1. Fulton, Janet S. PhD, RN

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We gathered in San Antonio for the annual National Association of Clinical Nurse Specialists (NACNS) conference, about 400 of us, and the energy was daunting. The pulse of clinical nurse specialist (CNS) practice was palpable everywhere. The presentations were built around a theme of renaissance. A good theme, it seems in looking back. For 4 days I wanted to shout that movie line-we're baaaaaack! The renaissance for CNSs is occurring. The stated objectives for the conference were, as you might expect, to acquire knowledge of innovations in evidence-based practice, enhance knowledge to shape CNS practice in new ways, and network with peers on issues and trends in CNS practice and education. Objectives are all well and good; however, along the way I have heeded the sage advice-never let the stated objectives get in the way. Here are some personal and professional objectives I accomplished at the conference attended by CNSs representing every conceivable specialty. CNS faculty, students, entrepreneurs, authors, techno-geeks, you name it; they came to experience the renaissance.


The abstract for this presentation was intriguing so I planned to attend. When I got to the session, I was not disappointed.


As a result of our program, she explained, ventilator-associated pneumonia was reduced from 20% to 0%. Zero! Over a 2-year period, this reduction in pneumonia cases resulted in millions of dollars in savings related to DRG 483.


She continued with the details neatly formatted on color slides with tables and graphs. She explained how she, the critical care CNS, developed and implemented programs to work with the staff to achieve the outcome.


The interventions that led to these millions of dollars of cost savings? Handwashing and elevating the head of the bed! Yes, that's it. Nursing interventions purposefully aimed at risk reduction in a vulnerable population. The interventions are simple; getting the staff to consistently perform the interventions in a goal-directed manner is quite another issue-one that requires the competencies of a CNS. The objective-identify the impact of CNS practice on safe, cost-effective, quality nursing outcomes-a reaffirmation of the value of CNSs.


From another presentation[horizontal ellipsis]


The session had begun when I slipped into the back of the room. Magnet accreditation was the topic, and I could see from the handouts that the presenter had successfully achieved the goal.


The staff is really excellent; they just don't know it.


She hammered on this theme.


Get the staff engaged by rewarding what they do well-celebrate accomplishments. You get what you ask for. Emphasize accountability and reward a job well done. Be a coach, a mentor, a cheerleader. We used the motto we will be the premier leader in the practice of professional nursing.


Reward good work through praise. It sounded so fundamental hearing it that way. How often do nurses not receive feedback about their good work? More likely, we send and receive only negative feedback about failure to nurse the system-oversights in acuity reports, incomplete linen inventory counts, hoarding supplies over a holiday weekend. Here was an example of nurses experiencing job satisfaction as an outcome of CNS practice. I was reminded to reach out, take control of our destiny; make it a good one. We are in this together-this practice of professional nursing. Another objective-learn strategies for enhancing the careers of nurses.


From a third session[horizontal ellipsis]


We have the same goals. We want what the regulatory bodies want-CNSs that are competent in practice, and protection of that practice without barriers. The challenge before us, explained the speaker at the legislative forum, is to work through our different perspective toward the common goal.


What is not working for you in the regulatory arena, she inquired.


They told her. They testified to problems involving the regulation of their practice.


As a pulmonary CNS, one attended responded, I see patients with asthma from adolescence through old age. My state board of nursing says my practice must match my certification-which is adult. Where does adult begin, and where does it end and become gerontology?


Good question, I thought. Tidy little boxes can make big barriers.


This issue of the journal includes a letter to the editor from the National Council of State Boards of Nursing, with a response from the NACNS Board of Directors. This correspondence assures us that the dialogue continues, and that the journal, like the conference, is an important forum for engaging a national conversation about important topics for CNSs. The objective-it's a matter of professional citizenship, to be engaged in the process and to advocate for those who can't necessarily advocate for themselves.


In this case, it's for our clients-patients, families, and communities-who are the reason for CNS practice. The speaker reminded us to keep our focus on the client as we struggle to meet the goal.


Every conference emphasizes networking opportunities and meeting new people who share your interests.


She seemed a little unsure, hesitant. She spoke softly.


Excuse me, can I tell you something?


Sure, welcome! Are you enjoying the conference?


Yes, well, I'm a graduate student. I really wanted to be a CNS, and so I enrolled in the closest program-a 100 miles from where I live and work. I get a lot of negative comments from coworkers about going to graduate school. I get comments from nurses who wonder why I would ever want to be a CNS and not a nurse practitioner. Sometimes I wonder myself, especially when other programs are much closer. I'm so glad I came here. I know now that I made the right decision. It's worth the drive, and yes, I definitely want to be a CNS.


Then she walked away, as if she had a mission to deliver the message, and the mission was complete.


I reflected that validation is an important objective. Every year we gather to take note of why we do what we do and to pause to reflect on the importance of our work. Validation may be the most important of all reasons for attending the conference-the ultimate objective!


This issue of the journal includes abstracts of the 2004 Annual Conference of the National Association of Clinical Nurse Specialists. NACNS hopes that by publishing abstracts and board responses to other national bodies you too can achieve the conference objectives-acquire knowledge of innovations in evidence-based practice, enhance knowledge to shape CNS practice in new ways, and network with peers. Or the information may initiate your personal CNS renaissance experience and achievement of your professional objectives-and that is a good thing, too.