This is my final president's message, and I am struck by many simultaneous reactions to the knowledge that soon after you read this, it will be my responsibility to support and facilitate the leadership of a new president.
I have tried to live this year with deliberate mindfulness,1 focusing on accepting varied challenges and directing my attention toward circumstances that could and should be changed. I have attempted seeing the nursing world with fresh eyes-recognizing that the decisions leading to the best outcomes are most likely the result of mindfully attending to the newness of each experience, refusing to be held to previous reactions, mind sets, and explanations. This perspective was critical to my belief that bridge building is essential to ensure that the National Association of Clinical Nurse Specialists (NACNS), in partnership with the larger nursing community, moves as a "whole" with a unified voice and vision, particularly at this point in history.
I have observed that just about everyone engaged in professional nursing organizations works hard with limited and often inadequate resources to accomplish what is viewed as "the right thing to do." The right thing to do varies in definition and, at times, is contrary to what NACNS would prefer. In situations of conflict, mindfulness requires deliberate self-awareness that can facilitate thoughtful response rather than automatic reaction.1
Several years ago, Dr Angela Clark,2(p222) commented in her president's address that "taking the high road is the desired goal of the NACNS board in areas of conflict-examining differences, encouraging meaningful dialogue, providing rationale for our positions, and communicating our enthusiasm about CNS practice." This high-road approach is consistent with approaching circumstances in a truly mindful way so that organizational concerns can be addressed with grace, integrity, and efficiency. There are currently several high-stake national initiatives that have challenged and continue to challenge NACNS leadership in its pursuit of the high road.
Implementation of the Advanced Practice Registered Nurses Consensus Model through Licensure, Accreditation, Certification, and Education (LACE) efforts has proven to be a challenging endeavor. A recent LACE meeting was interesting for many reasons, but in particular, I was struck by the conscientiousness of the individuals at the table. Dialogue was candid but respectful. There were differences concerning the "right thing to do," but the commitment of the individuals doing this work was clear. Progress has been incremental, albeit slow. As I meet with groups in my geographic region, I am constantly struck by how little advanced practice registered nurses know about the Consensus Model and its implementation. I urge you to keep abreast of these activities, including interpretations by state boards of nursing.
The NACNS is working on developing criteria for clinical nurse specialist (CNS) education using an established, national consensus process. This effort is being led by a neutral convener, Theresa M. "Terry" Valiga, EdD, RN, ANEF, FAAN, director, Institute for Educational Excellence; Duke University School of Nursing. This national task force is charged with building on the work of a National CNS Educational Standards Task Force cochaired by Drs Clark and Peggy Gerard with representation from NACNS, American Association of Colleges of Nursing, and the National League for Nursing. There is a critical need for consensus regarding CNS education, and I anticipate that this work will be in final form by March, 2011-in time for the annual conference.
The CNS Core Competencies were endorsed by the NACNS Board of Directors. The 2008 CNS Core Competencies include prescribing nursing therapeutics, pharmacologic and nonpharmacologic interventions, diagnostic measures, equipment, procedures, and treatments to meet the needs of patients, families and groups, in accordance with professional preparation, institutional privileges, state, and federal laws and practice acts. Other significant changes described in the Executive Summary relate to the incorporation of 3 different models for CNS practice: (1) the 3 spheres of influence as defined by NACNS; (2) the 7 advanced practice nursing competencies as defined by Hamric and Spross; and (3) the Nurse Characteristics identified in the American Association of Colleges of Nursing Synergy Model.
Member and affiliate response to the CNS Core Competencies has been highly variable, reflecting the diverse regulatory and practice environments in which members live their professional lives. Some members have been enthusiastic and have viewed the incorporation of other practice models and a prescription (pharmacologic) competency as positive steps. Others have expressed grave concerns. Ultimately, the NACNS Board of Directors determined that the competencies are a first-step in a process that will unfold and develop with subsequent revisions and editions. Twenty-two organizations were represented in the CNS Core Competency efforts, including NACNS. As with any endeavor that strives for inclusiveness, compromise does occur. Whether compromise is positive or negative probably depends on personal perspective informed by any number of events and characteristics, including personal temperament and values. The CNS Core Competencies do have implications for CNS educators and clinicians, and the NACNS Board of Directors is mindful of these challenges. The NACNS serves as the steward of the CNS Core Competencies with responsibility for convening future national efforts to review and revise the competencies.
I had the opportunity to meet with the Wisconsin Association of Clinical Nurse Specialists at its second annual conference. The group was enthusiastic, and the posters represented the diversity of CNS practice influences. The keynote speaker, Norma M. Lang, PhD, RN, FAAN, FRCN, Wisconsin Regent Distinguished Professor and Aurora Distinguished Professor of Healthcare Quality and Informatics, provided a wonderful overview of knowledge-based nursing and intelligent technology.
I will be representing NACNS at the National Summit on Advancing Health through Nursing that will be held November 30 to December 1, 2010, in Washington, District of Columbia. If you have not read the Institute of Medicine's report, "A Summary of the February 2010 Forum on the Future of Nursing," I encourage you to do so. This is an exciting time, and it is our responsibility to stay abreast of these endeavors so critical to nursing and to society.
On a final note, as I mentioned, the Board of Directors retreat was held last September in Baltimore at the same venue as the 2011 conference. This conference promises to be a wonderful event. The hotel is beautiful, and the waterfront setting is exquisite. The board is very excited by the many changes in program format and routine. Our management team has been hard at work in partnership with conference cochairs, and I believe that you will be pleased with the outcomes. Please attend, and when you do, introduce yourselves! We're making an effort to ensure that you have ample opportunity to connect with directors.
The year has been humbling and inspiring, and I thank you for allowing me the privilege of serving this association.
1. Dixit J. The art of now: six steps to living in the moment. 2008. http://220.127.116.11/?q=node/view/2642. Accessed October 31, 2010.
2. Clark A. Notes from the board: a message from your president. Clin Nurse Spec. 2004;18:222-225.
News From Our Affiliates
California Clinical Nurse Specialist Network
The California Clinical Nurse Specialist (CaCNS) Network sponsors a quarterly educational session. The "Role of the CNS in Performance Improvement: Using Collaborative Alliance for Nursing Outcomes to Ensure Best Practice" was presented by Mary Foley at the Long Beach Memorial Medical Center on October 23, 2010. The next educational session is scheduled for January 2011.
The CaCNS Network is soliciting nominees for the positions of president-elect, hospital liaison, and student liaison. Contact Liz Budek, CaCNS president, at LBudek@fire.lacounty.gov.
The CaCNS Network will be participating in an Advance Practice Registered Nursing summit in the first quarter of 2011. The summit will focus on reviewing a white paper developed in collaboration with Advanced Practice Registered Nurses and the California branch of the American Nurses Association that details the educational preparation needed for prescriptive privileges and the educational and practice backgrounds required for all advanced practice nurses.
Cheryl Westlake has been invited to serve a 3-year appointment on the Heart Failure Society of America's Clinical Guidelines Committee. The first meeting was held in San Diego on September 12, 2010.
Military Virtual Affiliate
Congratulations to Air Force Maj Maria Yamzon from USNH Okinawa for her successful completion of the Clinical Nurse Specialist Core Exam. Way to go, Major!
COL (USA Ret) Cathy Johnson is a clinical nurse specialist and nurse practitioner at Samaritan Counseling Center in Fairbanks, Alaska. She is looking for another provider to work at this nonprofit mental health center serving interior Alaska to include Ft Wainwright and Eielson US Air Force Base families. Anyone interested in living close to Denali National Park and Mt McKinley who affords the opportunity to see the northern lights in winter months and 20+ hours of daylight in summer months, please call her at 907-590-1683 or e-mail her at Cathy.Johnson@Samaritanalaska.com. Cathy retired from the position as deputy commander for Nursing at Bassett Army Community Hospital, Ft Wainwright, Alaska, in 2003.
Ms Cindy Goldberg, clinical nurse specialist in the Surgical Neuroscience Nursing Section of Walter Reed Army Medical Center was a speaker on October 19, 2010, at the Nursing Polytrauma Conference sponsored by Veterans Affairs Department of Veteran Affairs Employee Education Services and the Office of Nursing Services. She was part of a 3-person pain panel that presented management of pain in the polytrauma patient along the continuum of care beginning with the initial injury through acute care to care in a rehabilitation facility. Approximately 120 people attended the presentation as part of the 3-day conference at the Hyatt Regency Hotel in Arlington, Virginia.
Submitted by LCDR Tina M. Cox, MSN, MSM, CNS-BC, RNC
Veterans Affairs Virtual Affiliate
Elissa Brown, clinical nurse specialist (CNS), Mental Health, at the Veterans Affairs (VA) Greater Los Angeles Healthcare System is now the new VISN 22 (Veterans Integrated Service Network 22) CNS representative to the national VA's Advanced Practice Nursing Liaison group. She is also the new vice chairperson for the American Nurses Association Constituent Assembly. As presiding American Nurses Association-California president, she also presented at the California Nursing Students Association Convention in October.
The Indianapolis VA hosted a pharmacology update conference for Advanced Practice Registered Nurses in September 2010 at the Indiana University-Purdue University Indianapolis student center. Six pharmacology continuing education units were awarded for this event. More than 80 participants attended from the VA as well as other facilities in the region. The course planning committee included Kathleen Sisk, Phyllis Baker, Anna Bober, Jayne Emerick, Earlie Hale, Sue McManus, Jane Sprinkle, Janet Stockbridge, Cheryl Petty, Shannon Wallace, LeAnn Wenzel, Lynn Young-Bolden, and M. J. Wiley.
For the second successive year, the Advanced Practice Registered Nurses from the Indianapolis VA volunteered in June of 2010 at a local Habitat for Humanity project to help build a house for a veteran. Because such a large number of volunteers from the VA committed their time to this project, our group was able to sponsor an entire day for this project and provided all the volunteers needed for that day. Once again, we were able to give back to those who have given so much for our country.
Susan Gresser, geriatric clinical nurse specialist from the Milwaukee VA Medical Center presented "CNSs With Prescriptive Authority" at the 2nd Annual Wisconsin Association of Clinical Nurse Specialist's Conference in Pewaukee, Wisconsin, on October 15. She spoke on her role at the Clement J. Zablocki VA and her use of prescriptive authority as the leader of their Dementia Consultation Team.
Donna Fritz, oncology clinical nurse specialist at the Denver VA Medical Center since 2008, has achieved certification as the Oncology Nursing Society's Advanced Oncology Clinical Nurse Specialist.
Submitted by Kathleen L. Dunn, MS, RN, CRRN, CNS-BC
Wisconsin Association of Clinical Nurse Specialists Affiliate
The Wisconsin Association of Clinical Nurse Specialists (WIACNS) is celebrating a busy and productive 2010. The affiliate has set several goals and is actively working on achieving them. Our biggest goal for 2010 was to plan and host our second annual conference on October 15, 2010, in Pewaukee, Wisconsin. The conference was well attended by clinical nurse specialists (CNSs) throughout the state. Speakers shared their expertise on the topics of CNS influence on nursing sensitive outcomes, national CNS landscape (opportunities and challenges), the role of CNS in 3 different practice settings, and an update on the Wisconsin registered nurse survey with messages for the CNS. We were honored to have National Association of Clinical Nurse Specialists (NACNS) president, Dr Patti Zuzelo, speak at our conference in 2010 and provide us with an update on the national issues for CNSs.
Another affiliate goal relates to the celebration of National CNS Week. The affiliate wanted to recognize CNSs during CNS Week in health care organizations and across the community. We used online documents from the NACNS Web site to submit proclamations to the mayors of Madison and Milwaukee and to Wisconsin governor, Jim Doyle. All 3 of these government leaders signed proclamations designating September 1-7, 2010, as CNS Week. These proclamation documents were shared throughout health care organizations in the respective cities and at the September WIACNS meeting and October CNS conference. WIACNS members are very proud to have received these proclamations in honor of the work of CNSs throughout the state.
Our general membership meetings continue to be held on the odd months, and steering committee meetings are held on the even months. Conference calling is available for both meetings. Membership to WIACNS is free. Each general meeting contains an educational offering for members. Educational topics for 2010 have included a recapitulation of the 2010 NACNS conference, mobilizing your leadership skills, and pain management.
Current WIACNS officers include Stephanie Kraus, president (University of Wisconsin Health); Julie Darmody, president-elect (University of Wisconsin-Milwaukee); Sue Fuhrman, past president (ProHealth Care); Brenda Larkin, treasurer (Aurora Healthcare); and Michel Hardwick, secretary (Wheaton Franciscan Healthcare).
To find out more about WIACNS including our annual conference, visit our Web site (http://www.wiacns.org).
Submitted by Stephanie Kraus, MS, RN, CCRN, WIACNS President
NACNS CONFERENCE UPDATES
The NACNS conference planning committee has developed an outstanding program for the 2011 NACNS Annual Conference, "CNS: Your Clinical Innovation Expert." There has been a fabulous response to the new conference schedule: More than 180 abstracts were submitted for the conference, and the best were selected for 90 podium presentations and more than 50 poster presentations.
The program begins with an opening keynote address by Patricia E. Benner, PhD, RN, FAAN, FRCN, professor emerita of the Department of Social and Behavioral Sciences with a joint appointment in the Department of Physiological Nursing at the University of California San Francisco. She has conducted extensive research on skill acquisition and clinical judgment in nursing practice.
We want to thank and recognize the 115 NACNS members who volunteered to review the abstract submissions. The 2011 conference would not be possible without the work of these individuals.
The bylaws subcommittee of the NACNS Board has conducted a careful review of the bylaws. A document that identifies all of the proposed revisions will be distributed to members by mail. These changes must be voted on in writing by the membership and returned by mail ballot or in person at the annual meeting. Voting will be finalized at the annual business meeting scheduled for Friday, March 11, 2011, during the annual conference and also in a summary report in the newsletter.
The proposed revisions fall into 2 categories. The first category involves editorial changes to (a) address inconsistencies between different sections of the bylaws and (b) provide clarification of terms. The second category involves substantial changes to the bylaws.
Please take time to review and vote on the proposed bylaws changes.
Call for News Items
If you have information you want to share about yourself, your NACNS peers, or your affiliate/affiliate peers, please send the news item to email@example.com. News items for the 2011 May/June issue are due by February 28, 2010.