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

Article Content

NAME: Sue Sendelbach, PhD

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CURRENT POSITION: Director of Nursing Research


CURRENT AFFILIATION(S): Abbott Northwestern Hospital




PROFESSIONAL EDUCATION: MS and PhD in Nursing, University of Minnesota School of Nursing


CERTIFICATIONS: Certified Critical-Care Clinical Nurse Specialist (CCNS)


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


Leadership is the ability to focus on and achieve a common goal. Leadership is not management. Leadership and management both require a common vision. However, with leadership you guide the process, as opposed to management, where you have control of the process. Leadership requires collaboration and engagement of the team. The leader is one of the members of the team.


In changing practice, it sometimes seems easier to not include dissenting voices. However, important perspectives can be missed by excluding persons who may not be easy working partners. Issues that you may not have considered can be raised early before they inevitably surface. It is far more effective and respectful to have all stakeholders involved from the beginning, including the patient and family, where appropriate. In clinical care, it's most important to identify the patient's goal and coordinate care that will most effectively achieve the desired outcome for the patient. Clinical nurse specialists have a significant role in leading clinical care-it's how we are educated; we are change agents.


Given the changes in healthcare, what do you see as the contributions of clinical nurse specialists?

Both the IOM Future of Nursing and in the Affordable Healthcare Act (ACA) emphasize redesigning healthcare in the US. No other nursing role that is better prepared to participate in this endeavor than CNSs because the concept of change is integral to our advanced practice preparation. We lead and influence change based on our analysis of evidence and use theories of change to guide the implementation and evaluation of changes in practice that are based on evidence. CNSs are uniquely educated to examine healthcare from the patient/client, nursing/nursing practice, and system/organizational point of view. And, CNSs look beyond traditional boundaries of care to include communities of practice and the economics of practice.


Most leaders enjoy the benefits of mentorship. Define your view of a mentor.

I have been greatly impacted by 2 persons who mentored me-Jody Portu and Dr Ruth Lindquist. What was unique about both of them is that they had the other person's best interest at the core-they were not about promoting themselves. They guided me toward opportunities and provided help along the way. There were times when they would work with me, and other times they would let me work by myself, but I always knew they were available to me. I try to follow their model of mentorship. For example, I was recently asked to write an article for a professional organization. I asked a CNS colleague to write it with me so she could get the experience and understand the process of writing for publication.


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

Time-a precious commodity. Mentors need to be available to the next generation of CNSs, to be present in their practice and development. Advocacy is important so the next generation is positioned to effectively contribute to patient outcomes and improve healthcare. Mentors network beyond the walls of the immediate work setting and draw novices into the opportunities that networks such as the National Association of Clinical Nurse Specialists provides. Mentors model leadership both at local and national venues so the future leaders see us in action. And, importantly, mentors listen. Many years of experience doesn't mean a mentor has all the answers. Mentoring is not a 1-way street; it is a reciprocal process. I remember being a student nurse and working with a very seasoned staff nurse. I suggested an alternative approach to patient care and she said, "Yes, let's try it." I was so impressed that someone with so many years of experience would listen to a student. This experienced nurse showed me how to listen to other voices because they have new perspectives and fresh ideas.


As a past National Association of Clinical Nurse Specialists (NACNS) president, what do you perceive to be key issues for clinical nurse specialist practice today?

When I ran for the NACNS presidency, I said that a key issue for CNSs is a poor understanding of CNS practice by other healthcare providers and the public. I believe we still struggle with that today. However, in the hospital where I work, everyone tells me that they want CNSs because of the tremendous impact CNSs have made for individual patients and on the system. Our outcomes are our best advertisement. Each CNS should be able to articulate very quickly and succinctly describe the outcomes of CNS practice. We need to advocate for each other and find opportunities to engage CNSs in research, programs and projects. Practicing CNSs should collaborate and work with schools of nursing and chief nursing officers to advance the CNS role-and one good way is to be a CNS student preceptor. Working within our professional organization, NACNS, is critical key because there is strength in numbers. However, there are also opportunities to work at the local level and CNSs need to be involved in discussions about the CNS role and practice both locally and nationally.


How do you see clinical nurse specialists leading nursing in regards to these key issues?

CNSs need to be at the table to advance the IOM's recommendation of practicing to the full extent of our education. Collaborating with groups other than CNSs will allow us to engage in new partnerships and promote the advanced practice of CNSs. Interprofessional involvement can influence and open doors to new areas of service and the advancement of nursing practice. Again, networking is critical to the process.


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

I enjoy influencing and changing patient outcomes for the better. As a new CNS, I was working with patients who had undergone a cardiovascular angiogram. After the procedure was completed, the catheter in the patient's groin was removed and 10 minutes of manual pressure was held. Finally, a 10-pound sandbag on the placed on the patient's groin to maintain (I thought) hemostasis. In examining the literature, we found there was no evidence supporting the 10-pound sandbag, which was a source of much discomfort for patients. I collaborated in the conduct of a small research study that demonstrated there was no difference in bleeding when there was a sheet wrapped around a patient's leg versus the 10-pound sandbag on the patient's groin. It is now almost impossible to find a sandbag in the hospital. This type of evidence-based practice change has been repeated many times by CNSs-it's CNSs changing practice to make the experience optimal for the patient-what I love the most about being a CNS.


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

Find a mentor. If there is not someone within your immediate setting, connect with other CNSs in your local NACNS affiliate organization. With technology, explore opportunities to be mentored at a distance. Your practice will be greatly enhanced and enriched by doing so, and so will your mentor's.