The champagne cork popped and glasses clinked after the contract was signed. Janet Hall, publisher from Williams and Wilkins, Judith Papenhausen, and I celebrated the birth of Clinical Nurse Specialist. We were in Baltimore, Md, and the date was February 18, 1986.
Approximately 1 year earlier, I was teaching clinical nurse specialist (CNS) students under a joint appointment with a local university. At the time, I found the CNS literature scanty. The role and functions that I performed as a CNS could not be found within the current nursing literature. It was necessary to pull articles from many different disciplines to teach the role course. I believed that the best way to teach CNSs was through the experiences of other CNSs. For this to occur, CNSs needed to write and publish their experiences carrying out the CNS role.
A book on the role of the CNS specifically aimed at students took shape in my mind. I approached Judy Papenhausen, who was also teaching CNSs at the time, to edit the book with me. As preparation, we started writing chapter 1 and attended a CNS conference in Scottsdale, Ariz. This was in spring 1985. When I was sitting in the sessions and listening to questions from the audience, another idea took shape-a CNS role journal. CNSs truly needed an ongoing structure to publicize what they did and how they had an effect on patients' health as well as nursing practice. At the time, CNSs had limited venues to share their work with other CNSs. In fact, the ability to influence the practice of other CNSs and make public their practice to other nurses was extremely limited.
As the vision took hold, destiny played a role. The conference facilitator helped us locate a typewriter, and we hastily compiled a short survey to assess conference participants' interest in a journal dedicated to the CNS role. The response was overwhelming. In addition, I ran into Margo Neal, a colleague from graduate school who was in publishing. She put us in contact with Williams and Wilkins, which started the wheels in motion.
A preliminary evaluation indicated that as a specialty area, CNSs were experiencing growth and recognition but no journal was targeted specifically to them. According to the 1980 figures from FACTS ABOUT NURSING, 1984-1985, published by the American Nurses Association (ANA), there were 19,070 CNSs. Approximately 70% of CNSs were employed in hospitals with responsibilities, including clinician, patient and peer educator, consultant, researcher, change agent, etc. The CNSs were at least master's prepared and in an area of specialization such as maternal-child, psychiatry, oncology, etc. Moreover, a computer literature search of nursing journals between August 1983 and July 1985 showed 110 published articles on CNSs in general, 526 articles on the role of nursing, and 41 articles on the role of the CNS. These articles appeared in a variety of nursing journals.
On November 15, 1985, Williams & Wilkins mailed a survey to 500 CNSs from the ANA Council of Clinical Nurse Specialists. By January 16, 1986, a 53% response rate was received, even though a 10% to 20% response rate had been expected. Highlights of the survey results indicated that: (1) 68.3% of respondents were employed full-time as CNSs, 95% had master's degrees, and 68.7% were employed in hospitals; (2) in response to the question "Would you subscribe?" based on a scale of 1 to 5, the mean was 3.96; (3) respondents were willing to pay an average price of $26.01 for an annual subscription; 4) 87.8% responded "yes" to submitting articles, and 68.7% responded "yes" to serving on the editorial board; and 5) the average number of journals to which the respondents subscribed was 4, and the average number of articles they had submitted to journals for publication was 2.
Conclusions from the evaluation were that input was positive from CNSs for this type of journal and that the time was right to launch it as soon as possible. As originally conceived, the journal was not to focus on specific areas of clinical practice but rather was organized into sections that were consistent with the then-established subroles of the CNS, which were consultation, education, executive, and research. Each section was intended to present articles with theoretical as well practical approaches to the implementation of each role function. The idea was that articles would span all clinical areas and the content would be generic enough for application in any clinical setting. Clinical content was the purview of the clinically oriented journals for which CNSs were already subscribers. The first issue of Clinical Nurse Specialist appeared in print in spring 1987. By March 1988 the journal had a total paid circulation of 2,783 and by March 1989, 3,274.
During the last 15 years the CNS role has advanced to meet society's changing needs for healthcare. Six years ago, the National Association of Clinical Nurse Specialists (NACNS) rose to the challenge of bringing together CNSs as a single voice for "enhancing and promoting the unique, high-value contribution of the CNS to the health and well-being of individuals, families, groups, and communities, and to promote and advance the practice of nurse."1(p1) Three years ago the journal was adopted as the Official Journal of the National Association of Clinical Nurse Specialists. Now with a journal and a national association to address the needs of CNSs, my vision for sharing the work and accomplishments of CNSs is complete. I am relinquishing leadership of this journal and passing the torch to a new generation of CNSs. I am in debt to many individuals for the success of this journal-the many aspiring authors who I have had contact with throughout the years, the readers who sustained the momentum, and the editorial board members who contributed their heart and soul to the journal's success. As I look forward to new professional challenges and rewards, I will not easily forget the struggle for CNS recognition and acknowledgment.
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