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

Article Content

This is my last address as President of the National Association of Clinical Nurse Specialists (NACNS). It has been an honor and privilege to serve you this year. I sincerely thank you for this opportunity, for your support and constructive criticism, and for your commitment to nursing, to advanced practice and the role of the clinical nurse specialist (CNS), and to this organization. I wish to acknowledge the Board of Directors who worked tirelessly on your behalf including Les Rodriguez, Peggy Barksdale, Rachel Moody, Tanya Williams, Anne Muller, Cecelia Gray, Ann Hysong, Ginger Pierson, Gayle Timmerman, Fiona Winterbottom, and Jan Fulton. Melinda Mercer-Ray, executive director, and Jason Harbonic, managing director, are exceptional individuals who have contributed in countless ways to the progress and successes NACNS has made.


As I reflect on this past year, the one constant has been change. The nature of the healthcare landscape is evolving with the enactment of the Affordable Care Act, insurance exchanges, medical homes, and accountable care organizations. Despite of the months of planning and preparation that took place prior to 2014, implementation has been less than optimal. Yet, it is clear healthcare reform was and is needed. As the government, organizations, providers, and clients go forward with resolve to optimize programs and the safety and quality of care delivered, the fear of the unknown consequences and unforeseen changes that will occur is palpable. For the CNS, there is significant opportunity to lead and guide. However, this can be challenging and uncomfortable. The role of the CNS will continue to evolve over the next few years in ways we cannot imagine now. It is essential for each of us to actively position ourselves to define the scope of our practice and guide the future.


Our association and our members continue to be challenged by competitive demands, market pressures, and insufficient demonstration and evidence of productivity and outcomes specific to CNS practice. This year NACNS will focus significant efforts on our membership for growth and sustainability. The strategic plan outlines goals and tactics that will drive the work of the organization over the next 5 years. The board is aware of the choices each of you must make professionally, and it is our hope that you continue to recognize the importance and value of belonging to the one organization that fully supports your professional role. Intentional work will be done to promote the unique value the CNS brings to interprofessional teams and healthcare delivery. The work of the Cost and Outcomes Task Force is one effort to assist all CNSs to measure, analyze, and evaluate their work. We have called upon our faculty and schools to enhance curriculum, providing a foundation for the CNS to be prepared for program development and creating a business case.


Recognition of success and accomplishment is important, and at our annual meeting, we collectively celebrated our award winners. I am pleased to report that we have had a record year of individuals stepping forward to volunteer for committees, task forces, affiliates, and leadership positions. This trend is encouraging and confirms NACNS is acting on issues that are important to our members. Efforts to incorporate diverse backgrounds, experiences, and specialties within our working groups have been made and will continue. Collaborations with other organizations have expanded this year, and new partnerships are being explored. One such effort will be charged to the Research Committee to seek opportunities for NACNS to engage and energize our membership in the work of PCORI (Patient-Centered Outcomes Research Institute). There may be other professional nursing organizations NACNS can partner with in comparative clinical effectiveness research. KAR Associates has represented us extremely well on the Hill, and PR Solutions had increased the public's awareness of NACNS. These things are just a sampling of the positive steps made this past year.


Change, challenges, celebrations was the theme for this past year. I thank you for accompanying me on this journey. The annual report of NACNS and the presentation I gave at the annual meeting can be found on the NACNS Web site. If you were unable to be in Orlando with us, please take the time to review what has been done, see our award winners and volunteers, and view the strategic plan for the next 5 years. It is my hope that you will be pleased.



Congratulations to the California Association of Clinical Nurse Specialist as the affiliate of the year. The California Association of Clinical Nurse Specialists (CACNS) started in the late 1980s, formerly as the Southern California CNS Network when a group of clinical nurse specialists (CNSs) working at Kaiser Permanente in Fontana, California, banded together to share expertise. Over the past 33 years, the CACNS has grown from a handful of members to 192, and we have changed our name to reflect participation by all interested CNSs in the entire state of California and to be more in synch with the NACNS. Our organization has fluctuated some with the economic times and continues to grow significantly in numbers and scope from the small beginnings. Efforts are credited to a membership body with vast expertise and also to a board of officers and directors who coordinate all activities.


A large and multitalented group has created an energy that has seen them through significant growth as they strive to keep members abreast of the legislative and political changes affecting the role of the CNS locally, regionally, and nationally. One major goal was to strengthen their ties with the National Association of Clinical Nurse Specialists, and they proudly state that 51% of their members are also members of NACNS. In addition, several members currently hold positions within NACNS or actively participate in the APRN (advanced practice registered nurse) Coalition and the California Action Coalition, illustrating their continued commitment to national organizational efforts. It has always been their philosophy that there is power in numbers. They all value the significant impact the role of the CNS plays in a variety of clinical and academic settings and how the marriage of the NACNS and CACNS organizations will help us continue to see this to fruition.


The National Association of Clinical Nurse Specialists Encourages Cancellation of MTV Show "Scrubbing In"

On October 24, MTV began airing a new reality show about nurses that has caused uproar in the nursing community. The show, "Scrubbing In," features a cast of young traveling nurses and focuses primarily on their personal lives, rather than their work as nurses.


The National Association of Clinical Nurse Specialists (NACNS) called on MTV to cancel the show on the grounds that it is demeaning to nurses and detrimental to efforts to address the nursing shortage. Several other nursing associations, including National Nurses United, American Nurses Association, Canadian Nurses Association, and, have also urged the network to chancel the show, pointing out that its portrayal of nurses is offensive and may harm efforts to encourage young people to enter the profession.


In a letter addressed to MTV President Stephen Friedman, NACNS President Carol Manchester wrote:


As an organization representing nurses, we at the National Association of Clinical Nurse Specialists are deeply disappointed in MTV's decision to air the reality television show "Scrubbing In." This program portrays nurses in a disrespectful and unfair light for purely salacious purposes. We urge you in the strongest possible terms to cancel it.


As the largest group of healthcare professionals, nurses are central to providing and improving our nation's healthcare. As you must be aware, the United States is facing a shortage of nurses, and there are efforts underway across the country to encourage young people to enter nursing and increase enrollment in nursing schools. A television program that intentionally reinforces negative and antiquated stereotypes about nurses and that shows them in the worst possible light does nothing to support those efforts, and, in fact, serves to do the opposite.


At a time when our nation needs nurses more than ever, this program is denigrating and demeaning the members of what has been shown time and again to be one of the most trusted professions in the United States. "Scrubbing In" does a serious disservice to nurses, nursing students, our healthcare system, and our nation as a whole.


NACNS 2014 Conference, The Best Kept Secret-The Clinical Nurse Specialist Contribution to Quality Care, March 6 to 8, 2014

It is time to consider your plans to attend the NACNS 214 Conference. The conference offers the opportunity for you to network with your colleagues as well as enjoy the sunny resort environment of the Orlando World Center Marriott and of course the many activities in Orlando. Conference registration and lodging information will be available soon. Room rates at the Orlando World Center Marriott will be available for $189 per night for single or double rooms. For specific questions about registration or hotel accommodations, please contact the NACNS office at 215-320-3881 or


NACNS Comments on Veteran's Health Administration Nursing Handbook 1180.03

In September, NACNS sent a letter to the Department of Veteran's Affairs Secretary Eric Shinseki to comment on the Veterans Health Administration (VHA) updating of the VHA Nursing Handbook 1180.03. The VHA is a leader in healthcare delivery and is moving to more fully utilize the APRN including the CNS. This draft of the VHA Nursing Handbook recognizes APRNs, including CNSs, as licensed independent practitioners. In our comments, we reinforced unique and advanced level competencies that the CNS possesses that can meet the increased needs of improving quality and reducing costs in our healthcare system. We spoke to the CNS as leaders of change in health organizations, developers of evidence-based programs to prevent avoidable complications, coaches of those with chronic diseases to prevent hospital readmissions, and facilitators of teams in acute care and other facilities to improve the quality and safety of care, including preventing hospital-acquired infections and reducing length of stays. In addition, we noted that there are growing numbers of CNSs providing Medicare Part B services to beneficiaries and have prescriptive privileges in most states.


NACNS also highlighted the need for the VHA to consider some modifications that would allow the CNS section of the VHA Nursing Handbook to be more closely aligned with the state implementation of the APRN Consensus Model. We specifically identified the challenge that certain CNS groups face with the lack of population certification examinations in their specific area of practice.


NACNS will continue to monitor the progress of the VHA's Nursing Handbook 1180.03.


NACNS Joins Numerous Healthcare Organizations Expressing Concern Over FDA's Promotion of Up-Scheduling of Hydrocodone Products

The diversion, misuse, and abuse of opioids have reached unacceptable levels in certain parts of the United States and in an effort to reduce this problem, the US Food and Drug Administration (FDA) has sent a letter to the Department of Health and Human Services asking for efforts to reclassify hydrocodone-combination drugs as Schedule II controlled substances. Because of the impact this move would have on access to care and the ability of many nonphysician providers to prescribe pain relief medications for their patients, NACNS and these organizations in declaring this action would "[horizontal ellipsis] irrefutably have serious health consequences for patients." Overall, reclassification would severely limit patient access to effective pain treatment and would, in some cases, completely eliminate the ability of some types of providers to deliver treatment to their patients when they need care and during a critical time in the healing process.


Of course, it is important to underscore that NACNS, and these partner organizations, wholeheartedly agree that concrete steps must be taken to help stem the tide of abuse, misuse, and diversion of all opioid products, but the FDA recommendation that calls for the wholesale up-scheduling of hydrocodone-combination products is a blunt and imprecise tool that will in the end prove to do more harm than good. In our letter, we asked Secretary Sebelius to reject the FDA recommendation and engage in discussions with the full prescribing community to come up with reasonable strategies to find a more targeted and less harmful approach to combatting opioid diversion, abuse, and misuse across America.



California Association of Clinical Nurse Specialist 2013 Members Achievements

California Association of Clinical Nurse Specialist (CACNS) held their annual conference, "Changing Healthcare One CNS at a Time," on October 26th at Northbay HealthCare, Fairfield, California.


Terri Ares, PhD, RNC-NIC, CNS-BC, presented "The Professional Socialization of Students in Clinical Nurse Specialist Programs" at the 18th Joint Southern California Chapters of Sigma Theta Tau International-Nursing Odyssey Conference 2013 in San Diego, California.


Pam Bellefeuille, MN, RN, ACNS-BC, CEN, Clinical Professor, UCSF, has 2 abstracts/posters accepted to the 14th International Meeting on Simulation in Healthcare Conference January 25 to 29, 2014: "The Art of Science: Unfolding Case Study Simulation Based on a Theatre Approach"' (Pam Bellefeuille, Dan McGuire, and Wes Cayabyab) and "Emotional Impact of Active versus Observational Roles During Simulation Learning"' (Pam Bellefeuille, Sandrijn van Schaik, and Amanda Sanders).


Kelli Jackson, MSN, RN, CNS, CCRN, is presenting her poster, "Do We Respect Patient's Wishes at End of Life?"' at the January Society of Critical Care Medicine conference in San Francisco, California.


Ann M. Mayo, DNSc, RN, FAAN, in November 2013, was featured as keynote speaker at the annual San Diego Evidence-Based Practice Institute & Consortium for Nursing Excellence. The title of her presentation was "The Road Forward: Sustaining Nursing Evidence-Based Practice."


Patti Radovich, PhD, RN, CNS, FCCM, in November 2013 had an oral presentation at the American Public Health Association Annual Meeting in Boston on "Risk Perception Related to Communicable Disease Among International College Students. "She has also been asked to be a member of the NACNS Task Force on Alarm Fatigue.


Elizabeth Scruth, PhD, MPH, RN, CCNS, CCRN, will be inducted as a fellow into the College of Critical Care Medicine in January at the Society of Critical Care Medicine conference in San Francisco. In addition, she has the following publication, "Post Intensive Care Syndrome," in the December/January issue of the Clinical Nurse Specialist and accepted for publication "Transformation of Quality in Kaiser Permanente Northern California,"' by Adams C, O'Brien, and Scruth E.


Diane Solic N, RN, ACNS-BC, CPAN, CAPA, has become board certified and secured a position at Sharp Memorial Hospital as CNS of Acute Care Surgical.


Ann Rocha, MSN, PhD(c), RN, CNS-BC, a member of the NACNS Conference Steering Committee as well as the Education Committee, wants to alert members to the annual conference coming up on March 6 to 8, 2014, in Orlando, Florida. The Education Committee will be hosting a preconference on "Optimizing Educational Partnerships Between Schools of Nursing, Clinical Agencies, and Preceptors."


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


The Oklahoma Association of Clinical Nurse Specialist

The seventh Annual OACNS (Oklahoma Association of Clinical Nurse Specialists) Pharmacology Conference will be held April 10 to 12, 2014, at INTEGRIS Baptist Medical Center in Oklahoma City. Nurses completing the entire conference will be awarded 12 to 15 Pharmacology Level B continuing education hours. All advanced practice nurses are welcome. For additional information, please visit


Veterans Affairs (VA) Virtual Affiliate2013 Members Achievements

Beverly Bell (staff development CNS) and Elizabeth Reid (wound CNS) were members of a research team at the Birmingham (Alabama) VA Medical Center, which received 1 of 10 national VHA Office of Nursing Services Innovation Awards for 2013. The project, entitled "Reducing Incontinence Associated Dermatitis (IAD) Using the VA-TAMMCS Improvement Model," has resulted in the reduction of their acquired IAD rate in the MICU to zero.


Ann Busch, liver transplant program CNS at the Portland (Oregon) VA Medical Center, presented "Liver Failure Is More Than Alphabet Soup," at the Annual Conference of the Greater Portland Area Chapter of the Academy of Medical-Surgical Nurses on October 28, 2013.


Kathleen Dunn, spinal cord injury CNS at the VA San Diego Healthcare System, recently completed her mentorship of a staff nurse in the 9-month San Diego Evidence-Based Practice Institute. She and her fellow (mentee), Anna Cunningham, BSN, RN, presented a poster and platform presentation at the Institute graduation and sixth annual San Diego EBPI conference, titled "Oral Care and Hospital-Acquired Pneumonia in SCI Patients" in November, 2013.


Donna Fritz, oncology CNS at the Denver (Colorado) VA Medical Center, was selected as an item writer for the Oncology Nursing Society for their new online chemotherapy/biotherapy course. She attended item writer training in October in Pittsburgh, Pennsylvania, and has submitted 25 additional questions for the examination to date.


Reggie Horwitz, critical care nurse educator at the Durham (North Carolina) VA Medical Center completed her Adult-Gerontology Clinical Nurse Specialist Post-Master's Certificate Program at the University of Detroit Mercy's McAuley School of Nursing in December, 2013.


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