President's Message
Since the inception of National Association of Clinical Nurse Specialists (NACNS), our organization's leaders have placed a high priority on moving NACNS into all forums where issues of importance to clinical nurse specialists (CNSs) are discussed. One current national forum of critical importance is the advanced practice registered nurse (APRN) consensus work group/joint dialogue group initiative that has produced draft recommendations for the future of APRN licensure, certification, education, and practice. Since 2004, NACNS leaders have participated in this work.
The APRN consensus work group, comprised of organizations having an interest in advanced practice, was formed in 2004 by the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties to address APRN certification, licensure, education, accreditation, and practice. In February 2006, the National Council of State Boards of Nursing (NCSBN) circulated a draft of "Vision Paper: The Future Regulation of Advanced Practice Nursing" to the nursing community, with a request for feedback. As you may recall, that proposal did not include CNSs in the definition of APRN.
The APRN consensus work group and the NCSBN APRN advisory committee agreed to collaborate with the intention of creating one article. A draft of this article entitled "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education" has now been released for stakeholder organizations' consideration.
We have been well represented on this work group by our current representative, Dr Kelly Goudreau, past president of NACNS. She carried on the work of our past leaders, who represented us in the APRN consensus work group over the past 4 years: Nancy Dayhoff, Jan Fulton, Angela Clark, Kathy Baldwin, and Theresa Murray. Their collective advocacy for CNSs has ensured that the CNS is clearly defined as 1 of 4 advanced practice nursing roles.
Because of Dr Goudreau's presence and her working on behalf of NACNS, our voice continues to be heard at this very important table. Dr Goudreau presented the most recent draft of the joint dialogue article at the 2008 NACNS conference wherein members had an opportunity to discuss the proposed recommendations and outline for the NACNS leadership their concerns. Dr Goudreau brought NACNS members' concerns back to the work group, and many of these concerns were shared when a larger group of APRN stakeholders met at American Nurses Association headquarters on April 14. I attended that meeting, along with Dr Goudreau and our chief executive officer (CEO), Chris Filipovich.
Originally, the plan for this document called for it to be completed in time for presentation at the August 2008 NCSBN annual meeting. The importance of this document is not underestimated, and we need to be clear about what our final recommendation will be. Again, I cannot stress enough the value of Dr Goudreau's strong leadership as the NACNS representative and the advocate for you and all CNSs at this table.
Another major initiative of NACNS is our work with the American Nurses Credentialing Center to develop a core CNS certification examination. National Association of Clinical Nurse Specialists members comprise most of the members on the examination content expert panel and the test item writers' panel. Creation of this examination is becoming increasingly important, as more states have or are considering requiring certification for recognition of CNSs. For example, in my state of Minnesota, CNSs need to be certified with an examination specific to CNS practice. This core examination, partnered with a portfolio, is expected to offer a psychometrically sound and legally defensible mechanism for certifying competence of CNSs who currently cannot obtain certification in their specialty. We expect the first examination to be offered in May 2009. National Association of Clinical Nurse Specialists plans to schedule an examination preparation course in conjunction with our March 2009 conference.
These are just 2 examples of how NACNS continues to work on issues of importance to CNSs. Because of the expertise and education of CNSs, we provide skills to patients/clients, nursing/nursing practice, and organizations/systems that are unique to the CNSs. We are fortunate to have so many CNS leaders who are willing to share their time and talent.
National Association of Clinical Nurse Specialists is committed to strategic direction and investment of our resources to continue to promote the essential role of the CNS.
News From Our Affiliates
Oregon Affiliate News
In February 2008, a special legislative session was held, and SB 1062 was unanimously passed in the Oregon State Senate and House. SB 1062, introduced by Deputy Senate Majority Leader Laurie Monnes Anderson (D-Gresham, Troutdale, Fairview, and Wood Village), was designed to increase the speed and efficiency with which patients can receive needed prescription drugs.
Before SB 1062 was passed, nurse practitioners and CNSs had prescriptive authority based on a drug formulary maintained by the board of nursing. The board was required to periodically update the formulary with newly approved prescription drugs. The board members approved new drugs at their regular meetings, which only occur 5 times a year, and newly approved drugs were often on the market for 4 months before the board could add them to the formulary. The process for the board was a redundancy in healthcare, which provided no benefit to patients. Nurse practitioners and CNSs found this change to be vital for improving patient access to medication and provided testimony in a special hearing. Now both groups with prescriptive authority will be able to prescribe based on their scope of practice without the required formulary.
Oregon Council of Clinical Nurse Specialists is pleased with the collaborative efforts that took place throughout the process. The success of this bill could not have been possible without the work of Deputy Senate Majority Leader Laurie Monnes Anderson, nurse practitioners of Oregon, and the Oregon Council of Clinical Nurse Specialists. Work such as this will continue to move healthcare in a forward direction.
Submitted by Jane Sawall
Chair, Oregon Council of Clinical Nurse Specialists
Virtual Veterans Affairs Affiliate
Veterans Affairs Clinical Nurse Specialists Help With Shortage of Nursing Faculty
Clinical nurse specialists at the Veterans Affairs San Diego Healthcare System (VASDHS) are expanding their "sphere of influence" to include nursing students! In an effort to increase the number of nursing faculty at San Diego State University, unit-based medical-surgical and critical care CNSs Karen Carroll, Rebecca Long, Beth Palmer, Allison Perkins, and Barbara Rose are being "loaned" to the university as part-time clinical instructors. Veterans Affairs San Diego Healthcare System was selected as 1 of 4 sites nationwide to receive grant money to support this program, which is now known as the Veterans Affairs Nursing Academy (VA Nursing Academy). There are advantages for everyone involved. As a result of the additional clinical faculty, San Diego State University has been able to increase the number of students it admits to the nursing program. The VASDHS hopes that the VA Nursing Academy will increase recruitment. The students have the advantage of being supervised by a "clinical expert" for the unit on which they are training. Beth Palmer, a VA Nursing Academy CNS, says, "I enjoy helping to educate a new generation of nurses, and I appreciate the additional time I get to spend with the nursing staff and patients on my unit." The VA Nursing Academy hopes this program will become a model for the future of nursing education.
Submitted by Kathleen L. Dunn, MS, RN, CNS, CRRN-A
Montana Affiliate
Members of the Montana Association of Clinical Nurse Specialists have been busy this spring presenting and attending conferences. Dr Susan Luparell, who speaks frequently to healthcare faculty around the country about how to manage incivility and other difficult student situations, presented a workshop entitled "Managing Incivility and Other Student Challenges" at the National Student Nurse Association Annual Convention in Grapevine, Texas, and again for the Alabama League for Nursing in Montgomery, Alabama. In addition, she presented a poster at the Western Institute of Nursing annual research conference in Garden Grove, California, entitled "Defining and Measuring Incivility in Nursing Education." Other members who presented at Western Institute of Nursing were Dr Jean Shreffler-Grant (poster) and Drs Sandy Kuntz and Charlene Winters (symposia). Sandy and Charlene also presented the results of their study of the health status of persons exposed to Libby asbestos at the Montana APRN conference. Clinical nurse specialist student member, LT Pat Fitzpatrick, represented Montana Association of Clinical Nurse Specialists at the affiliate breakfast with NACNS president and board members at the 2008 NACNS conference in Atlanta, Georgia.
Members of the Montana affiliate are looking forward to a productive fall. Their plans include a joint research dinner and lecture with Zeta Upsilon Chapter of Sigma Theta Tau International, collaboration with other APRNs, developing an affiliate newsletter, and increasing their membership.
Submitted by Charlene A. Winters, PhD, APRN, CNS-BC
The Oklahoma Association of CNSs
In February, the Oklahoma Association of Clinical Nurse Specialists and the University of Oklahoma hosted our first 2-day conference focusing on advanced pharmacology and disease management for advanced practice nurses (APNs). The conference was highly successful, with attendance rates of approximately 100 CNS and nurse practitioners each day.
The year 2008 has been eventful for CNSs in Oklahoma. After months of work and discussion on the topic of controlled substance prescription duration, the Oklahoma Board of Nursing voted unanimously to recommend extending the 7-day rule on prescribing controlled substances to 30 days. The governor signed the recommendation, which will go into effect July 1, 2008, allowing all APNs including CNSs with prescriptive authority to write schedule II-V prescriptions for 30 days.
From the legislative arena, there were additional concerns after the introduction of a senate bill that threatened to dramatically affect all APN practice. SB 1638 would have placed CNSs and other APNs under the oversight of the Board of Medicine. This bill was met with a tremendous outpouring of organized APN opposition in the form of e-mails, letters, and personal contact with legislators and the governor. Thanks to this show of force, the bill was not passed by the Rules Committee and is officially dead [horizontal ellipsis] for now.
The Third Annual Clinical Nurse Specialist Recognition Day Fall Conference will be held Friday, October 10, 2008, in Tulsa, Oklahoma. This year's theme is "Oklahoma Clinical Nurse Specialists: One Voice, One Vision." Course sponsors are the Oklahoma Association of Clinical Nurse Specialists and The University of Oklahoma College of Nursing.
Submitted by Stephanie Moore and Susan Dresser
Delaware Valley Networking Group
The Delaware Valley NACNS Networking Group (DVNG) was well represented at the 2008 national NACNS conference, with approximately 15 members in attendance. Two graduate student members, Nancy Cook and Susan LaSalle, presented posters. Nancy Cook was recognized as a graduate student poster awardee for her work describing registered nurses' accuracy in telemetry monitoring alarm identification. Several DVNG members presented papers and also facilitated new vendor participation, including the Hospital of the University of Pennsylvania. Two DVNG members, Anne Muller (DVNG cochair) and Robyn Strauss, provided 2 different podium presentations, whereas 2 relatively new CNSs, Melanie Banks and Colleen Quinn, presented a process for preparing for the American Nurses Credentialing Center CNS examination.
The most recent DVNG dinner meeting was held on December 12, 2007. La Salle University hosted the program. (It was supported by funds from the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services under grant number D09HP00020, CNS/clinical nurse educators for $465,588.) The information or content and conclusions should not be construed as the official position or policy of nor should any endorsements be inferred by the Division of Nursing, Bureau of Health Professions, Department of Health and Human Services or the US government). Melanie Duffy, MSN, RN, CCRN, CCNS, critical care CNS, Pinnacle Health System (vice president, NACNS), presented "Title Protection HB 1254: CNS Practice Implications." The program was attended by more than 40 participants and was received very positively. Delaware Valley NACNS Networking Group collected approximately $700 for donation to the NACNS Foundation.
Patti Zuzelo's (DVNG cochair) recent book, "The Clinical Nurse Specialist Handbook," was awarded the 2008 American Journal of Nursing Book of the Year in the Advanced Nursing Practice category.
Submitted by Patti Zuzelo
Illiana Lakeshore Affiliate
Member Kim Nagy will be speaking on "Endotracheal Tube Stabilization: The Current State of the Art" at a conference on May 2 at MD Anderson Hospital in Houston, Texas, and on May 6 in Chicago at the National Teaching Institute of the American Association of Critical Care Nurses. Kim recently completed a clinical trial at Provena Saint Joseph Medical Center in Joliet using the Hollister Anchor-Fast device that is currently released for use clinically. Kim is also a coinvestigator on another study entitled "Assessment of the Economic Impact on Fecal Containment in Bedridden Patients Comparing Zassi Bowel Management (BMS) with Flexi-Seal Fecal Management System."
Submitted by Kim Nagy
Association of Central Florida CNSs
The Association of Central Florida Clinical Nurse Specialists, a relatively new NACNS affiliate as of November 2007, is the first Florida affiliate. The Tampa Bay Area CNS Network, which was started in spring 2006, decided to become an affiliate and to expand to Central Florida. The meetings are held bimonthly at a hospital with Web cast and teleconferencing capabilities. The purpose of the ACFCNS is mainly networking and collaboration with sharing of best practice and clinical solutions. Addressing legislative and academic issues is a secondary purpose. Updates regarding CNS title and certification are presented through the e-mail networking group. The affiliate meetings are open to all CNS and CNS students.
Submitted by Barbara Hatfield CNS-BC, MS OCN ACRN
California CNS Network
The California CNS Network sponsored an educational program on the role of gerontological CNS presented by Geri Westad and an update on Department of Human Services pressure ulcer regulations and reimbursement presented by Margaret Talley on April 18, 2008, held at Torrance Memorial Medical Center. The 2 remaining education programs scheduled for this year will be on August 2, 2008, at Cottage Hospital in Santa Barbara and on November 8, 2008, at Rancho Las Palmas Resort and Spa in Palm Springs, California.
In response to our January Conference and our 2007 survey results on CNS prescriptive privilege, we are initiating a fundraising campaign. The funds raised will be used to increase legislative knowledge of the issue and to pursue development of a legislative agenda on prescriptive privileges for CNSs. A fundraiser is scheduled on May 31, 2008, at the home of Cheryl Westlake in San Clemente, California. Please RSVP to Cheryl at [email protected].
Submitted by Evelyn McLaughlin
Upstate New York Chapter of CNSs
Clinical nurse specialists in New York State are joining together to begin the process of obtaining title protection for CNSs. Members of the affiliate are requesting all CNSs in New York State who are interested in learning more and or being involved in this pursuit to contact Melanie Kalman at [email protected] or Lorissa Plis at [email protected]
You may be as involved or not involved as you wish, but we need support (even if it is your name) to pass this much needed legislation.
Submitted by Lorissa Plis, MS, RN, CCNS
Member Recognition
Christine Carson Filipovich, CEO of NACNS, was recently named the recipient of the 2008 Frances Payne Bolton Alumni Association Award for Excellence. Established 30 years ago, the award for excellence is given to a Frances Payne Bolton School of Nursing alumna who has demonstrated outstanding leadership and achievement in nursing and who has made significant contributions to nursing or related areas of healthcare. Christine's professional career spans a wide range of practice settings and includes positions in public health consultation and administration, nursing consultation, undergraduate nursing education, health policy, and advanced nursing practice as a perinatal CNS. As owner and CEO of Professional Nursing Resources Inc, Christine has spent the last 10 years building and developing an organization that provides core management services for clients around the world. We are proud of Christine and believe that she is most deserving of this award.
News Briefs
The Indiana State Board of Nursing voted to create the Advance Practice Nurse Subcommittee. The APN subcommittee is charged with developing recommendations on rule changes and other measures for protecting and improving advance practice nursing in the State of Indiana. The subcommittee is asked to report to the board on its progress and recommendations at the regular monthly board meeting scheduled for October 16, 2008. There was a significant CNS presence in the attendees at the interest meeting sponsored by the ISBON.
Brenda Lyon, professor, Indiana University School of Nursing; CNS; past president, Indiana State Nurses Association
Catherine Jones, certified nurse midwife
Marcia Plant Jackson, family nurse practitioner; president-elect, Coalition of Advanced Practice Nurses in Indiana
Cindy Wilson, Mental Health CNS, Ivy Tech Nursing Faculty
Samantha Meeks, family nurse practitioner
Kathy Rich, cardiovascular CNS
Jennifer Embree, CNS; president-elect, Institute of Oklahoma Nursing Education; Board of Directors representative, Indiana State Nurses Association
Teresa Holland, CNS
Sally Hartman, Women's health nurse practitioner
Sue Gabler, nurse practitioner