NAME AND CREDENTIALS: Sharron D. Coffie, MS, RN, CNS-BC
CURRENT POSITION: Clinical Nurse Specialist (CNS)
CURRENT AFFILIATION(S): Froedtert Hospital, Milwaukee, Wisconsin
AREA(S) OF SPECIALIZATION: General Cardiology; Heart Failure and Health Literacy
PROFESSIONAL EDUCATION: Bachelor of Science in Nursing: St Louis University, Missouri; Master of Science in Nursing: University of Wisconsin, Milwaukee
CERTIFICATIONS: American Nurses Credentialing Center Board Certified as a Clinical Nurse Specialist; CNS Board Certification: CNS; American Heart Association of Advanced Cardiovascular Life Support
Sharron D. Coffie, MS, RN, CNS-BC, is the 2011 recipient of the Clinical Nurse Specialist Preceptor of the Year Award, presented by the National Association of Clinical Nurse Specialists (NACNS) at the annual 2011 March meeting in Baltimore, Maryland. Ms Coffie was nominated by her colleague, Julie Darmody, PhD, RN, ACNS-BC, assistant professor, College of Nursing, University of Wisconsin-Milwaukee, and one of her CNS students, Cristin T. Phillips. She was described as an amazing preceptor and mentor who is paving the way for new CNSs. She shares her expert knowledge and is dedicated to ensuring the student's autonomy and growth. She operates in all 3 spheres of influence: patient-rounding on heart failure patients daily, providing patient education, and following up with them after discharge; nursing-demonstrating best practice to staff, ensuring that they implement evidenced-based practice into care; and system-improving the discharge teaching process for patients with heart failure, leading a team to improve practice around peripheral IV complications, and facilitating interdisciplinary rounds.
You are obviously highly respected as a role model for CNS students, what do you feel are the most important skills or competencies to mentor for such students?
One of the most important skills for a CNS student is to understand that unbiased listening and genuine caring are important to healing. As we help patients move along the continuum of their illness, our challenge is to help them meet their health needs with relevant, realistic, and achievable goals. We have to respectfully meet patients where they are.
Collaboration with physicians and other key stakeholders, especially other CNS peers, is essential to plan and implement coordinated patient-centered care. In the patient sphere, I teach my students to consider the entire person, which may include their significant others. I employ them to understand and incorporate concepts from health literacy into their practice.
It is important for the CNS student to clearly consider that they may have been an expert nurse before they embarked upon this journey. However, knowing how to be a CNS will require a new set of skills and competencies. The role of the CNS is a lifelong journey of learning and determination to turn every learning situation into an opportunity to grow. I give students "permission" to be a novice clinician upon starting their first CNS job, which is based on Benner's Novice to Expert Model.
In the organizational sphere of influence, a key activity for students is to learn how to track their activities and link their work back to unit-based and organizational initiatives. I provide every student with a logistics planning tool and a biweekly feedback communication tool to keep organized and to track their outcomes in the Three Spheres of Influence.
One of your personal skills mentioned by your nominees was challenging students to sharpen their critical thinking. What do you think are the best precepting methods to do this? What other most frequently used preceptor strategies do you use?
In preparation for the staff sphere of influence, developing critical thinking during clinical is a must. Each day, the student must verbalize key objectives for the day with references to theory, guidelines, research, and/or best practices. I ensure that we get exposure to those objectives during our day and then discuss how those objectives were met at the end of each clinical day. Other strategies includes having the student read the NACNS Clinical Nurse Specialist Toolkit1 and participate in discussions of jointly read articles and debriefing after meetings and situations that offered key learnings in the 3 spheres of influence.
In your years of experience, is there one particular aspect of clinical nurse specialist practice that you think students struggle with the most and why? What successful learning activities do you use to help them in this area?
One aspect that CNS students seem to struggle with is moving from an expert bedside nurse to a novice CNS. The transition can be tough and growth can be painful. At times, students want to hang on to what is familiar and has proven successful. The desire to operate in the familiar can offer conflict and role confusion. I have had to remind the student to "stay in their CNS lane" and not try to be all things to all people. Creating a new norm and paradigm is essential. Our clinical time is filled with both brief and extensive reflective discussions that are designed to help the student open their mind to different ways of seeing and doing things. My goal is to foster advanced thinking and decision making that will have positive influence on the bedside nurse and serve as a foundation for their future CNS practice.
Another learning activity is role playing, coaching, and mentoring. How and when to have conversations related to expected clinical outcomes can be scary and tough. I have learned that helping the CNS student give timely, constructive, and thoughtful feedback is a critical intervention. By doing this, they learn how the informal power of influence can move clinical practice in the right direction.
What helped you the most in preparing for the role of a clinical nurse specialist?
In preparing for the role of a clinical nurse specialist, I had to watch and listen to my clinical preceptor. She was wise and had 25 plus years of experience. I also referred to my Hamric, Spross, and Hanson's Advanced Nursing Practice2 book before and after each clinical. I read the NACNS Statement on Clinical Nurse Specialist Practice Education,3 numerous journals, including my CNS journal. I also had an exceptional clinical advisor whose required reading included CNS role enactment journal articles, white papers, legislative updates, role playing, and postclinical reflective journaling. Additionally, every class I took during my graduate program gave me key elements that contributed to preparation for my role. The curriculum helped change my thinking and helped me mature from a bedside nurse into an advanced practice nurse.
What do you find you learn from the experience of precepting clinical nurse specialist students?
Being in the position to be a role model and mentor to future CNS students has been one of my greatest accomplishments. I mentor both undergraduate and graduate students and I love it because I learn from them. They come with fresh ideas, new journal articles, challenging verbal exchanges, different ways to think about things, and great energy.
What has it meant to you to receive this award both personally and professionally?
I have been a nurse for almost 30 years. I have precepted and mentored more nurses than I can remember. It is my passion and responsibility to help nurture the next generation of nurses. I always believe that if I can positively influence one nurse, I can touch countless of patients and families. Each nurse brings extraordinary things to the table and I have always felt that if I give them my all, they can add to what they bring and be a phenomenal success. Therefore, when I learned that I would receive this national award, I was caught totally off guard, and yes, there were a few tears. Very busy people had to take time out of their complex schedules to take time to do the submission. I am humbled and honored.
My benchmark for being a preceptor is to help others to achieve greatness and to always know that greatness comes from a place of being a servant leader.
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