1. Horner, Sharon D. PhD, RN, CNS, FAAN

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President's Message

March is a bittersweet time of year. It is a transitional month for nature because winter draws to an end, and signs of spring begin to emerge. It is also the transition time for the National Association of Clinical Nurse Specialists (NACNS). Over the past 12 months, I have had the honor, privilege, and responsibility, as your president, of representing NACNS and the membership on the national front. I noted in an earlier newsletter that we live in a complex ever-changing world. Whew! That was an understatement! The organization, the board, committees, and task forces have been extremely busy dealing with a multitude of issues (see January 2017 newsletter). I would like to take this time to discuss 3 major initiatives that NACNS has been working on for our members.


National Association of Clinical Nurse Specialists identified the problem of opioid misuse as a serious and significant public health concern. Moving forward on this issue, we became a member of the Health and Human Services Opioid Working Group that had its first meeting in January 2016. The board called for volunteers and established an Opioid task force to address opioid misuse management and prevention strategies for the clinical nurse specialist (CNS). This task force is busy working on their charge for the organization. In the meantime, because of our membership on the national Opioid Working Group, Melinda Mercer Ray, executive director of NACNS, and I were invited by the Office of Women's Health to attend a meeting in Washington, DC on "opioid use, abuse, and overdose in women." Attendees at this meeting included representatives from professional organizations (eg, dentistry, medicine, psychology, social work, nursing), grassroots organizations, clinicians, and advocates who had the common focus of wanting to reduce and prevent opioid misuse. This informative 2-day meeting included panel presentations and break-out group discussion sessions. I want to share an anecdote from that meeting: Overheard in the ladies' room during the very first break, "Why are the nurses here?" Over the course of the 2-day meeting, Melinda and I divided our efforts to attend 8 of the 16 break-out group meetings. In every meeting, we introduced ourselves and said 'why' the opioid crisis was an important issue for CNSs. We were quickly involved in the discussions with attendees from other disciplines. Without being confrontational, we decisively answered the question of "why the nurses are here." A draft report of the meeting was provided to attendees, and it is currently being vetted for the final (official) report that will be posted for public access. We have shared the various public resources with our Opioid Task Force when they became available. This significant work will continue in the coming year.


In May, the Veteran's Healthcare Administration announced its intention to change its policy to allow advanced practice registered nurses (APRNs) to function to the full scope of their education and training. This announcement led to point and counterpoint reverberations because groups came out in opposition or in favor of this policy change. National Association of Clinical Nurse Specialists communicated our support for the proposed policy within days of the announcement through a news brief report, in letters to the editor, and through an opinion editorial written in response to a particularly vitriolic letter to the editor against the policy published by USA Today. Our response, also published in USA Today, was a thoughtful, reflective presentation of the facts and our position that CNSs have always worked with our healthcare colleagues to improve the health of our patients. National Association of Clinical Nurse Specialists submitted formal testimony in June to the Department of Veterans Affairs (VA) in support of this proposal. Many of our members also submitted comments and letters during the formal-response period. The VA ruled in favor of this policy for nurse practitioners, certified nurse midwives, and CNSs. This ruling was formally announced on December 14 and will take effect 30 days later, in January 2017.


The third item I want to discuss is the contentious decision by the Standard Occupation Classification Policy Committee of the Office of Management and Budget to again classify CNSs as general registered nurses (RNs) despite our efforts to educate them on this issue. We protested this decision in a news release and in a HealthLeaders Media interview. Most importantly, we submitted formal written comments to Standard Occupation Classification that laid out a detailed comparison of CNS roles and functions to those of RNs and presented survey evidence that clearly identified CNSs as distinct from general RNs and how the CNS's work has been measured in national surveys by other organizations and in our own CNS survey. Finally, we stated unequivocally that this classification of the CNS, as a general RN, was wrong and furthered that it had the potential to harm CNSs. We wait with "unabated" breath for their determination.


National Association of Clinical Nurse Specialists and your board continue to advocate for and represent CNSs on the national stage. These efforts will be especially important given the unsettled and unsettling nature of our new federal administration. We will continue to collaborate with our friends and colleagues (ie, individuals and organizations) who share our vision for supporting the health of the population and the essential and vital role that CNSs play in the healthcare system. We will also reach out to make "new friends" who support this vision. We will work hard to keep our members informed when new issues arise and will be calling on our members to contribute their expertise, energy, and voice when issues arise. This is not a time to be unseen and unheard.


At our annual conference in Atlanta, I will close out my year as your president and hand over the reins to President-elect Vince Holly. I wish Vince the best of luck, good health, courage, and stamina in the year ahead. There is much work to be done, and we must remain vigilant to ensure that CNSs are fully recognized as APRNs in whatever policies, and initiatives are launched in the coming years. Lastly, and most importantly, I want to thank the members for their efforts and support of NACNS and CNSs across the nation.



Upcoming Webinars

March 23, 2017-Medication-Taking Across the Care Continuum: Implications for CNS Practice


Webinars are held monthly and will provide Continuing Education (CE) at a reduced price of $25 for members. Nonmember price is $60, and student price is $30. Group pricing is also available; please send an e-mail to for specific group-size information. To register, visit the NACNS Web site.


Your purchase of the webinar includes access to the national-level CNS-specific continuing education and 1 person's CE. If multiple individuals are listening to the webinar, the CE will only be available for 1 attendee. If you wish to register a group on 1 call-in line, please contact A group discount will be given for each additional CE on a single line.


All webinars have been archived for later viewing. Send an e-mail to to order an archived webinar. Listen at your leisure and apply for CE certificate.



Virginia Affiliate of CNSs

The Virginia Association of Clinical Nurse Specialists updated the definition of a CNS as an APRN in the Code of Virginia through legislation, which took effect on July 1, 2016. To support continuing education, our second pharmacology conference for APRNs was held in Richmond in September. Our CNSs have been busy promoting excellence and evidence-based practice:


Beth Quatrara, DNP, RN, CMSRN, ACNS-BC (University of Virginia Health System) and Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC (Carilion Roanoke Memorial Hospital)


Beth and Cindy presented at the 25th Annual Academy of Medical-Surgical Nurses Convention on September 30 in Washington, DC. Beth was a copresenter of "Mastering the Next Level of Quality Patient Care by Addressing Malnutrition." Cindy and colleague Wendy Sullivan presented "Effects of Nurse-Physician Collaborative Rounding."


Amy Lucas, MSN, RN, CCNS, CCRN-K; and Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC (Carilion Roanoke Memorial Hospital)


Amy and Cindy presented a poster, "Using Social Media to Increase Engagement in Nursing Organizations," at the 25th Annual Academy of Medical-Surgical Nurses Convention in Washington, DC. Amy and Cindy published the article "Using Social Media to Increase Engagement in Nursing Organizations (Nursing, 2016;46[6]:47-49)." It focuses on the use of social media to increase engagement.


Donna Bond, DNP, RN, CCNS, AE-C, CTTS (Carilion Roanoke Memorial Hospital)


Donna received the 2016 Virginia Magnet Consortium Award for Advanced Nursing Practice at the Virginia Nurses Foundation Gala on September 24.


Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN (Carilion Roanoke Memorial Hospital)


Jen was elected director-at-large for the Virginia Nurses Association Board of Directors.


Sheila Delp, MSN, RN, AGCNS-BC (Carilion Roanoke Memorial Hospital)


Sheila spoke about delirium and dementia at the Care of the Elderly seminar in Bedford, Virginia, sponsored by the Blue Ridge Chapter and Star City Chapter of the Academy of Medical-Surgical Nurses and Centra on September 19, 2016.


Lucy Smith, RN, MS, CNS, PMHCNS-BC (private practice in Adult Mental Health and dean of Nursing Fortis College, Richmond, Virginia)


Lucy presented 2 sessions at the American Association of Medical Assistants Annual Conference in Reston, Virginia on September 16, 2016, on the following topics: "Critical Thinking: Teaching Students How to Think" and "It's All Up to You," which focused on how to teach and develop personal and professional accountability.


Phyllis Whitehead, PhD, APRN, ACHPN (Carilion Roanoke Memorial Hospital)


Phyllis was a copresenter of "Implementation of a Moral Distress Consult Service" at the 2nd International Ethics in Care Conference and 17th Nursing Ethics Conference, Ribeirao Preto, Sao Paulo, Brazil on September 14, 2016. Phyllis and the CNS practice were highlighted in the August edition of Virginia Nurses Today in an article written by Amanda Golino, MSN, RN, CCRN, CCNS, RN-BC, Inova Loudoun Hospital.


Phyllis has several articles published or in press:


Whitehead PB. Medical, surgical and geriatric. In: Dahlin C, Coyne PJ, Ferrell BR, eds. Textbook of Advanced Practice Palliative Nursing. New York, NY: Oxford University Press; 2016.


Whitehead P. Radford University VNA CE. Pain Management and the Older Patient. In press.


Whitehead PB, Clark RC. Addressing the challenges of conducting research with end-of-life populations in the acute care setting. Appl Nurs Res. 2016;5(30):12-15.


Whitehead P, Ramalingam N, Katz K, Carter K, Harden S. Nurse practitioners' perspectives on the patient preferences about serious illness instrument (PASI). J Hosp Palliat Nurs. 2016;18(4):332-341.


Whitehead P. Management of an inpatient palliative care unit. In: Conversations in Palliative Care: Questions and Answers with the Experts. 4th ed. Pittsburgh, PA: Hospice and Palliative Nurses Association. In press.


Whitehead P. Oral NSAIDs versus other oral analgesic agents for acute soft tissue injury. Int J Evid Based Healthc. In press.


Kim Ramsey, MSN, RNC-NIC, ACCNS-N (Carilion Roanoke Memorial Hospital)


Kim had a poster, "Examination of an Outpatient Approach to the Treatment of Neonatal Abstinence Syndrome," at the 16th National Neonatal Nurses Conference, sponsored by the Academy of Neonatal Nursing Conference on September 8 to 10, 2016, in Nashville, Tennessee.


Kim Hall, DNP, RN, GCN-BC, CWCN-AP, COCN (Carilion Roanoke Memorial Hospital)


Kim and Wound Team colleague Jessie Patterson, BSN, RN, CWON presented a poster, "Don't Dwell on the Past, Instillation is the Future of Wound Care! A Case-Study Series Examining the Outcomes of Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWT-id) for Complex Wound Healing," at the Southeast Region of the Wound Ostomy and Continence Nurses Society Annual Conference on August 25 to 27, 2016, in Greensboro, North Carolina.


Cathy Jennings, DNP, RN, ACNS-BC (Carilion Roanoke Memorial Hospital)


Cathy and coauthors had an article, "A Comparison of Three Practices for Dressing Chest Tube Insertion Sites: A Randomized Controlled Trial (2016;25[4]:229-231, 250)," published in the July/August issue of MEDSURGNursing.


Kimberly Nelson, DNP, RN-BC, ACNS-BC, CHFN, CCCC, CCRP, RDCS (Virginia Commonwealth University)


Kim presented "Cardiac Imaging Modalities" at the American Association of Heart Failure Nurses Annual Conference on June 24, 2016, in Scottsdale, Arizona.


Sheila Delp, MSN, RN, ACNS-BC, GCNS-BC; Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC; Nancy Altice, DNP, RN, CCNS, ACNS-BC; Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN; Donna Bond, DNP, RN, CCNS, AE-C, CTTS; Kim Hall, DNP, GCNS-BC, CWCN-AP; Ellen Harvey, DNP, RN, CCRN, ACNS-BC; Cathy Jennings, DNP, RN, ACNS-BC; Amy Lucas, MSN, RN, CCNS, CCRN-K; Phyllis Whitehead, PhD, RN-BC, MSN, APRN, ACHPN; and Kimberly Carter, PhD, RN (Carilion Roanoke Memorial Hospital)


The CNS team at Carilion Roanoke Memorial Hospital had an article, "Spheres of Influence[horizontal ellipsis] Clinical Nurse Specialists: Sparking Economic Impact, Innovative Practice (47[6], 30-37)," published in the June 2016 issue of Nursing Management.


Ethlyn Gibson, MSN, RN, BC (Riverside Program for All-inclusive Care for the Elderly)


Ethlyn had a poster, "Developing Project Healthy Grandparents in Virginia: African American Grandmothers Raising Grandchildren," at the Virginia Governor's Conference on Aging on May 2, 2016, in Richmond.


Amanda J. Golino, MSN, RN, CCRN, CCNS, RN-BC (Inova Loudon Hospital)


Amanda had a poster presentation, "Bust a Move: Progressive Mobility in the ICU: Focus on the Patient and Family," at the Virginia Hospital and Healthcare Association Conference, Richmond, Virginia on February 4, 2016, and at the University of Virginia Evidence-Based Practice Conference, winning the triple crown on May 4, 2016. Moreover, presentations are pending at the Reston Hospital Research Symposium on May 13, 2016, and ENRICH Yale Conference on June 2016. The project also received honorable mention, Best Nursing Team, from Advance Healthcare Network for Nurses on May 2016 (


Congratulations to Linda Thurby-Hay, DNP, RN, ACNS-BC, BC-ADM, CDE, Adult Health Clinical Nurse Specialist, Virginia Commonwealth University Health System, Richmond, on her election to the 2016 to 2017 Board of Directors of the NACNS!



After a very long journey, our bill, House Bill 5400, was passed by both legislative chambers and is headed to the governor for his signature. The governor will have 14 days to sign the bill into law, which was given immediate effect by the legislature. The revisions in the bill include adding CNSs as APRN to the Michigan Public Health Code. This will allow for specialty certification for the CNS role and adds CNS to the Michigan Board of Nursing. The Michigan Public Health Code now defines APRN as a registered professional nurse who has been granted a certification in 1 of 4 fields (nurse midwifery, nurse anesthetist, nurse practitioner, or CNS).


This legislation also allows an APRN to order, receive, and dispense a complementary starter dose drug without delegation from a physician and, as delegated, act, order, receive, and dispense a complementary starter dose of a controlled substance. An APRN is able to make calls or go on rounds, and the revisions in the bill include an APRN in the definition of "prescriber" in the Public Health Code. In addition, it now includes a CNS among the designated professionals eligible for the state's essential health provider loan repayment program. The bill also allows an APRN to prescribe physical therapy and speech therapy and order restraints autonomously. In relation to drug prescription, it allows an APRN to prescribe schedule II-V drugs under delegation without restriction to setting or circumstance and permits an APRN to prescribe nonscheduled drugs autonomously. Michigan Association of Clinical Nurse Specialists is extremely excited to be venturing into new territory with full title protection and a measure of prescriptive authority. For more information, please contact Kathleen Vollman at or Cathy Lewis at



Kathleen Dunn, Spinal Cord Injury CNS at the VA San Diego Healthcare System, retired on January 31, 2017, after 28 years of VA service. Kathleen Ellstrom, pulmonary/critical care CNS at the Loma Linda Veteran's Affairs Medical Center, is assuming the chair position for the NACNS VA Virtual Affiliate, aided by cochair Ann Busch, liver transplant CNS at the Portland, Oregon Veteran's Affairs Medical Center.


Ann Busch, liver transplant CNS at the VA Portland Health Care System, was reelected for a 2-year term to the International Transplant Nurses Society Board as education director.



We are thrilled with the news that the Northeast Ohio Clinical Nurse Specialist Affiliate has been selected as the newest NACNS Affiliate of the Year! We are looking forward to 3 exciting programs in 2017. Our winter program, "live well, be well, be a CNS," will offer techniques to encourage healthy living for CNSs. Our spring program is focused on activities and strategies that CNSs can use to "promote your very best self." Our fall program will be held on September 7 to celebrate National CNS week. It will be our third annual Chief Nursing Officer/Clinical Nurse Specialist networking breakfast. Our keynote speaker will be Richard Frankel, PhD, professor of medicine and geriatrics at Indiana University. He will be speaking on "fostering civility and resilience in the workplace." In addition, to sponsor these compelling programs, we are giving back to our communities by collecting food, education supplies, and personal care items at each of our programs. These items will be used to nourish, educate, and comfort those in need in Northeast Ohio. Please visit our Web site at to read about all of our professional activities and contributions.


*These activities have been approved for contact hours by the Alabama State Nurses Association. The Alabama State Nurses Association is accredited as an approver of continuing education by the American Nurses Credentialing Center's Commission on Accreditation. [Context Link]