We could not agree more strongly with Jan Fulton's suggestion that the clinical nurse specialist (CNS) as "attending nurse" is an idea whose time has come. In our agreement, we do not imply a need for change of title or regulation but rather a recognition of stature earned. The need in hospitals and health facilities for patient care quality and safety and the development of both expertise and collaborative teamwork of nurses and other healthcare providers are clear and recognized. The CNS is well prepared as an attending nurse. However, we would not have gone to the physician literature to find the kernel of the idea. Diane Cooper, attributing the idea to her colleague Mildred Czar, wrote in 1983 that the CNS with more than 5 years of experience "should be the essence of the refined expert," or the attending nurse.1^(p2) According to Cooper, CNSs should achieve the refinement, excellence, stature, and desire for learning exemplified by top attending physicians.

Later, in our book Clinical Nurse Specialist: Implementation and Impact,2 Cooper described a statue in Philadelphia named Consultation, which depicts a group of 5 physicians in different roles and which captures the peer esteem earned by each. The attending physician in the statue stands as a resource for others; they value his direction because it is based in deep clinical experience, and he listens and hears differently compared to the others in the group. Then Cooper envisioned a future time (now?) when a similar statue will exist but the depicted professionals will be nurses and the focal point of the statue will be the CNS-the attending nurse exuding confidence and the skill of years of direct clinical activity with patients.

The literature now yields models for attending nurses. The attending nurse model in adolescent psychiatry was developed by Niemela et al3 and further described by Moreau et al.4 Watson and Foster5 described the attending nurse caring model as a way to address the nursing shortage, the crisis of patient safety, and care dilemmas of our current healthcare system. We suspect that there are many more examples of effective attending nurse models.

1. Cooper DM. A refined expert: the clinical nurse specialist after five years. Momentum. 1983;1(3):1-2. [Context Link]

2. Sparacino PSA, Cooper DM, Minarik PA, eds. The Clinical Nurse Specialist: Implementation and Impact. Norwalk, CT: Appleton & Lange; 1990. [Context Link]

3. Niemela K, Poster EC, Moreau D. The attending nurse: a new role for the advanced clinician. J Child Adol Psych Nurs. 1992;5(3):5-12. [Context Link]

4. Moreau D, Poster EC, Niemela K. Implementing and evaluating an attending nurse model. Nurs Manage. 1993;24(6):56-58, >60,64>. [Context Link]

5. Watson J, Forster R. The attending nurse caring model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice. J Clin Nurs. 2003;12:360-365. [Context Link]