Once again, in this issue, the journal is pleased to bring you the abstracts for the 2010 National Association of Clinical Nurse Specialists Annual Conference. Starting in 2002, the past 8 years of abstracts provide evidence of clinical nurse specialist (CNS) practice. Consistently, CNSs are leading nursing and multidisciplinary evidence-based practice changes, spearheading implementation and evaluation of care guidelines, and developing, delivering, and monitoring systemwide programs of care. As a group, we provide nursing interventions for disease prevention and screening, coordinate services for individuals and families with complex needs, and collaborate with other providers to configure best practices. The clients we serve cover the developmental spectrum from vulnerable infants to frail older adults. Our clinical expertise includes diseases such as diabetes, cancer, and heart failure, along with functional problems involving mobility and cognition and focused problems such as pain and pressure ulcers. We have committed to addressing lingering old problems while steadily making progress into the future. A couple of thoughts come to mind as I reflect on the national agenda for advanced practice education, accreditation, certification, and regulation in light of the abstracts.
The healthcare world in which nurses function is influenced by science, technology, politics, financial markets, immigration patterns, natural disasters, and a host of other variables, all occurring in complex systems best understood as evolutionary in nature. Rule-determined behavior is giving way to a naturalistic approach to understanding the interaction between a system's boundaries and the individuals acting within it. Clinical nurse specialists are now and will continue functioning as evolutionary pseudopods morphing nursing practice to meet ever-changing demands inside pliable boundaries and multiple crisscrossing relationships. The practice of tomorrow will demand maximum intellectual ability to flex and negotiate.
Education for the future is all about how to think. Education's long-standing focus on things to know is ending. Information and data points are omnipresent and ever changing. Success will be derived from thoughtful consideration of problems in context, the ability to turn data into information (yes, this does include being literate in statistical theory and methods), and judicious application of ethical principles in diverse situations. The raw material of information is instantly downloadable to a mobile pocket-size device. The day has arrived when you can obtain a list of a medication's adverse effects in less than 30 seconds-there's an app for that!
Nursing's advanced practice certification examinations, once designed for validating excellence, are now entry-level, lowest-common-denominator evaluations of things to know. Certification mechanisms relying solely on multiple choice examinations are of little value in determining a candidate's ability to find, apply, and evaluate information for delivering contextually sensitive care, negotiating with peers, or leading and influencing practice. Certification bodies must move beyond the multiple-choice test if they are to be relevant as validation of practice abilities.
Regulation should support delivery of competent care in the broadest terms. Narrowly defining populations is obsessively rigid, and a priori sorting of specialties and subspecialties is programmed obsolesce. Solid data about incompetent practice by CNSs or any advanced nursing practice group are lacking, although available data suggest it is negligible. Overzealous regulation directed at a supposedly small but unsubstantiated problem constrains nursing at the very time complexity science suggests we need the capacity to evolve for current and future public needs for nursing care.
Clinical nurse specialists should continue active participation in the national dialogue about advanced nursing practice, advocating for forward thinking lest the prevailing winds of change blow us back to yesteryear with prescriptive curriculum, awkward regulatory constraints, and antiquated certification mechanisms. As the abstracts demonstrate, CNS practice is taking on the new and emerging challenges of today. Our education, certification, and regulation need to be aligned with the future.