1. Section Editor(s): Rust, Jo Ellen MSN, RN

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NAME: Vince Holly, MSN, BA, RN, CCRN, CCNS

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CURRENT POSITION: Clinical Nurse Specialist-Critical Care


CURRENT AFFILIATION: Indiana University Health Bloomington Hospital


AREA(S) OF SPECIALIZATION: Critical care: delirium, progressive mobility, pressure ulcer prevention, sedation practices.


PROFESSIONAL EDUCATION: Bachelor of Arts in Biology, Indiana University 1991; Bachelor of Science in Nursing, Indiana University 1996; Master of Science in Nursing, Indiana University 2005


CERTIFICATIONS: CCRN, American Association of Critical-Care Nurses (AACN) 2006 to present; CCNS, AACN 2007 to present.


Vince Holly, MSN, BA, RN, CCRN, CCNS, is a recipient of the 2012 Circle of Excellence Award presented by the American Association of Critical-Care Nurses (AACN). The award will be presented at the National Teaching Institute and Critical Care Exposition in Orlando, Florida, May 19 to 24, 2012. The Circle of Excellence award recognizes and showcases excellent outcomes in the care of acutely and critically ill patients and their families. Recipients become part of the Circle of Excellence Society. Criteria used to select the Circle of Excellence award winners include the following:


* relentlessly promotes patient-driven excellence


* models skilled communication, true collaboration, effective decision making, and meaningful recognition


* transforms thinking, structures, and processes to address challenges and remove barriers to advance patient-driven excellence


* furthers AACN's mission and key initiatives at influential forums


* enriches own and other organizations by influencing and mentoring others in achieving excellence


* achieves visible results that validate the impact of individual leadership contribution to organizational excellence



Vince was nominated by his clinical nurse specialist (CNS) peers and the director of Clinical Education and Practice at Indiana University Health Bloomington Hospital. Vince has sustained excellent results in the prevention of ventilator-associated pneumonia (VAP). In collaboration with the critical care pharmacist, he has changed the practice of prolonged sedation for mechanically ventilated patients and developed an innovative protocol to treat delirium. His efforts reach beyond critical care as the leader of the team to prevent hospital-acquired pressure ulcers. His team has decreased the hospital-acquired pressure ulcer rate from 2.6 per 1000 patient-days to 1.4 per 1000 patient-days. Vince has hardwired early progressive mobility in critical care and, with the help of 2 CNS colleagues, leads the implementation of the protocol throughout the hospital. Although he has been involved in many successful initiatives, he gives the credit to the staff nurses, respiratory therapists, patient care technicians, and others directly caring for the patients. The staff need to be open to change and dedicated to improving their practice in order to achieve great outcomes.


What first motivated you to become a CNS?

I first became interested in becoming a CNS after my hospital hired the first CNS. I had worked with this nurse and consider her one of my mentors. She was the clinical educator for our critical care units, and seeing her develop into the role of the CNS inspired me. She was influencing the system to support the bedside staff in their pursuit of excellent patient care. She was involved in high-level operations in the hospital while maintaining her contact with individual patients and the nursing staff. I knew I wanted to further my education but wanted to remain embedded in the nursing domain. As a bachelor-prepared nurse, I could see the positive impact I was making while caring for my daily patient assignment. When I explored the role of the CNS, I realized I could improve patient outcomes on a much larger scale.


What do you perceive are the key issues for CNS practice today?

The implementation of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education is the issue that impacts CNS practice the most. There are too many questions unanswered and too many pieces that need to be in place for implementation of this model. This model is many years from full implementation, but parts of the model are already affecting CNSs. Eligibility criteria to sit for certification now include 3 separate graduate courses in the advanced physical assessment, advanced pharmacology, and advanced pathophysiology. To accommodate this requirement, CNS programs needed to eliminate other courses or increase the number of credit hours for graduation. If you have already graduated and wanted to obtain certification, you will need to take these 3 courses to be eligible to apply for certification. It is unclear how the regulatory model will be implemented, because it is up to each state to independently regulate APRNs. The regulatory model's premise of standardizing licensure, accreditation, certification, and education is good, but it does not mean states will universally adopt the model as it is written.


To date, what do you perceive as your greatest accomplishments as a CNS?

I felt established as a CNS when each of our critical care units achieved 1 year without a VAP. In my graduate program, I had the privilege of working with a CNS who is well respected in the specialty of critical care nursing. She is an incredible person and taught me so much about being a CNS. To this day, she is my mentor and continues to help me develop as an advanced practice nurse. During my final semester, she reached the 1-year mark without a VAP in 2 of her critical care units. I learned how she was able to lead the team to accomplish this outcome, which was unique in 2005. It inspired me to lead a team to eliminate VAP in my hospital. I put into practice what I had read in the literature and what I learned from my mentor. It was rewarding to lead a team of nurses, respiratory therapists, pharmacist, and physicians in the implementation of evidence-based practice. When we reached the landmark of 1 year without a VAP, I felt validated as a CNS. I was proud to demonstrate the CNS competencies I learned in my graduate program. It also provided me the confidence to take on other challenging initiatives.


What do you enjoy or value most about the role of a CNS?

My value to my hospital is mainly cost avoidance and improving our quality indicators. I take great pleasure in seeing our pressure ulcer rates decrease and saving the hospital several thousands of dollars in VAP prevention. I value working collaboratively with the CNSs from other hospitals in our healthcare system. It is rewarding to work together to establish evidence-based protocols that improve nursing care throughout the system.


What excites me the most is seeing the impact we make on individual patients' lives. I was consulting on a patient who was failing her spontaneous breathing trials every morning. The plan was to place a tracheostomy tube and find a facility to accept her and care for her long-term needs. After further assessment, it was clear that she needed to improve her mobility, position the patient to allow her to expand her lungs, and strengthen her respiratory muscles. After collaborating with the pulmonologist, he decided to hold off on the tracheostomy placement and allow the nurses and respiratory therapists to work to get her stronger. We mobilized this patient and positioned her for successful spontaneous breathing trials. She was extubated in a few days and eventually discharged to her home.


What advice would you give a new CNS starting out in this role?

There are many suggestions I would make to a novice CNS, but I will highlight two that will help you grow professionally. You should start to establish a network of CNS colleagues, and you should become involved in your professional organizations at some level.


You have already started a CNS network with the people from your graduate courses. Keep in touch with these individuals, because you can learn from each other as you transition into your new role. You should also identify 1 or 2 mentors to help with your professional development. Mentors could be former instructors, preceptors, or established CNSs in your institution.


As a CNS, you should feel an obligation to belong to National Association of Clinical Nurse Specialists (NACNS), the authoritative voice of CNSs. I also belong to my specialty organizations, American Association of Critical-Care Nurses and the American Delirium Society. Being a member of your professional organizations provides many advantages and usually includes journal subscriptions. Journals are a great link to innovative practice changes. But to get the full benefit from your professional organization, you should attend local and national meetings. These meetings provide an excellent opportunity to build your network of colleagues. I attend the NACNS conference every year for the networking opportunities as well as the content of the presentations. I also recommend serving on a committee. I have been a member of the NACNS Practice Committee for almost 6 years. The experience has been very rewarding and has kept me connected to the NACNS Board. Becoming involved at a deeper level helps you understand what your organization is doing to represent you and allows you an opportunity to influence some of their decisions. As my term ends for the Practice Committee, I will be looking for other opportunities to serve the NACNS.