As we move into 2008, I wish each of you the happiest and most healthy year yet. I thank each of you for your hard work for our patients and for our association.
Incoming President's Message
Sue Ellen Sendelbach, PhD, RN, CCNS, FAHA
I am very privileged and honored to be the next president of the National Association of Clinical Nurse Specialists (NACNS). I am humbled to follow such incredible past leaders, including Theresa Murray. Theresa is not only the president, but also one of the elite group of past "CNS of the Year." This speaks to her clinical abilities as well as her leadership skills. Anyone who knows Theresa knows of her passion for patients and CNSs. As the NACNS president, Theresa continued to increase the influence and visibility of CNSs in many national venues. I am very fortunate to be able to continue to work with her as she continues to share her expertise and wisdom on the Board of Directors as past president. I am also very fortunate that we have a particularly strong NACNS board as leaders of our organization.
My past experience in serving with NACNS includes president of the Minnesota Affiliate, Affiliate Committee cochair with Dawn Wilson, NACNS Board of Directors for 1 year, vice president for 1 year, and president-elect for 1 year. I've also been one of the 4 facilitators of the Doctoral Competency Task Force along with Peggy Gerard, Kathy Baldwin, Ann Jacobson, and Phyllis Gaspar, and I am presently cofacilitator, along with Kelly Goudreau, on the Core CNS examination. It's been a gift to be able to be a part of the work and projects NACNS has embarked on and to be able to learn from all those with whom I have served.
The Law of Priorities
In John C. Maxwell's book, The 21 Irrefutable Laws of Leadership, he talks about the Law of Priorities and how we should never get to a point where we no longer need to prioritize. Maxwell gives examples of successful leaders, including Jack Welch, the CEO of General Electric, and John Wooden, the former head basketball coach of the UCLA Bruins. What both of these men had in common was their ability to prioritize and maintain focus of those priorities. This is one of the reasons I believe NACNS continues to be successful-we prioritize, maintain focus, and continue to support efforts that strengthen the work of CNSs that is ultimately focused on safety and quality of patient care delivery systems. Whether this work is conducted in the patient/client sphere, or the nursing/nursing practice sphere, or at the organization/system sphere, the CNS is always focused on how to provide care based on the best evidence available to ensure that patients are kept safe and receive the highest level of quality care. The NACNS continues to develop its strategic plan with this focus as a priority. As the healthcare system evolves and changes, the CNS is educated to provide safe and quality care wherever the care is needed to be delivered. I believe the need for CNSs will continue to increase as this healthcare evolution continues.
What Can CNSs Do?
It is important that CNSs continue to work together to communicate what and how we add to patient quality and safety. We need to speak up in our places of work and clearly identify how patient outcomes are positively influenced because a CNS was a part of the work.
We also need to become involved in NACNS at both a local and national level. If you are not a member of NACNS, I highly encourage you to join. If you have a local affiliate, join that also! You can find a list of affiliates with contact information and also information on how to start an affiliate if there is not one in your area (http://www.nacns.org).
In conclusion, I am so honored to be the president of NACNS and to work with the NACNS Board of Directors. I look forward to this next year with great anticipation.
NACNS Updates
In Memoriam
National Association of Clinical Nurse Specialists is deeply saddened by the December 2007 death of Kathryn Ann "Katie" Brush, RN, MS, CCRN, FCCM, a member of the NACNS Board of Directors and a well-known CNS leader. Katie was a CNS for 10 years in the Surgical Intensive Care Unit at Massachusetts General Hospital. She was known for her work with patient safety and for her national and international humanitarian relief efforts. Katie was one of the first members of the Patient Safety Improvement Corps, a national partnership program formed in 2003 between the Agency for Healthcare Research and Quality and the Department of Veterans Affairs. She was able to use her patient safety skills to achieve a zero-level line infection rate within the intensive care unit. Katie was a member of the country's International Medical-Surgical Response Team and served in Iran following a major earthquake in 2003. She was also involved in providing relief efforts following natural disasters in this country as well as in other areas of the world. In addition to providing relief efforts, Katie was a participant in the Harvard Medical International/Institute for Nursing Healthcare Leadership Program. In this role, she helped to develop a department of nursing education at the Hospital de Universitario San Vicente de Paul in Medellin, Colombia.
Katie's honors were many, and her level of professional commitment was high. In 2002, she was inducted as a fellow in the American College of Critical Care Medicine. Also, she was one of 33 clinicians named to the Working Group on Emergency Mass Critical Care to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack. She served several terms on the NACNS Membership Committee, was a member of the Disaster Committee for the Society of Critical Care Medicine, a member of the American Association of Critical Care Nurses, and current secretary and founding member of the Council of Armenian American Nurses.
Katie was a great friend and colleague to many throughout the country. She was energetic, witty, and a strong advocate of the CNS role. She accomplished much during her lifetime, and she will be greatly missed.
The CNS Foundation Trustees have initiated a scholarship fund to honor Katie's remarkable life. Donations indicating that the funds are for the Katie Brush CNS Scholarship should be sent to the CNS Foundation, c/o NACNS, 2090 Linglestown Rd, Ste 107, Harrisburg, PA 17110.
News From our Committees
Gero Task Force: A Subgroup of the Practice Committee
Members of the Gero Task Force have had a busy year. Joanne Alderman, MS-N, RN-BC, GCNS, APRN-Rx, FNGNA, and Ron Walent, MS, RN, CNS, BC, presented at the National Gerontological Nurses Association (NGNA) in October 2007. The title of their presentation was "Advances in Nursing Home Care in America." They were also instrumental in creating a special interest group within NGNA for gerontological CNSs. In addition, Ms Alderman will be a writer for the American Nurses Association's Scope and Standards of Practice for Gero Nursing. Sheryl Yauk, PhD, RN, CNS, was selected to present a poster in this year's Gerontological Society of America convention. The title of her poster presentation is "Increasing Communication in Individuals With Dementia." Deborah Conley, MSN, APRN-BC, FNGNA, is editor-in-chief of the NACNS PEPID Gerontological Nursing Project that was brought to market in October 2007. This is a reference tool in electronic format intended for use at the "point of service" (bedside). In addition, she presented at the NGAN national conference on several topics including "EBP Gerontological Nursing on Falls" and "EBP Pain Strategies in Elders." She also taught the 2-day Gerontological Nurse Certification Exam Preparation preconference. Finally, Sue DeRosa and a number of Gero Task Force members, at the request of NACNS, have been providing their thoughts, concerns, and ideas to the APRN Consensus Work Group. The focus of this discussion was on Gerontological Nursing as a population focus or as a specialty. All of this work is in addition to the work the members of the task force do every day to "make a difference" in the care of our elders.
Submitted by Susan E. DeRosa, MS, APRN, BC
News From our Affiliates
California
Our organization started the New Year with a big event which was a full-day educational offering on January 19 entitled "Prescriptive Authority: The Future Is Now." This was unusual for us to coordinate and work on program planning during the holidays, and we thank the board members who volunteered their precious time. The board encouraged wide participation in this conference to address the benefits of having prescriptive authority as an option for CNSs. Prescriptive authority will allow them to order not only medications but also durable medical equipment, which is an important component of the CNS's practice in many specialties. Having the ability to prescribe will reduce the delay in the care and treatment of patients and improve the quality of patient care that CNSs provide.
At our quarterly meeting on November 2, 2007, 41 participants attended the excellent presentation of Cheryl Canary and Kathi Ellstrom on "Dissemination of Research: How to Write a Compelling Abstract and Develop a Poster." We look forward to our members sharing their successes, and we encourage all to submit an article to the newsletter or plan for a poster presentation at future educational conferences.
Submitted by the California CNS Network
Veterans Affairs Virtual Affiliate
The members of the Veterans Affairs (VA) Virtual Affiliate have had a productive year. Elissa Brown, psychiatric CNS from the Greater Los Angeles VA, was a finalist for the California Nurse Week Award for Excellence in Community Service, September 2007. She was also a recipient of the VA Secretary's Award for Excellence in Nursing for Advanced Practice Nurse, May 2007, at the Greater Lost Angeles VA. Kathleen L. Dunn, spinal cord injury CNS for the VA San Diego Healthcare System was nominated (although not elected) for the Spinal Cord Injury Hall of Fame, Spinal Cord Injury Educator category, which is awarded annually by the National Spinal Cord Injury Association. She was also selected to serve on the Department of Defense/Veterans Health Administration Collaborative Task Force on Safe Patient Handling and Movement. Christy Locke, Med-Surg CNS at the Portland, Oregon, Veterans Affairs Medical Center (VAMC), was the recipient of the 2007 VA Office of Nursing Service Innovation Award for her project, "Developing a Non-ICU Insulin Infusion Protocol for Improved Patient Outcomes." Her coauthor was Judy McEuen, BSN, RN, CDE. Other team members included Rob Felder, DDS, Blake Lesselroth, MD, and LeAnn Snodgrass. She is also the co-primary investigator of a research project funded through the VA's Quality Enhancement Research Initiative with a grant award amount of $27,400 (October 2007). The project title is "Glycemic Management Using an Insulin Infusion Protocol in a Non-ICU Area." Ann Busch, Liver Transplant CNS at the Portland, Oregon, VAMC recently published an article with several CNS students, C. Perez, K. Oyama, and N. Jackson. C. Perez was the lead author on the article entitled "Collaboration to Improve Education After Liver Transplant: The Experience at Portland VA Medical Center." The article was published in 2007 in the journal Progress in Transplantation. Linda Parker, Oncology CNS at the Atlanta VAMC, recently published an article in the Oklahoma Nurse journal entitled "Prevention and Management of Mucositis in an Outpatient Setting." Finally, Janette Elliott, Pain Management CNS at the Palo Alto VAMC, recently published along with J. Chapman and J. D. Clark an article in Pain Management Nursing entitled "Videoconferencing for a Veteran's Pain Management Follow-up Clinic."
Submitted by Kathleen L. Dunn, MS, RN, CNS, CRRN-A
News From the Clinical Nurse Specialist Foundation
The Clinical Nurse Specialist Foundation sponsored a special opportunity on Thursday, March 6, from 7 to 9 PM at the 2008 Annual NACNS Conference entitled "Planning Your Financial Future: The Importance of Financial Literacy." This program focused on developing an understanding of the basics of investing and financial organization including the positive impact of developing a philanthropic ethic for charitable giving in areas that really matter. Registration was limited to 25 participants! This session was presented by Don K. Shuck, CNS Foundation trustee, and senior vice president, Merrill Lynch.
On Friday, March 7, from 7 to 9 PM, the CNS Foundation hosted its fourth fund-raising event at the NACNS annual conference in Atlanta. The theme of the festivities was "Moonlight, Magnolias, and Moola." Throughout the evening, CNSs who have advanced the Foundation's progress toward the campaign "1000 at $1000" were honored, awardees of Foundation scholarships announced, and progress on the Foundation's other goals reported. Stay tuned for the announcement of the success of our fund-raising efforts!
As always, the Foundation Board is grateful to all benefactors who support the mission and vision of the CNS Foundation. We would like to share with you some of the creative ways people have identified to help us reach our goals. Recently, one of the NACNS affiliates, the Delaware Valley NACNS Networking Group, hosted their winter program. They received a grant to support their program from La Salle University (the employer of the group's leader) and used the nominal program registration fees ($15) as a donation from Delaware Valley NACNS Networking Group for the CNS Foundation. Thank you, Delaware Valley for your contribution!
Member Recognition
Cindy (Reno) Balkstra, MS, APRN, BC, was recently elected vice chair of the American Nurses Association Constituent Assembly. She is also the current president of the Georgia Nurses Association having been initially elected to the position of president-elect during 2005. In addition, she is immediate past president of the Respiratory Nursing Society. Ms Balkstra works as a clinical consultant for Cardinal Health/Alaris and as part-time nursing staff for St Joseph's/Candler and United Hospice on an as-needed basis.
Margo Halm, PhD, RN, clinical nurse specialist and director of Nursing Research/Quality at United Hospital in St Paul, Minnesota, is the author of a new column in the American Journal of Critical Care. The column, "Clinical Evidence Review," is intended to review the latest science on nursing interventions to help clinicians stay up-to-date on the latest evidence.
Janet Parkosewich, MSN, RN, CCRN, FAHA, was recently nominated for the Council on Cardiovascular Nursing Excellence in Clinical Practice Award. This award recognizes and encourages excellence in cardiovascular nursing practice. Ms Parkosewich is a cardiac CNS at Yale-New Haven Hospital.
News Briefs
Geriatric Nursing Publishes Nurse Competence in Aging Supplement
The November/December 2007 issue of Geriatric Nursing, a journal published by Elsevier, Inc, features a special supplement on the results of the highly successful Nurse Competence in Aging Initiative. This 5-year initiative was funded by the Atlantic Philanthropies (USA) through a grant to the American Nurses Association through the American Nurses Foundation. The project engaged members of 55 specialty nursing organizations to enhance geriatric-related education that is highly targeted to nurses practicing within each specialty.
The Geriatric Nursing supplement will be highly useful as a blueprint for associations undertaking the task of improving approaches to care for older adults. The supplement is available free of charge online at http://www.gnjournal.com/issues/contents?issue_key=S0197-4572(07)X0065-X. To obtain a print copy of the supplement, please contact Elsevier Customer Service at [email protected].
Bibliography on Certification Is Now Available
The American Board of Nursing Specialties Research Committee is very pleased to announce that the updated nursing certification bibliography is now available on the American Board of Nursing Specialties Web site. The bibliography can be accessed by visiting http://www.nursingcertification.org.