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

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NAME: Elissa Brown, RN, MSN

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CURRENT POSITION: Clinical Nurse Specialist


CURRENT AFFILIATION(S): VA Greater L.A. Health care System


AREA(S) OF SPECIALIZATION: Psychiatry/Mental Health






Elissa Brown, MSN, RN, PMHCNC-BC, is the 2009 recipient of the Clinical Nurse Specialist of the Year Award, presented by the National Association of Clinical Nurse Specialists (NACNS) at the annual 2010 March meeting in Portland, Oregon. Ms Brown was nominated by her colleagues, LuAnn Sanderson, MSN, PMHCNS-BC, associate chief, nursing service, and Helen Bonanomi, MSN, RN-BC, CARN. Ms Brown coordinates an interdisciplinary geropsychiatry clinic at the Veterans' Administration Greater Los Angeles Healthcare System. She is viewed as an expert in her specialty and demonstrates competencies in all 3 spheres of clinical nurse specialist (CNS) influence: direct patient care, promoting high standards of nursing practice, and programming quality service delivery within complex systems. She assists patients and families to negotiate the system and to be assertive and effective participants in their treatment. She has facilitated caregiver support/education groups for more than 20 years and established a concurrent group for patients. Letters of appreciation from patients' families recognize her as someone who listens, cares, and makes things happen. Ms Brown believes in building coalitions to discuss issues and problems and to work together on improving patient outcomes. Her colleague, Ms Bonanomi, reports that Elissa practices her belief that even one person speaking up can make a difference.


What first motivated you to become a clinical nurse specialist?

I went to work as a staff nurse in psychiatry, as part of a government grant. While there, I was invited to become a part-time clinical instructor at a university school of nursing, an opportunity I accepted. It was during my teaching that I realized what I did not know and so decided to return to school. At that time, in the late 1960s, there was a push to put all master's-prepared nurses into either administration or education. I chose a psychiatric CNS program because I liked the idea of advanced prepared nurses going back to work with patients and staff at the bedside.


My passion was and still is patient care. I minored in both education and administration but focused on clinical practice. Where I worked during school and after graduation, we had a unique situation: those RNs working on their CNS masters degrees were called nurse clinicians who worked with the CNSs.


What, if any, professional or career issues did you face early in your career as a CNS? What helped you address them?

I faced the usual task of explaining and justifying my role as a CNS. I believe I created the role in at least 4 of the places I have worked. Creating and explaining the CNS role actually became familiar and expected. These experiences served as opportunities to clarify the role for myself and others. I started a CNS or APRN group in each of the places I worked, that built a base for us and a chance for peer review, peer support, and strength for CNSs and other APRNs within the organization.


What do you perceive are the key issues for clinical nurse specialist practice today? What do you see as the future role of clinical nurse specialists in health care reform?

Key issues for today are:


Articulate how and where we fit in the health care system in general, and into the places where we work? We need to be in strategic positions in the systems in which we work.


The CNS potentially has the best take on the "bigger picture" and a vision for a better future in health care. Because we are nurses, we bring the holistic perspective to our work and to the team. Furthermore, the CNS role involves multiple spheres of influence, including the all important systems approach, all of which should enable CNSs to play key roles in health care reform. We need to promote this.


The CNS needs to be more visible at health care forums and involved in policy discussions. In issues such as the medical home movement, we need to promote inclusion of CNSs on the teams, including CNSs as providers and specialty consultants.


Other issues:


How can we increase our numbers and our strength and ability to work to our optimum potential?


How do we maintain common understanding of CNS practice amongst our peers, and how do we educate other professionals and the public?


How do we improve our educational system, that is, more standardization of programs, more faculty, sharing of resources, and appropriate preparation for the real world.


To date, what do you perceive as your greatest accomplishments as a clinical nurse specialist?

I have many accomplishments as a CNS, the relationships built with colleagues and with patients and families; positive patient and family/caregiver care outcomes; coordinating a geropsychiatry clinic, including facilitating caregiver support groups, for 27 years now. I am especially proud of the CNS of the Year Award-of being recognized by my peers for doing well what I love to do. I cannot think of a much higher honor.


What do you enjoy or value most about the role of a clinical nurse specialist?

What I value most about the CNS role is the ability to do so much in so many arenas, to represent nursing and promote interdisciplinary team work, to be creative in designing and implementing ways to improve patient care outcomes, to work with staff to improve their care and their pride in themselves and in their profession.


What advice would you give a new clinical nurse specialist starting out in this role?

I actually wrote an article about this back in 1983, called "From the Membership: Making it." In the article, a few of the ideas I shared were:


Clarify your role and position on the organizational chart, clarify role expectations, focus on patient care, maintain records, document, continue professional growth.


A delightful CNS colleague, whom I met at the NACNS conference, asked me if I were the person who was the author. Then she told me-and this was one of the highlights of being at the conference-that she had been using that article when teaching CNSs. What a moment, to hear one may have made a difference, perhaps helped others. I thank her so much for that "gift."


And, I would add: find a mentor who really knows the CNS role and with whom you can work, join or start a CNS and\or APRN group where you work, view challenges as opportunities, get on committees that involve decision making about patient care, and join one's general professional and specialty nursing associations to stay up to date, have your voice heard, and participate in invaluable networking.