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NAME: Theresa Murray
CURRENT POSITION: Critical Care Clinical Nurse Specialist
CURRENT AFFILIATION(S): Community Health Network, Indianapolis, Ind.
AREA(S) OF SPECIALIZATION: Critical Care
PROFESSIONAL EDUCATION: MSN
CERTIFICATIONS: CCRN, CCNS
Theresa M. Murray MSN, RN, CCNS is the recipient of the 2005 Clinical Nurse Specialist of the Year Award. This award is presented annually by the National Association of Clinical Nurse Specialists to a clinical nurse specialist (CNS) who demonstrates outstanding professional achievement and exemplary CNS practice. Ms Murray, a critical care CNS, was recognized for her excellence in patient care, for mentoring and leading nurses, and for her abilities to effect change in the healthcare system. Her dedication to safe, high-quality nursing care has been cited as positively impacting patient and inspiring other nurses.
I was interested in having the best of all worlds. For me, that was being a clinical expert working with patients and families in crisis, being a liaison between staff and leadership as part of a team, and influencing quality of patient outcomes at the system level. CNS practice involves advancing patient care from all directions and perspectives-improvements in protocols, equipment, systems of care delivery; staff education regarding current evidenced-based practice; and collaborative clinical case management, all with the patient at the center. Having been a CNS for many years now, I believe the CNS is most uniquely competent to address the recommendations of the Institute of Medicine regarding patient safety.
My first and only position as a CNS was in the hospital system in which I had worked as a staff nurse. Having "grown up" in the system, I had the advantage of longstanding relationships with many staff nurses and physicians as well as senior nurse leaders. These relationships were important leverage points in my work as a CNS, as I have been challenged with helping to move the system toward a common vision and mission. However, there are people who remembered me as an inexperienced nurse who, no doubt, made her share of mistakes and political blunders. To have others see me in a new role, it was important to concentrate on the task at hand and to demonstrate competence around selected projects. Eventually, staff came to understand my new role but it takes time and occasionally some "testing" does occur.
One very significant issue is lack of clarity about the CNS role itself. The most significant consequence of lack of clarity is the underutilization of CNS practice competencies, particularly in the areas of patient care, quality improvement, safety initiatives, and cost reduction. The outcomes of CNS practice are at multiple levels-patients, staff, and system-but always contributing to improved nurse sensitive patient outcomes.
CNSs are sometimes confused with nurse practitioners. These two roles are both advanced practice, but have very different competencies and outcomes. I believe we need to increase our efforts to clarify the differences between the two roles so we will be better able to offer mutual support in both the work setting and political arena.
Working with great people and raising the standard of care for critically ill patients. By role modeling behaviors to other caregivers, I am able to encourage nurses and strengthen their passion about critical care nursing. I am thrilled when a staff nurse asks "I wonder what the literature says about that?" It's even better when we review the literature and make decision about change that is based in evidence. I'm convinced that staff would not appreciate the need for evidence had I, as a CNS, not been role modeling and championing this approach. As a result, the medical staff is more collegial, and we accomplish more as a team because they understand that nursing is committed to changes that reflect best practice.
I love my job! I always say that I am having the time of my life, doing what I love and getting paid for it. I love that no 2 days are the same. I love that I work in the gap between what is known scientifically and what is practiced clinically.
While my work-a-day world is varied, I am most committed to being directly involved with patients and their families. An intensive or critical care unit can be a scary place. It is my mission to assure that families are informed, connected, and engaged and that nurses and other staff members are working together, with family input, toward the best possible patient outcomes. In most cases, this means an aggressive treatment plan; however, when aggressive care is not helping and cure is not possible, I often provide the clinical leadership for refocusing the family and staff on managing a peaceful, dignified, spiritual and meaningful death. The comfort work of nursing is vital and yet so poorly understood and undervalued. I am pleased to have heightened the awareness of the comfort work of nurses for critically ill patients and their families.
Where the CNS role is understood and the practice competencies fully operationalized, CNSs are able to influence care delivery on all levels within a specialty. In my system, Community Health Network, the CNS role is exquisitely understood by the chief nursing officer and the nursing management team. I value their support and as a result, there is not a nuance related to critical care of which I do not have knowledge of or which I am not able to influence.
The thing to keep foremost in your thinking is that the CNS role is about relationships and credibility. I do not have line authority. I don't hire, fire, or budget. The things I am able to change result from my clinical reputation. A CNS needs to be viewed as a thoughtful person who can be counted on to get the job done. It is vital to know your stakeholders and their issues. Be collaborative and form partnerships, help others be successful and you will be successful.
Much of my success is measured by the success of the people I support. Help the nurse manager improve the unit's bottom line by finding less costly supplies of equal or better quality. Help a staff nurse successfully precept a new graduate. Show the Pharmacy Department how it can cut waste. Manage the angry family that is lashing out at physicians. Be available, be helpful, be humble.
I don't know if there are words to express my feelings. It is an incredible honor to be recognized as the CNS of the year. I am just speechless, and that is saying something! I was selected by my peers as outstanding in a field of outstanding candidates. I treasure this recognition. I value the trust that it infers that I will continue to illustrate the best the CNS role has to offer.
The role of the CNS is the role of a clinically focused nurse in a specialty. Prepared at the graduate level, CNSs are indeed expert clinicians who nurse at an advanced level for the purpose of advancing the profession. I must recognize and give accolades to the incredible people who have invested in me, mentored me, and with whom I work on a daily basis. Together we are proud of winning this award.
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