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

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NAME: Kelly A. Goudreau, DSN, RN, ACNS-BC

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CURRENT POSITION: Designated Learning/Education Officer


CURRENT AFFILIATION(S): Portland VA Medical Center


AREA(S) OF SPECIALIZATION: Orthopedics, Urology, Administration


PROFESSIONAL EDUCATION: Bachelor of Science in Nursing, University of British Columbia; Master of Science in Nursing, Washington State University; Doctor of Science in Nursing, University of Alabama at Birmingham


CERTIFICATIONS: Adult Clinical Nurse Specialist, American Nurses Credentialing Center


Describe your definition of leadership and why it is so important for clinical nurse specialists (CNSs) to provide leadership today in health care.

Leadership to me is recognizing the changes that are pending in the future and taking steps to assist others to see the pathway to excellence so that ultimately patient outcomes are stellar. As a CNS and as a leader I see that pathway very clearly being forged and maintained by CNSs for others in the nursing profession. All CNSs are leaders. They must be in the health care system of today if patient care is to be at a level where both the patient and the nurse can thrive.


What uniquely qualifies CNSs to serve in this capacity?

Clinical nurse specialists are educated to be change agents, negotiators, and conflict managers and to have a vision of how care can and should improve. All of these qualities are unique among the nursing roles, and CNSs have been doing them for years. There needs to be enough of us to assist and manage the changes that are coming with health care reform. That is why I am so pleased to see the resurgence of CNS educational programs in many areas of the country.


Define your view of a mentor.

A mentor is someone who assesses you and knows your abilities and then encourages you to try something you have never tried before. They are there to provide guidance and support as you try something, but they also will step back and allow you to make mistakes. It is the mistakes we make that truly teach us what we need to know, but we need to make them within the confines of a protective and supportive relationship with a mentor. The mistakes can be analyzed and put into the proper context if you have a strong, supportive, and guiding mentor.


What do you think it takes to mentor others to become leaders?

It takes balance and patience to mentor others to become leaders. It is very hard to step back and allow someone to make mistakes so that they learn the process and can integrate the information into their own leadership abilities. It takes role modeling and discussing why you made the decisions you made and being honest about whether the outcome was what you expected. It takes transparency and a willingness to share yourself with the individual you are mentoring[horizontal ellipsis] warts and all! Finally, it takes willingness on the part of the person being mentored to see that it is what the mentor is doing and to be open to the process of sharing. If the person is unwilling or unable to see what is being offered, the mentoring relationship will not exist.


As a past president of the National Association of Clinical Nurse Specialists, what do you perceive are the key issues for CNS practice today?

There are many issues facing CNSs today. Each of them is complex and multifaceted and will require strong leadership if CNSs are to not only survive but also thrive in a changing landscape.


The first issue I see that needs strong CNS leadership is the APRN (Advanced Practice Registered Nurse) Consensus Paper and the implementation of the LACE (Licensure, Accreditation, Certification and Education) initiatives that will be involved. There are many issues facing CNSs in the full implementation of this document that will include recognition for CNSs in states where CNSs are not currently recognized. Part of that recognition must include certification options being available for various CNS population foci where currently no certification options exist. Nursing education programs will need to change and include the core competencies for CNSs and must include the population competencies as well as specialty-focused competencies, and they must be preaccredited before being allowed to admit students so that students can be assured that there will be options for licensure upon completion of the program. These are not easy issues to tackle and will take some time and strong leadership skills on the part of many individuals.


The second issue needing strong CNS leadership is health care reform. Clinical nurse specialist leaders need to clearly identify where CNSs belong in the change that is to come in the health care systems. I see a strong need for CNSs in the system, but the leaders in Congress need to see that need too if CNSs are going to not only survive but also thrive in the changing health care environment.


What can CNSs do or how do you see CNSs leading nursing in regard to these key issues?

Be proactive. Become interested in what is happening in your state in regard to the APRN Consensus document implementation. Offer to provide your perspective on issues relevant to CNS practice. I know that being politically active is sometimes the farthest thing from the minds of the CNSs who are overwhelmed with clinical issues within their current clinical environment but the concern is that if they do not stand up and identify what they are doing for anyone who will listen, they run the risk of being misunderstood and found to be an expensive irrelevancy. Prevent the loss of CNSs from the care of the patients and the nurses and systems that they support. Be proactive, and be the leader.


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

I both enjoy and value being a resource guide and mentor for the nurses, the system, and a resource for other CNSs. From the vantage point of the CNS, there is no problem that cannot be identified and assessed fully. Planning can then be done to address the issue. Implementation of those plans with the support of a multidisciplinary team and assessment/evaluation of the outcomes of the planned interventions are key. The CNS is the change agent and catalyst for improving patient outcomes. That is an essential role in the health care system and one that cannot be underestimated.


What advice would you give a new CNS starting out in this role who would like to identify a mentor?

Look for someone that you may have watched for a number of years within your environment and that you admire. If you have no one in your environment directly, then look for someone at a national level that fits the criteria. As CNSs, we love to guide and mentor individuals and will take time out a busy day to spend time with a new CNS or a student. It fulfills the soul to reach out and offer guidance to others who may be struggling with a concept that you also struggled with in the past or to offer suggestions in a case where you have not encountered the situation either. We need to provide the support to those who are learning and fulfill our promise to society to be there as a resource for generations to come. My advice is to just ask[horizontal ellipsis] you will be surprised by the answer in most cases!