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Lord, when we are wrong, make us willing to change. And when we are right, make us easy to live with. - -Dr Peter Marshall


Out beyond ideas of wrong-doing and right-doing, is a field. I'll meet you there. - -Rumi


Taking the High Road

Because of our commitment to NACNS members to represent clinical nurse specialists (CNSs), we are at "the table" in many important national arenas. These meetings provide opportunities to foster long-standing, collegial relationships between NACNS and other national organizations, though sometimes, because there are such major philosophical differences in positions, it's tough to maintain healthy communication. I believe it is always necessary to separate the people from the issues, and to maintain mutual respect and allow for discussions about positions.


Wherever people are, there will always be conflict.1 It's a rare CNS who doesn't deal with conflict on a regular basis in the work setting. People have differing opinions about almost everything, because of our individual values, beliefs, and priorities, and these carry over into our professional work lives. Add a touch of miscommunication to the mix and we find ourselves engaged in and defending against worrisome behaviors.


It's important to recognize that conflict is a normal state and is inevitable. The real issue is not the conflict, but how to respond to it in a healthy way. There are many paradigms about the structure of conflict. Hendricks2 identified 3 stages that seem pretty logical to me: stage 1, daily events where conflict is ongoing and generally requires little action; stage 2, challenges that take on an element of competition, typified by a win or lose attitude; and stage 3, battles, where conflict has escalated and being right and punishing wrong become consuming motivations. Food for thought.


Leaders in our organization are engaged in many initiatives that require attentive listening to others, thoughtful sharing of our positions (verbal and published), and a willingness to engage in dialogue with people who express divergent opinions. Your NACNS board of directors meets every month, and also communicates constantly by e-mail and phone about how to best represent CNS interests. We just completed another wonderful 3-day June Retreat and Board Meeting at the beautiful Jawacdah Farms, as guests of the Hillenbrand family (makers of Hill-Rom beds and other health-related products), hosted by Bill Dunlevy. We celebrated many successes of our growing organization at our retreat. Taking the high road is the desired goal of the NACNS board in areas of conflict-examining differences, encouraging meaningful dialogue, providing rationale for our positions, and communicating our enthusiasm about CNS practice.


We conducted analyses on a variety of important national issues, including the worrisome APRN Compact language. As presently worded, the proposal by the National Council of State Boards of Nursing (NCSBN) is harmful to CNS education and practice. We also analyzed the proposed clinical nurse leader role about which so many of our members (and nonmembers!!) have called or e-mailed board members voicing their concerns. Our position statements are on the NACNS Web site at Please continue to let us know of your thoughts on these and other issues of concern to you and your organization.


June was actually a busy month for NACNS. Many of our members shared their practice successes at the American Nurses Association Convention in June in Minneapolis. Many thanks to Dr Sue Davidson, a past president of NACNS, who led the initiative to get a variety of papers submitted for peer review and eventual presentations to showcase CNS practice. Several leaders from the board (Dr Jan Fulton, Dr Nancy Dayhoff, Theresa Murray, and myself) participated in the "APN Consensus Conference," an important meeting in Washington, DC, on June 9, 2004. Leaders from approximately 32 organizations that have some stake in 1 of the 4 advanced practice nursing groups met to discuss issues around specialization and regulation. A highlight of the meeting for me was the opening presentation by Dr Barbara Safriet, associate dean and lecturer in law at Yale University Law School. NACNS representatives at the meeting were cheering her words as she cautioned attendees (and especially regulators) about the dangers and pitfalls of overregulation of advanced practice nurses, an idea consistent with ours, and one of the major areas of conflict between the NACNS and the NCSBN (whose representatives were also in attendance at the meeting). According to Dr Safriet, we have overregulation and the nursing profession is "fractured in the regulatory arena." She warned that while the purpose of regulation is to protect and promote the public's interest, regulators are going to the point of overprotection and setting the bar too high. She suggests that we should aim for the most expansive scope of practice and the least restrictive regulation that can safely be implemented, and also provide for alternatives. Amen.


In July, NACNS hosted an invitational Legislative-Regulatory Summit of leaders of organizations who represent CNSs in particular specialties. The meeting was again held at Sigma Theta Tau headquarters in Indianapolis, Ind. We appreciated the dialogue with our colleagues about solutions to the continuing barriers to CNS practice. Unlike the June meeting where all 4 advanced practice nursing groups were represented, this meeting included only those with CNS members to help us focus more clearly on our own issues. We are fortunate to have so many committed leaders who are willing to go the extra mile to represent CNSs and our NACNS members. Did we say thank you? Oh yes, thank you!!


One of the unexpected joys of serving as your president thus far has been the communications I have received in this era of e-mails. I have heard from both long-time members and new members (probably joining as a result of barriers to CNS practice) about areas of concern that I could not have predicted months ago. We are listening and I promise you that we will continue to respond to your issues if you will commit to letting us hear from you. My e-mail is We celebrate you as CNS educators and as CNSs in practice who are collectively making a difference in the lives of thousands of patients and families every day. Keep the faith.


NACNS Statement on Clinical Nurse Specialist Practice and Education, Second Edition, Newly Revised!!

This document articulates the core competencies requisite to CNS practice, outlines the outcomes of CNS practice, and provides direction to schools of nursing regarding the preparation of CNSs. Endorsed by the American Organization of Nurse Executives (AONE) as "a comprehensive reflection of the contemporary role that Clinical Nurse Specialists play in the delivery of quality nursing care," this new and updated version contains information for contemporary clinical nurse specialist practice and education. You can purchase your copy through the NACNS Office at a cost of $25 per copy for members of NACNS and $45 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.




1. Cardillo D. Seven strategies for managing conflict. Nurs Spectrum South Ed. January 2004;5:27. [Context Link]


2. Hendricks W. How to Manage Conflict. Shawnee Mission, Kan: National Press Publications; 1989:1-14. [Context Link]

NACNS Update

News From Our Affiliates


This is the second installment in a column designed specifically for our affiliates to voice their issues and ask for dialogue from peer affiliate groups. It is still fledgling and will continue to grow with feedback from the affiliates themselves. This is your forum!! Use it to articulate your concerns and begin a dialogue with your peers in other states.


Ohio: At the June Jawacdah retreat held by the board of directors we approved the charter of the newest affiliate. Welcome to the Clinical Nurse Specialists of North-East Ohio!! We hope to hear from you soon in this column.


Minnesota: The MN CNS Networking Group was formed in 1997, joining fellow APRN colleagues, the Minnesota Nurses Association, and the Minnesota Board of Nursing (BON) in crafting a new Nurse Practice Act related to advanced practice nursing. The CNSs played a pivotal role in assisting the BON with implementation of this legislation. Through this work, a closer link with CNSs nationally was established when the MN CNS group became an affiliate of the NACNS in 1999. Since that time, the purpose of the affiliate has been to provide a networking group, improve communication among CNSs across the state, and develop peer understanding of the complexity of the CNS role in many settings, as well as to continue liaison work with the BON. The group meets quarterly for an educational offering and meeting.


The MN CNS group is sponsoring its annual CNS conference, "Celebrating the Past-Building the Future," on Friday, October 8, 2004, in Minneapolis, Minn, with the keynote speaker being Angela P. Clark, PhD, RN, CNS, FAAN, FAHA, president, NACNS, and associate professor, University of Texas at Austin School of Nursing. Allina Hospitals & Clinics is accredited as a provider of continuing nursing education by the American Nurses Credential Center's Commission on Accreditation. This activity for 7.2 continuing education hours is provided by Allina Hospitals & Clinics. If you are interested in more information about the group or the conference, please contact Sue Sendlebach at


Kansas: The Kansas City affiliate representing CNS practice since 1992 across the Kansas-Missouri state line and surrounding communities, the Greater Kansas City Clinical Nurse Specialists Group, became an affiliate member in July 2002. Through the transition of time and membership, the goal of the organization has grown to support clinical practice locally and nationally. We are very proud to have a representative, Mary Stahl, Medical Cardiology CNS, St. Luke's Hospital, to the national affiliate advisors group. Local accomplishments include the following: Karen Wiegman completed her PhD in nursing in December 2003 with a dissertation on "The Development and Psychometric Testing of the Dignity Instrument." She has accepted a position as director of patient care services at Mid America Rehab. Kathy Jensen, CV CNS, Shawnee Mission Medical Center, and Nancy Richards, CV Surgery CNS, St. Luke's Hospital, received their CCNS certification in 2003. Janet Ahlstrom recently accepted the role as director of professional practice, nursing resources and nursing outcomes for Carondelet Health. Thanks so much!! Barbara Flakus, MSN, RN, APRN, BC.


Oregon: Initiatives that we have undertaken include, but are not limited to, legislative action to address the status of CNSs as independent and recognized practitioners (successful in 2001). In fact, the language we created is being used as a template by other states seeking legislative changes that will recognize the role and protect the title of the CNS. Recent legislative action has focused on prescriptive privilege for CNSs who need it to provide comprehensive service to their patients. We are also actively working to recruit members in both the NACNS and the Oregon Nurses Association and have worked collaboratively with the Nurse Practitioners of Oregon to successfully authorize a pilot program for reduced dues for noncollective bargaining membership. We are also an integral component on the team that is planning the fourth biannual Northwest Clinical Nurse Specialist Convention that will take place on Saturday, October 9th, at the Oregon Health & Sciences University School of Nursing. Our keynote speaker will be Jan Fulton, immediate past-president of the NACNS. Come and join us for an after the conference dinner cruise on the Willamette river!! Kelly Goudreau.



There are a number of committees associated with the board. If you are interested in participating on any of the committees please submit a curriculum vitae to Christine Filipovich, the executive director for NACNS. Your application will be reviewed by the president and considered by the board prior to appointment, but do not let that stop you!! We are in need of CNS leaders who are committed to the role and future of the CNS.

Affiliate Advisory Committee


The Affiliate Advisory Committee shall provide information and guidance to affiliates, and shall ensure communication between the affiliate(s) and the board of directors.

Communications & Marketing


The Communications & Marketing Committee ensures that the association is able to communicate with its membership and professional partners using current electronic, computer, and Web-based technologies.

Education Committee


The Education Committee provides guidance and consultation to graduate programs, faculty, students, and national accrediting and credentialing bodies regarding NACNS recommendations for preparation of CNSs and ensures that current data related to the preparation of CNSs are obtained and disseminated.

Finance Committee


The membership of the Finance Committee consists of the NACNS Board of Directors with the NACNS Treasurer serving as chair of the committee. The committee's purpose is to supervise and direct the financial affairs of NACNS.

Legislative/Regulatory Committee


The Legislative/Regulatory Committee monitors legislative and regulatory issues affecting CNSs on the state and federal level, analyzes statutory and regulatory language governing CNS practice to identify barriers to practice, and develops model statutory and regulatory language to govern CNS practice.

Membership Committee


The Membership Committee develops and oversees all efforts to boost membership in NACNS while ensuring the needs of current members are met.

Nominating Committee


The Nominating Committee solicits nominations for all offices up for election and presents a slate of candidates to the membership for election. The election is conducted in accordance with the bylaws of NACNS.

Practice Committee


The Practice Committee identifies contemporary and evolving practice issues that affect CNSs and develop related activities such as, but not limited to, practice advisories and position statements. The Practice Committee collaborates with the Research Committee to develop evidence related to the practice of CNSs.

Publications Committee


The Publication Committee oversees all materials drafted by NACNS committees and recommends the types of materials to be published by the NACNS.

Research Committee


The Research Committee conducts and/or directs research activities supporting the organization and CNS practice.


Some new work groups are also being proposed. If any of these groups are of interest please let us know!!


* An ad hoc exhibitor/sponsor recruitment task force for the annual convention.


* A portfolio work group that would clearly outline the process and content for development of a professional portfolio for CNS practice.


* A bylaws committee that would address the issues of changes to the bylaws.


New Board Member Introductions


There are a number of new members on the board and the updates section of the journal offers an opportunity to get to know who they are. Look for a different member to be briefly introduced in coming editions. In this edition, we are pleased to introduce Pat Bielecki, MS, RNC, APN/CNS.


Pat is presently a director on the board of directors, and has worked in 8 different hospitals (all in Chicago suburbs) in Labor and Delivery, Nursery, Mother/baby, Postpartum, and in both the traditional and LDR, LDRP settings. She has held positions as a staff nurse, charge nurse, clinical coordinator, head nurse, director, and as a CNS in 3 different hospital systems.


Pat reports that her husband is retired from AT&T and was an electrical engineer. Now, she reports that "he is just a Cubs fan year round." She and her husband have 3 grown-up children (Matt, Amanda, and Liz) and she is a grandmother to beautiful 2-year-old Kate. Pat's mom is still alive and active at 86 and is a retired nurse. She tells stories of acting as a nursery head nurse in her senior year of nursing school (and we think WE have a shortage of nurses)!!


Pat became a nurse after her children were born and she attended a 2-year ADN program. She went on to a BSN completion program and then continued on for her MS in parent-child nursing with a focus as a CNS in a community setting.


Currently, she is the APN/CNS in a 600-bed hospital, part of an 8-hospital system. Pat is the CNS and is responsible for nursing excellence and care for Labor and Delivery, 2 mother/baby units, a 20-bed antepartum/gynecology unit, and a 60-bed well-baby nursery. She has been in this position for more than 4 years. Pat is also a pioneer in NACNS and is a past-president of the NACNS when it was first getting started.

Don't Forget the 2005 Annual Convention!!


We will be in beautiful Orlando, Fla, March 9-12, 2005. Mark your calendars now and prepare to attend!! Watch the newsletter for future postings and information that will be up to the minute!!

Member-Get-A-Member Campaign Continues!!


Don't forget our annual Member-Get-A-Member campaign in an effort to welcome CNSs into the organization that speaks for them at a national level. As we grow in number of members, the power and voice of NACNS will ensure the future viability of the CNS role within healthcare. The campaign will run each year from January 1 to December 31.


WIN Free membership for one year for all who recruit more than 10 new members.*


One grand prize will be awarded: Free registration to the 2005 Annual NACNS National Convention and free membership for one year for the member who recruits the most new members.*


See our Web site,, for membership applications. You may duplicate the form and give it to your CNS colleagues, coworkers, and friends. Make certain that your name is in the "recruited by" section. If a "recruit" applies for membership via the NACNS Web site, fax, or phone, make sure he/she indicates that you are the recruiter.


Get busy and encourage your colleagues to become a member of the professional organization exclusively designed to meet the professional role development needs of CNSs.


Together we can make a difference.

Are You Interested in an Institutional Membership or Corporate Partnership With NACNS for Your Organization?


At the board retreat in June the board approved an action to create institutional membership category for educational and healthcare institutions, and corporate partnerships. The details were being worked out as this newsletter went to press so watch future newsletters for further details!!

Are There Other Things You Would Like to See in the NACNS News Section?


Please feel free to provide your comments and suggestions to Kelly Goudreau at