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

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NAME: Stephenie Cerns-Rach

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CURRENT POSITION: Palliative Care/Internal Medicine Clinical Nurse Specialist


CURRENT AFFILIATION(S): Local: President, Wisconsin Association of Clinical Nurse Specialist (WIACNS); President-Elect, Wisconsin-American Society of Pain Management Nursing (ASPMN); Member, Greater Milwaukee Chapter, Hospice and Palliative Nurses Association (HPNA). National: Member, Sigma Theta Tau International Honor Society of Nursing, National Association of Clinical Nurse Specialists (NACNS), HPNA, and APSMN.


AREA(S) OF SPECIALIZATION: Palliative Care/Nursing Pain Management


PROFESSIONAL EDUCATION: Master's of Science in Nursing, Marquette University; Bachelor's of Science in Nursing, Alverno College


CERTIFICATIONS: Adult Health Clinical Nurse Specialist (ACNS-BC), Pain Management (RN-BC), Certified Hospice and Palliative Nurse (CHPN)


The 2012 Clinical Nurse Specialist of the Year, Stephenie Cerns-Rach, MSN, RN, ACNS-BC, RN-BC, CHPN, was nominated by Kristi Opper, MS, RN, A-CNS-BC; Sharron Coffie, MS, RN, A-CNS-BC; and Joe Beiler, MS, RN, A-CNS-BC, and her supervisor Sandy Simuncak, MSN, RN, OCN, director of nursing for Blood & Marrow Transplant, Hematology/Oncology, Palliative Care and Vascular Access Team, at Froedtert Hospital, Madison, Wisconsin. Ms Cerns was presented her award at the Annual Conference of the NACNS in Chicago, Illinois, this past March. Stephenie is described as "one of the most inspiring clinical nurse specialists (CNSs) that we have on staff at our hospital." She works on a palliative care, internal medicine and hematology/oncology unit within a collaborative practice model that engages key stakeholders from physicians, nurses, and support staff. She leads with a gentle spirit and is able to guide staff and students to the next level of development. She was a key facilitator on a key organizational initiative, the team was able to reduce the readmission rate for patients with sickle cell pain crisis. During the pilot phase, these sickle cell patients had a 7-day readmission rate back into the hospital. At the end of the pilot, the sickle cell patients improved to a 21-day readmission rate. The sickle cell patients have seen a 50% decrease in their readmission rate since the completion of this pilot. This project resulted in new standing orders, process improvement in the care and management of acute pain/crisis of patients with sickle cell anemia, and a transition and home follow-up plan that has resulted in decreasing time between admissions. Her work on this project was accepted as a poster to the National American Nurses Credentialing Center Magnet and WIACNS conference. She also taught at Marquette University to advanced practice nurse graduates students about the sickle cell patient program-evidence-based practice interventions across the life span.


Stephenie is a great patient advocate. She works to ease the transition of teens with sickle cell disease from the children's hospital to an adult hospital. She promotes ethical decision making around pain management and palliative care. She routinely teaches pain management at End-of-Life Nursing Education Curriculum. She works closely with the Regional Anesthesia Acute Pain Service (RAAPS) and also collaborates with interdisciplinary teams such as the Children's Hospital of Wisconsin Hematology Clinic Advance Practice Nurses (APNs) and Medical College of Wisconsin Palliative Care APNs. She cochairs the house wide Pain Steering Committee is a key facilitator incorporating best practices related to nursing pain management at the bedside. She also facilitated the revision of the Removal of Mechanical Ventilation in Dying Patients guidelines in our multidisciplinary critical care work group. She has provided a wide range of education for all levels of providers. She promotes the use of research and evidence-based practice into direct nursing care. She embraces Benner's Novice to Expert Model in her work. Her practice is grounded in cultural competence and minimization of disparities at point of care. She teaches the 3 spheres of influence as she precepts CNS graduate students from Marquette University and Alverno College and orients new CNSs at Froedtert Hospital. She is an active member of professional organizations including president of the Wisconsin Association of Clinical Nurses and serving as both a local and a national member of the NACNS and the HPNA. She is a member of the American Society of Pain Management Nursing, president-elect for the WI Chapter of American Society of Pain Management Nursing, and a member of the Sigma Theta Tau International. We are proud to showcase Stephenie Cerns as the 2012 CNS of the Year.


What first motivated you to become a CNS?

My primary focus and interest, as a nurse, is improving nursing practice at the bedside that directly influences patient outcomes. Core to the CNS position is bridging the integration of evidence-based practice and nursing research to bedside nursing. Choosing to pursue a graduate degree as an adult health CNS was a natural progression in my career.


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

An essential element, and an inherent issue, to the CNS role is the ability to clearly articulate the value that is brought to patients (families), nursing staff, and the organization. As a new CNS, this can prove to be a challenge. It is necessary to develop a tool box of definitions related to the role of the CNS and how the role can benefit the key stakeholders by "tailoring the message." I tailored messages to key stakeholders I would encounter daily, on what the benefit of a CNS is on a microlevel and macrolevel in relationship to overall patient outcomes.


What do you perceive are the key issues for CNS practice today?

The key issues for the CNS are the ever-changing education preparation requirements, development of similar yet different roles within nursing, and the lack of certification for specialties. In addition, the CNS voice has not evolved as much as I would prefer in the complex healthcare US political arena.


What do you see as the future role of CNSs in healthcare reform?

The role of the CNS in healthcare reform will make us more transparent to others and showcase our knowledge, competence and educational preparation. Our contributions within the 3 spheres of influence will further assist our healthcare organizations to remain robust and financially strong.


To date, what do you perceive as your greatest accomplishments as a CNS?

My practice is grounded in cultural competence and minimization of disparities at the point of care. Much of my EPB and quality improvement projects have centered on pain management, specifically for patients living with acute and chronic pain associated with sickle cell disease and palliative care.


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

I enjoy a wide variety of things about my role as a CNS. In particular, the breadth and depth of our clinical practice that directly impacts patients/families, nursing, and healthcare as a whole are core to my CNS practice and are the things I most highly value.


What advice would you give a new CNS starting out in this role?

After being in this role for a number of years, I have pearls of wisdom to share with future CNSs. However, I believe the overarching advice is how it is essential to the role of a CNS to have a transparent practice. Transparency lends itself to increasing the value that a CNS brings to nursing, patients/families, and healthcare. It is necessary for a CNS to have a collaborative practice model in order to promote the best possible outcomes for patients. I would also encourage early certification and consideration for doctoral education.