Authors

  1. CLARK, ANGELA P. PhD, RN, CS, FAAN, FAHA

Article Content

Very few burdens are heavy if everyone lifts. - Sy Wise

 

Leadership in the NACNS Family

One of the true joys and rewards of serving as your president this year is the opportunity to observe firsthand the many leadership activities in which the organization and individual members are engaged. Even more important are the efforts that are made to create opportunities to inspire and develop the leadership abilities of others within the profession of nursing 1 and NACNS itself. Our organization has a way of keeping leaders in the fold, where they continue to make a difference year after year. We must be vigilant and must continue to mentor new leaders for our future as an organization.

 

We can be proud of the number of initiatives that NACNS has taken. Recently, 4 NACNS representatives (Dr Jan Fulton, Dr Brenda Lyon, Chris Filipovich, our executive director, and myself) attended the APRN Roundtable held by the National Council of State Boards of Nursing (NCSBN) meeting in Chicago. NACNS continues to speak out about barriers to clinical nurse specialist (CNS) practice and education, including the potential implications of the APRN Compact language. (If you are not yet familiar with this document, I suggest you go to the NCSBN Web site and study the implications and potential threat to CNSs as well as nurse practitioner programs.) We are grateful to our many leaders within the NACNS family who monitor legislative activity in their states and communicate with NACNS and our Legislative-Regulatory Committee (chaired by 2 past presidents, Dr Brenda Lyon and Jo Ellen Rust) about their concerns.

 

In May 2004, we met with key leaders from the Division of Nursing Dr Denise Geolot, director, Donna English, deputy director, and Dr Pat Calico, nurse consultant in the Advanced Nurse Education Branch (Dr Calico also attended our national conference in March) about issues affecting CNS practice and education. We shared copies of the new second edition of the NACNS Statement on Clinical Nurse Specialist Practice and Education and discussed future funding of CNS programs. The division leaders continue to seek additional NACNS members willing to serve as grant reviewers (both educators and CNSs in practice), and expressed appreciation to those who had volunteered in the past. They emphasized the value of the Annotated Bibliography that is part of the statement because it describes outcomes of CNS practice that can be used in legislative communique. Of news to CNS educators and program directors is that there is grant money available for new and innovative CNS programs in a variety of funded initiatives. These nursing leaders in the federal system suggested that CNS educators send a one-page concept paper/proposal idea for their review and they will provide direction to them as to the best fit for submitting a grant for a CNS program. Please contact the NACNS office if we can provide you with more information about this opportunity.

 

Your representatives also met with leaders who accredit CNS education programs-Barbara Grumet, JD, executive director of National League for Nursing Accrediting Commission (NLNAC), and Jennifer Butlin, MA, director of the Commission on Collegiate Nursing Education (CCNE). As many of you are aware, our members have consistently asked for more influence from NACNS on the evaluation of quality CNS programs during the process of accreditation. Between 1999 and 2004, visionary leaders from the Education Committee (led by Dean Peggy Gerard and Dr Jane Walker) completed several steps of development for program review to become a reality. They presented the findings and their recommendations to the NACNS board of directors in March 2004. The board approved going forth with the process of program review and so we are now in the process of investigating possible partnerships with NLNAC and CCNE as we move forward. We are very appreciative of the deans and leaders from the schools who participated in surveys and pilot program reviews. Stay tuned.

 

Dr Ann Mayo, chair of the Research Committee, who is a CNS and nurse researcher from Kaiser Permanente in California joined me and our executive director in meeting with leaders from American Association of Colleges of Nursing (AACN)-Dr Geraldine Bednash, Dr Linda Berlin, and Dr Joan Stanley. We discussed the joint survey done by AACN and NACNS about enrollments and graduations, and the nature of specialty curricular content in CNS programs. NACNS continues to monitor significant trends and is interested in identifying the types of specialization for CNS education to respond to any barriers in the regulatory arena. We are so fortunate to have the expertise of leaders like Ann who continue to help us reach our goals for CNSs.

 

So many other connections are occurring as a result of the leadership of NACNS and its commitment to represent CNSs at the national level and promote the role of CNS practice. Being a leader is an essential characteristic of a CNS. 2 If you are interested in serving on one of our committees, please contact the NACNS office or send your curriculum vitae with a cover e-letter. We continue to seek energetic, visionary leaders for our many initiatives!!

 

NACNS Update

News From Our Affiliates

A new area in the NACNS updates is a forum for the affiliates to report activities, issues, and concerns. With a very short time line, these affiliates were able to provide an update of current events, provide information about their structure and process, and report issues in their areas. It is hoped that this area for discussion will provide insight into how to form your own affiliate chapter. If interested in further information on affiliate formation please contact Dr Sue Davidson at [email protected].

 

Minnesota: One of the issues we've looked at in Minnesota is do we want to start having dues etc and what would that mean. There's a lot involved when you do that and I'm sure it is state dependent but it would be helpful information (to share with other affiliates). Another issue is the clinical nurse leader role, as you know. It would be very helpful to have an area to address how other states are addressing it. Thanks. Sue Sendelbach, Minnesota Area Affiliate.

 

Oklahoma: The Oklahoma affiliate of NACNS, OACNS, is a strong, well-established organization. We hold an annual fall membership dinner meeting, and have just completed our third successful annual conference. As we grew and became more active we hired a management association to help with many of the day-to-day business tasks. Specifically, we pay them to update and manage our membership database, provide reports as requested, and assist with event planning (such as managing our annual conference). They also develop the vendor and sponsorship database, make travel and hotel arrangements for out of town speakers, arrange meeting space, provide telephone services for the organization, prepare and mail out the quarterly OACNS newsletter, and manage the bank account for the organization. Susan Dresser, RN, CCRN, CNS, Oklahoma Association of Clinical Nurse Specialists.

 

Missouri: Our group had been in place for many years before affiliating, and so a lot was already in place. We have a president and a president-elect (main responsibilities are agendas for meetings, running the meeting, and being official contact person), a secretary (meeting minutes, distribution list, which is primarily e-mail), and a treasurer (membership dues now $20/year or $10/year for students, keeps financial records, writes any needed checks). Meeting schedule and topics are decided by the group annually, and we rotate between hospitals, with the "host/hostess" member making the arrangements for the site (which sometimes includes sponsorship) and someone volunteering to arrange speakers when we have them and manage CEUs. Members generally rotate the roles to share the workload, and with it spread out this way it isn't too much burden on anyone. Mary A. Stahl, Greater Kansas City CNS Group.

 

New York: Greetings!! We just recently had our first Affiliate Meeting. I would appreciate any information/guidance as far as how your Affiliate developed. What committees were started first, did you develop your own bylaws, do you charge any fees/dues, etc? Thanks in advance. Linda Cohen, RN, MPH, CDE (soon to be MSN), New York Regional Clinical Nurse Specialist Chapter.

 

Indiana: We chose to keep our affiliate pretty informal, we rotate coordinating meetings, and I keep the membership list and send member communications. We chose no dues etc and try to get sponsorship for our meetings. Jan Powers, Central Indiana Organization of Clinical Nurse Specialists.

 

Oregon: We have quarterly meetings for the general membership that includes an educational component at all meetings. Discussions in the recent past have included topics such as the Critical Care Consortium, a highly successful collaborative venture in our local area that was brought together and is managed by CNSs and a presentation on "Oregon Hospice Nurses and Assisted Suicide: Implications for Nursing Practice."

 

New Board Member Introductions

There are a number of new members on the board and the updates section of the journal offers an opportunity to get to know who they are. Look for a different member to be briefly introduced in coming editions:

 

Kelly A. Goudreau, DSN, RN, CNS

Kelly is the new secretary for the board of directors and lives in the state of Oregon. She is the director of education for the Portland VA Medical Center and has had a varied past with roles in administration, academic educational settings, and direct clinical practice. She earned her baccalaureate degree in nursing from the University of British Columbia in Vancouver, BC, Canada, her master's degree as a CNS at Washington State University, and her doctorate in nursing education from the University of Alabama at Birmingham. In addition to being on the board of directors, Kelly is also the chair of the Oregon affiliate, the Oregon Council of Clinical Nurse Specialists (OCCNS).

 

When not busy with nursing or educational issues Kelly stays home with her 2 daughters Christianne and Kelsey, her husband Serge, and their 2 cats.

 

Are You Preparing for the 2005 Annual Convention?

We will be in beautiful Orlando, Fla, March 9-12, 2005. Mark your calendars now and prepare to attend!! Watch the newsletter for future postings and information that will be up to the minute!!

 

Member-Get-A-Member Campaign Begins!!

We are launching our annual Member-Get-A-Member campaign in an effort to welcome CNSs into the organization that speaks for them at a national level. As we grow in number of members, the power and voice of NACNS will ensure the future viability of the CNS role within healthcare. The campaign will run each year from January 1 to December 31.

 

WIN!! WIN!! WIN!! WIN!!

 

Free membership for one year for all who recruit more than 10 new members*

 

One grand prize: Free registration to the 2005 Annual NACNS National Convention and free membership for one year for the one who recruits the most new members*

 

See our Web site, http://www.nacns.org, for membership applications. You may duplicate the form and give it your CNS colleagues, coworkers, and friends. Make certain that your name is in the "recruited by" section. If a "recruit" applies for membership via the NACNS Web site, fax, or phone, make sure he/she indicates that you are the recruiter.

 

Get busy and encourage your colleagues to become a member of the professional organization exclusively designed to meet the professional role development needs of CNSs.

 

Together we can make a difference.

 

Watch for the NACNS Booth at a Convention Near You!!

In an effort to reach out to CNSs in every specialty, members of the board of directors and the chairs of various committees are attending and displaying our new display booth. Take a moment to speak to the NACNS representative, buy a revised statement on clinical practice and education, or talk about your ideas of how to increase membership so that NACNS speaks with a strong voice for all CNSs nationwide.

 

Watch for the booth at the NCSBN delegate assembly in August.

 

Consortium Releases Clinical Practice Guidelines for Quality Palliative Care

In response to the increasing importance and prevalence of palliative care in the treatment of patients with advanced chronic or life-threatening illnesses, leaders in the field have developed the first national Clinical Practice Guidelines for Quality Palliative Care. The guidelines, released April 30, 2004, are designed to help the rapidly growing number of hospitals, nursing homes, hospices, and health systems that are establishing palliative care programs to ensure high-quality, state-of-the-art care of advanced illness. The guidelines were developed by the National Consensus Project (NCP), a consortium of the American Academy of Hospice and Palliative Medicine, the Center to Advance Palliative Care, the Hospice and Palliative Nurses Association, Last Acts Partnership, and the National Hospice and Palliative Care Organization. The guidelines reflect the collective scientific evidence, clinical expertise, and experience of these organizations and their members, including more than 50,000 healthcare professionals and consumers in all 50 states. Information on the NCP and the guidelines can be found at http://www.nationalconsensusproject.org.

 

The Clinical Nurse Leader Initiative From the American Association of Colleges of Nursing-NACNS Takes a Position

Citing a need to focus education on preparation of nurses capable of addressing the healthcare dilemmas of the future, the American Association of Colleges of Nursing (AACN) proposes a new entry level master's prepared nurse. This new entry level nurse is proposed to target current and future leadership needs in all levels and types of healthcare settings and to implement outcomes-based practice, to improve quality, and to create/manage systems of care. The new nurse role-labeled the clinical nurse leader-is conceptualized based on 10 assumptions, 3 core competencies, 7 knowledge competencies, and 3 role competencies. No data are offered to support this conceptualization.

 

NACNS monitored the progress of this proposal since it came into the public domain in May 2003. Recently AACN's board of directors approved master's preparation for the new nurse. The move to master's education heightened existing concerns by NACNS members and the CNS community at large. In response, NACNS conducted a systematic analysis of the competencies of the new nurse. The analysis was based on a comparison of competencies described in the "Working paper on the role of the clinical nurse leader" 1 with competencies described in NACNS's Statement on Clinical Nurse Specialist Practice and Education. 2 Rationale for this comparison is that the CNS is a recognized clinical leader and expert at managing clinical outcomes. 3 The knowledge and competencies described in the working paper were also compared with The Essentials of Baccalaureate Education for Professional Nursing Practice4 because the proposed new role is an entry point into nursing practice.

 

The results of the comparison demonstrate that the proposed new nurse is an overlaying of the baccalaureate essentials on knowledge and competencies of the CNS. From this comparison, it is NACNS's opinion that the proposed competencies of the new nurse duplicate the competencies of the CNS. Additionally, it is NACNS's position that a clinical leader with systems level responsibilities cannot be prepared at the baccalaureate level; to be a leader requires competencies in the direct patient care level at the baccalaureate level upon which the master's preparation builds to prepare a clinical leader. CNS competencies build on baccalaureate competencies; therefore, the graduate degree awarded by programs preparing CNSs are focused entirely on advanced nursing practice. NACNS questions the ability of a master's program to include both the competencies needed for entry into practice and the competencies to practice in a leadership/advanced role as described in the working paper.

 

For AACN to propose this new nurse as either a replacement for or duplication of baccalaureate entry-level nurses who provide direct clinical care at a time of severe nurse shortage is a questionable use of scarce educational resources. The current number of CNSs is inadequate to provide the needed clinical leadership. Continued efforts to implement this new nurse proposal will disenfranchise CNSs, a role that has been providing leadership to meet the needs of healthcare of the public for the past 50 years. This new nurse role should not progress to implementation. Rather than spending scarce financial and faculty resources on developing this new role when there is a national shortage of nurses, including CNSs, the nursing profession would be better served to support baccalaureate nursing and CNS programs. NACNS acknowledges that baccalaureate nurses are in need of clinical mentoring and practice support and believes that CNSs are prepared to provide that support. NACNS is eager to collaborate with baccalaureate programs/healthcare agencies to develop mechanisms to enhance the actualization of baccalaureate leadership competencies. In addition, NACNS is interested in discussing with AACN and other organizations opportunities for supporting and strengthening CNS programs.

 

Alternative Link Partnership

The board of directors has entered into an agreement with Alternative Link for the establishment of a clinical expert task force to assist in developing terminology and codes for CNS professional services. Alternative Link, the developer of the ABC Coding Manual for Integrative Healthcare, has asked for the clinical expertise of CNSs in the development of codes that will significantly increase the billable services that nurses provide. If you are interested in assisting with the project, please contact Christine Filipovich, the executive director for NACNS.

 

Are There Other Things You Would Like to See in the NACNS News Section?

Please feel free to provide your comments and suggestions to Kelly Goudreau at [email protected].

 

References

 

1. McClure M. Leadership. Nurs Outlook. 2003;51(2):50. [Context Link]

 

2. NACNS. Statement on Clinical Nurse Specialist Practice and Education. 2nd ed. Harrisburg, Pa: NACNS. [Context Link]

 

1. American Association of Colleges of Nusing. Working paper on the role of the clinical nurse leader. 2004. Available at: http://www.aacn.nche.edu. Accessed March 15, 2004. [Context Link]

 

2. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, Pa: National Association of Clinical Nurse Specialists; 2004. [Context Link]

 

3. American Nurses Association. Scope and Standards of Practice. Washington, DC: http://Nursesbooks.org; 2004. [Context Link]

 

4. American Association of Colleges of Nursing. The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: American Association of Colleges of Nursing; 2004. [Context Link]

 

*Students counts as half a full member [Context Link]