1. Dykes, Anne Shirah MSN

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CURRENT POSITION: Perinatal Clinical Nurse Specialist


AREA(S) OF SPECIALIZATION: Perinatal healthcare-inpatient, outpatient and perioperative obstetrics, and inpatient normal newborn


PROFESSIONAL EDUCATION: Bachelor of Science in Nursing (1978) from Nell Hodgson Woodruff School of Nursing, Emory University and Master of Science in Nursing (1991) as CNS (with distinction) from Georgia Southern University


Certifications: National Certification Corporation (NCC) certifications in inpatient obstetrics and electronic fetal monitoring. National certification not available for perinatal CNS specialty

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The National Association of Clinical Nurse Specialists (NACNS) is proud to profile our 2004 CNS of the Year, Anne Shirah Dykes. Anne, a perinatal CNS at St Joseph's/Candler Health System, Savannah, Ga, was presented with this honor at the 2004 NACNS Annual Conference, San Antonio, Tex, March 2004.


Anne began her nursing career in 1978 with a BSN from Emory University and later, in a position as an emergency department nurse where she worked until 1986. Following her interest in obstetrical nursing, she accepted a position with the labor and delivery department. In 1991, she graduated with distinction from Georgia Southern University with a master's degree in nursing. For the last 13 years, Anne has been a perinatal CNS. She serves as the lead Neonatal Resuscitation Program instructor for her health system and has served on multiple committees covering such areas as patient care leadership, recruitment and retention, patient rights, value analysis, clinical research and development, clinical practice council, patient care policy, magnet standards, and nursing and physician peer review. She holds National Certification Corporation (NCC) certifications in inpatient obstetrics and fetal monitoring.


Anne is currently a member of Association of Women's Health, Obstetric, and Neonatal Nursing (AWHONN), Sigma Theta Tau International (STT), and the National Association of Clinical Nurse Specialists. Anne was instrumental in establishing a regional affiliate of NACNS in Southeast Georgia. Anne was nominated by her peers, Lora R. Sapp, MSN, RN, CCCN, and Patricia M. Valenzano, MSN, RN. Fellow CNS, Lora Sapp, described Anne "as a pioneer, one of the first clinical nurse specialists in the Savannah area who has paved the way for many others by proving her worth and value in the role."


What first motivated you to become a CNS?

After many years as a critical care and obstetric staff nurse, Freddie Hepner, my mentor and fellow instructor in our local nursing program, encouraged me to enroll in a new CNS program at our local university. She convinced me that I had the qualities to practice as a successful CNS. Freddie described those qualities as (1) a determination to succeed, (2) perseverance, (3) independence, and (4) "a fire that will never go out." We practiced together at St Joseph's/Candler, and she provided constant support as a mentor from early in my nursing career until her death, a span of 20 years.


What, if any, professional or career issues did you face early in your career as a CNS?

The first professional issue I faced was transition from a staff nurse to a CNS in the same unit. The advantage was that nurses and physician colleagues knew my clinical expertise; I did not have to prove it. The disadvantage was that they still related to me in the staff nurse role-making it difficult to recruit, support, and obtain buy-in for new projects. And, as other CNSs often comment, when I was not directly visible to the staff, it was like I was not there. I have often wondered which is more difficult-my situation or coming to an unfamiliar unit and having to begin the "proving of yourself" process.


A second issue involved being the first and only CNS in my hospital. It was advantageous that no one really knew what my job description was (other than the piece of paper I had written in graduate school and used to justify my hiring)-so I was independent-free to use my creativity on self-assigned projects and activities. The disadvantage was that since no one understood what I did, my leadership activities were often confused with management/administration. The confusion led physicians and staff to view me as a manager. I was serving as a clinical leader-an expert in evidence-based practice standards, not the management functions. In working with 3 different managers over the years, I have learned that it is important to clearly define and agree upon the areas of expertise and activities. Where there is overlap with management-real or perceived-ongoing conversation is key.


What do you perceive are the key issues for CNS practice today?

I think CNSs today have a constant battle to educate not only the public but also healthcare colleagues about what our practice is all about-who we are, what we do, and our specific contribution and worth. Our patients understand it!! Regulatory and reimbursement issues are also areas that many of us face daily. Progress often seems so slow in these areas-but so was the turtle!!


To date, what do you perceive as your greatest accomplishments as a CNS?

With much management/administrative support, I have been able to accomplish many things during my 13 years as a perinatal CNS. With great pride I can say I led the transformation of our nursing units from multiple care sites for labor, delivery, recovery, and postpartum to single-room comprehensive maternity care. This 2-year transition involved not only structural changes to the unit but also massive cross-training of more than 100 staff members from 3 separate units to provide obstetric and neonatal care in one setting with a true patient- and family-focused environment. The Telfair BirthPlace Residency Program was initiated during this process and is still in full swing today. This residency program is used to educate/train new obstetric/neonatal nurses. It is a model program that can easily be adapted to orient experienced nurses as well. The program's outcomes include a significant reduction in turnover rates and increased job satisfaction for staff and increased patient/family satisfaction. I am also very proud of our outpatient triage and antenatal testing unit staffed by highly skilled labor and delivery nurses. We see approximately 300 patients per month in this unit-patients who were previously assessed and cared for in a labor/delivery room. As a result of more intensive nursing assessment and monitoring, these patients have shorter lengths of stay and increased patient satisfaction.


What do you enjoy or value most about the role of a CNS?

I enjoy implementing evidence-based research into practice. I value clinical practice guidelines and standards and enjoy working with my staff, teaching them and facilitating clinical improvements on the basis of these best practices. It is a joy to watch the staff use this information in their daily nursing practice with patients and families.


What advice would you give a new CNS starting out in this role?

Prove yourself clinically to the staff and physicians. If you are new to the unit-work along side the staff nurses, include all shifts, and be visible on the unit long enough to establish your clinical expertise in the eyes of the nursing and physician staff. Build supportive relationships among nurses, physicians, and managers. Be available. Prove your worth by completing assignments/projects in a timely, cost-effective manner.