1. Manchester, Carol MSN, RN, ACNS, BC-ADM, CDE

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Frequently I am asked 2 questions, "What made you decide to be a CNS? Where does the passion come from?" I have no doubt that many of you are also asked similar questions by students, colleagues, and friends. For me, I can respond with relative ease as I know what has brought me to this place today.


Growing up, my grandpa was a very important person in my life. A kind, gentle, and patient man, he was a living example of one who provided unconditional love and care. He became ill shortly after his retirement, and for 18 months my mother and I helped my grandmother care for him at home. Mary Lou was the visiting nurse who came out 3 times a week in the early stages and nearly daily at the end of his life. Over that last summer, before I headed off to college to become a nurse, I watched Mary Lou as she provided care to my grandpa and to the family. She was proactive and an advocate, calling the doctor as needed, demonstrating comfort measures to ease the distress and pain he was experiencing, and always ensuring my grandmother was given explanations, support, and guidance throughout the remaining days. Mary Lou brought a smile, a soft touch, and the presence of her therapeutic self to professionally care for all of us to the end. Shortly after my grandpa passed, Mary Lou stopped by to see how everyone was doing. The blue vase in which she brought my grandmother a rose sits in grandma's china cabinet in my dining room today-a strong influence and memory of the power and influence a single nurse can provide.


Seven months before my graduation and entrance into the nursing profession, my professor, Dr Lyn Wescott, was observing me in a home visit as part of the public health nursing semester. It was near lunch time, and she said, "I have a surprise for you. Today, we are joining someone for lunch. Is that okay?" Well, of course it was, and I soon found myself picking up coney dogs with her and arriving at the house of Dr Mary Shanks, the dean of the Illinois Wesleyan University School of Nursing. As I sat in Dr Shanks' kitchen eating a coney dog and drinking coffee, I was asked, "So now that you are a senior with the end in sight, what is your vision?" I thought to myself, okay, is this a test? What is my vision? For the next 30 minutes, we discussed what I saw as my future in nursing, gaining clinical skills to be credible, gaining confidence for this self-proclaimed introvert, and eventually going to graduate school. One thing I was sure of was that I wanted to be "clinical." Before the year was out, she provided me with information about this new role coming called a clinical nurse specialist.


In graduate school, I had the opportunity to do clinical hours in the subspecialty of endocrinology. At the Diabetes Research and Training Center of Washington University at Barnes in St Louis, I became fascinated with the questions and the mysteries of glandular disease. My advisor at St Louis University and mentor, Dr Marilyn Rubin, helped me grow in my questioning, always wanting me and others to look deeper and explore how the medical-surgical CNS could examine a population and have an impact. A particular patient with type 1 diabetes mellitus allowed me to see the profound impact a chronic disease such as diabetes could have on an individual's life. Through her willingness to participate in research, the guidance of my advisor, and the support of staff to recruit others, I was able to study what effect autorhythmometry could have on chronodiabetic therapy. In today's terms, we call that diabetes self-management, utilizing tools of self monitoring, glucose sensing, and pattern management. A diabetes CNS with focus in chronic disease management was born.


Over the years, I have truly been blessed with opportunities, professionally and personally, that have allowed me to function and grow in the CNS role. From my experiences at the National Institutes of Health Institute of Diabetes, Digestive and Kidney Diseases to the University of Minnesota Medical Center and University of Minnesota Amplatz Children's Hospital. Over the years, I have watched students become excited as they engage in new learning opportunities and discover that they can also vastly impact various patient populations. It thrills me when a graduate student says, "I want to become a CNS." The passion and excitement are felt anew.


So why did I decide to take this path? I believe you all know the answer. Each of you is an inspiration to another. Your mentoring, coaching, prodding, and leading by example highlight the impact and value of the CNS to our patients, our interprofessional team members, and our future CNSs.



California Association of Clinical Nurse Specialists

The California Association of Clinical Nurses Specialist would like to acknowledge and congratulate our members' numerous achievements


Lianna Ansryan, MSN, RN, CNS, has been awarded the "NACNS Preceptor of the Year."


Cecilia Gray has become a content validation reviewer for the Center for Clinical Investigation of the WOCN Society and submitted an article, "The Efficacy of Active Leptospermum Honey in the Debridement Process," to the Journal of Advances in Skin and Wound Care for publishing.


Betty Halvorson, MSN, RN, ACNS-BC, MMgt, CNS, in the Transitional Care Unit, at Torrance Memorial Medical Center in Torrance, California, will be doing a 20-minute podium presentation on "Cultivating a Safe Patient Handling Culture in a Community Hospital", at the National Association of Clinical Nurse Specialists (NACNS) in San Antonio, Texas.


Peggy Holub, MSN, RNC-NIC, CNS, presented a poster at the NACNS conference in March, "An Evaluation of the Use of Mock Code Skills Stations in the Neonatal Intensive Care to Increase Nursing Confidence During Code Situations"


Alfie Ignacio, MSN, RN, FNP, ACNS-BC, CEN, CFRN, a Major in the US Airforce Reserve presented at the NACNS Conference and the AACN National Teaching Institute in Boston a poster presentation on "Hourly Rounding-Improving Patient Satisfaction in the Emergency Department." In addition, she will present another poster at NACNS titled, "Improving Neurologic Function After Cardiac Arrest Through Therapeutic Hypothermia."


Ann M. Mayo, DNSc, RN, FAAN, was recently awarded the NACNS 2013 Brenda Lyon Leadership Award


Kelli Jackson, MSN, RN, CNS, CCRN, completed her MSN and CNS from Mt St Mary's College.


Andrea C. Morris, DNP, RNC, CCRN, completed her DNP.


Jennifer McFarlane published 2 articles in Critical Care Nurse, 2012, "Defibrillation of Obese People" and "Blood Pressure Measurement in Obesity".


Norma D. McNair, PhD, RN, completed her PhD in nursing in June 2012 and is currently the interim director of Research and Evidence-Based Practice at UCLA Health System. She presented a poster at the International Brain Injury Association Meeting in Edinburgh, Scotland, March 2012, an oral presentation at Western Institute of Nursing in Portland, Oregon, April 2012, and she will be presenting at the American Association of Neuroscience Nurses.


Kathy McNeese, MN, RN CNS, and colleague, Monica Mungretto, MSN, RN, CNS, presented a poster in February 2013 (American Society for Bone and Marrow Transplantation) in Salt Lake City. It is titled, "Bridging the Gap-Educating and Preparing a Medical Oncology Unit to Care for the Stem Cell Transplant Patient."


Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC, has been appointed to the Board of Trustees of the American Psychiatric Nurses Foundation and is currently serving her third year on the Board of Directors of the American Psychiatric Nurses Association as immediate past president.


As participants in the Memorial Care Evidence-Based Practice Nursing Fellowship, Shannon Okura, MSN, RN, CNS, along with Laura Eichhorn, RNC-OB, BSN, C-EFM, collaborated on a quality improvement project titled, "Closing the Gap: Implementing an Obstetrical Code Blue Team at a Community Hospital." This project was presented at a poster session at the Association of California Nurse Leaders Annual Conference in San Diego, California. This project has also been accepted for an upcoming poster presentation at the Sigma Theta Tau International, Iota Eta Chapter Annual Research Program, in Long Beach, California, the 20th National Evidence-Based Practice Conference in Coralville, Iowa, and the 12th Annual International Nursing Simulation/Learning Resource Centers Conference in Las Vegas, Nevada.


Senene Owen, MSN, RNC, CNS, CPNP, copresented with Tracy Joseph, MS, (CNS student), a poster for CoCANN educational conference on February 4, 2013, at the California endowment. The poster was on "Neonatal Hypoglycemia Algorithm, SBAR Communication and the Golden Hour."


Ginger S. Pierson, MSN, RN, CCRN, CNS, has been reelected to the NACNS Board as a director.


Elizabeth Scruth, MN, MPH, RN, CCNS, CCRN, has an abstract accepted to present at the International Congress of Nurses Conference in Melbourne, Australia, in May 2013 on "Assessing Secondary Cardiovascular Risk in Women Post-Myocardial Infarction: Do Risk Scoring Tools Matter?"


Cheryl Westlake, PhD, RN, ACNS-BC, has been accepted to serve as a Fulbright US scholar. She will also be teaching in the School of Medicine and Public Health at Universidad de San Francisco in Quito while doing a research study of stage A/B heart failure in urban poor in Quito.


This past April, CACNS met at Huntington Memorial Medical Center in Pasadena, California, hosted by Jennifer McFarlane, MSN, RN, CCRN, CNRN, CBN. Member Ann M. Mayo, DNSc, RN, FAAN, presented "Identifying Valid & Reliable Outcome Measures for the CNS Spheres of Influence."


Submitted by Diane Barkas, MSN, RN, ACNS-BC, CCRN



Promoting Consensus Model Legislation

The Minnesota Affiliate of NACNS ( has joined forces with other advanced practice nursing organizations in the state to change Minnesota statute related to regulating advanced practice nurses. The Minnesota APRN Coalition ( was formed as an amalgamation of advanced practice nurses across Minnesota interested in promoting increased access to care, eliminating legislative and administrative barriers to practice such as written agreements with physicians, and identifying the State Board of Nursing as the sole authority over APRN regulation. A bill has been introduced into both houses of the Minnesota Legislature by the Minnesota Board of Nursing in cooperation with the Minnesota APRN Coalition. It is based on the Consensus Model document and is currently working its way through committees in both houses.


All members of the Minnesota APRN Coalition have agreed that this legislation is important to all advanced practice nurses in the state, and we intend to move ahead with this bill as a group, not as separate APRN specialties. We believe that this kind of collaboration will result in powerful legislation and ultimately will benefit the citizens of the State of Minnesota. Backed by the 2010 IOM Report, "The Future of Nursing: Leading Change, Advancing Health" (, and the 2012 Minnesota Governor's Taskforce Recommendations, "Roadmap to a Healthier Minnesota," ( we are optimistic that we will be able to join the other 21 states and the District of Columbia that already have Independent Practice for CNSs.


Submitted by Michael Petty, PhD, RN, CCNS, ACNS-BC



The Montana Association of Clinical Nurse Specialists (MACNS) is a statewide organization of CNSs engaged in practice, research, and nursing education. This past quarter, members participated in and planned conferences and published on issues important to practitioners, educators, and researchers.


In February, the MACNS and Zeta Upsilon Chapter of Sigma Theta Tau International cosponsored a research dinner in Missoula, Montana. The annual event, spearheaded by MACNS member Carolyn Mack, brings together nurses from practice and academia for an evening of research, good food, and fellowship. Attendees heard presentations from 3 nurses from a local community hospital who reported findings from their clinical research projects.


MACNS member, Dr Dale Mayer, provided the keynote presentation, "Best Practices for Family Support at Times of Sudden Death," at the Cardiac and Vascular Nursing Care Conference in Billings, Montana. She also authored a recent publication reflecting her research focus on sudden death [Mayer DM, "Family Support After Sudden Death. Association for Death Education and Counseling (ADEC) Forum, 2013;39(1):16].


Dr Charlene Winters reported the publication of her book focusing on rural health (Winters CA, ed. Rural Health: Concepts, Theory, and Practice. 4th ed. New York: Springer; 2013).


Submitted by Charlene A. Winters, PhD, APRN, ACNS-BC



In 2007, Dr Susan Williams, a devoted professor at East Carolina University College of Nursing, gathered a group of students and preceptors to promote a forum for collaboration, education, and title protection for CNSs in North Carolina. This small group later became an Affiliate of NACNS in 2009 and has contributed to the growth and development of CNS in North Carolina as well as NACNS. Quarterly meetings are held with mainstay agenda items of continuing education programs and political and legislative updates. March 2012 herald the first Annual Educational Extravaganza conference where CNSs and students learned more about the Consensus Model for APRN Regulation, recommendations from the APRN Advisory Committee to the North Carolina Board of Nursing, the Institute of Medicine Report and response from the North Carolina APRN Legislative Summit, a statewide research on creating a sustainable role for CNSs, the value of the CNS from the employer perspective, mentoring strategies for writing for publication and presenting, and methods to demonstrate CNS outcomes.


The North Carolina Affiliate has worked tirelessly to establish a collaborative relationship with the North Carolina Nurses Association for formal recognition with a council for representation and legislative advocacy. Furthermore, the affiliate has been actively working with the North Carolina Board of Nursing regarding the APRN Consensus Model and Lace Implementation. This endeavor is of the utmost importance for all APRNs, but especially for CNSs in North Carolina as they do not have role or title protection, or prescriptive authority. Prior to the Affiliate, a concerted local voice to advocate for and recognize the role and contributions of the CNS in North Carolina was essentially nonexistent. As a result of these endeavors, opportunities arose to not only provide education to APRN colleagues on the role, practice, and education of the CNS, but also to advocate for the CNS as well.


Submitted by Amelia Ross, MSN, RN, CCNS



Larry Lemos, gerontological CNS for the VA Long Beach (California) HCS was elected as NOVA (Nurses Organization of Veterans Affairs) president-elect and will begin his 2-year term as president in June 2013 at NOVA's 33rd Annual Meeting, "VA Nurses: Joining Forces With the Community in Caring for America's Heroes," which will be held in San Francisco June 20 to 21.


Marian Baxter, Compliance and Business Integrity Officer/Integrated Ethics Program Officer at the McGuire (Richmond, Virginia) VAMC, received her PhD in nursing on December 8, 2012. Her dissertation was titled, Being Certain in Moral Distress. She also presented a poster (same title) at the annual Southern Nursing Research Society meeting on February 28, 2013. Her poster was selected for the Top Student Award.


Marian Baxter was a coauthor of an article published in June 2012 [Tuck I, Johnson S, Kuznetsova M, McCrocklin L, Baxter M, "Sacred Healing Stories Told at the End of Life." J Holist Nurs. 2012;30(2):69-80].


Ann Herbage Busch, liver transplant CNS at the Portland (Oregon) VMAC, presented, "Oregon's Legislative and Regulatory Experience Regarding Prescriptive Authority for the CNS" at the NACNS preconference, "Legislative/Regulatory: Update on the Status of the APRN Consensus Model" on March 6, 2013, in San Antonio.


Reggie Horwitz, CNS student employed at the Durham VAMC, was a copresenter with Mary Holtschneider (simulation coordinator) of the paper, "Implementing a Stroke Code Process in the Hospital: What Simulation Uncovered," at the International Meeting on Simulation in Healthcare held in Orlando, Florida, January 26-30, 2013.


Submitted by Kathleen L. Dunn, MS, RN, CRRN, CNS-BC


Debbie Rovito, MSN, APRN, CNS-BC, CRRN, presented a poster at the NACNS conference in regard to CNS-led practice improvements in the nursing management of autonomic dysreflexia. Mrs Rovito is a CNS at the Louis Stokes VA Medical Center Spinal Cord Injury Center, and she implemented several targeted interventions that improved inpatient staff nurses' adherence to spinal cord injury standards and local policies that guide treatment when autonomic dysreflexia occurs in individuals with spinal cord injuries.


Submitted by Tanya D. Williams, MSN, RN, CCNS-BC



If you have information you want to share about yourself, your NACNS peers, or your affiliate/affiliate peers, please send the news item to Tanya D. Williams at