1. Conley, Deborah Marks MSN, APRN, BC, CS

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Name: Deborah Marks Conley, MSN, APRN, BC, CS

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Current Position: Gerontological Clinical Nurse Specialist on the Acute Care for Elders Unit, Acute Rehabilitation Unit, and the Orthopedics/Neurology Unit


Current Affiliation(s): Nebraska Methodist Hospital and College of Nursing at Nebraska Methodist College (joint appointment), Omaha, Neb


Area(s) of Specialization: Gerontological nursing, dementia care


Professional Education: MSN, University of Nebraska Medical Center, 1994; BSN, Central Missouri State University, 1976


Certifications: Clinical Specialist in Gerontological Nursing through the American Nurses Credentialing Center


Deborah Marks Conley is the 2004 recipient of the Gerontological Clinical Nurse Specialist of the Year Award, presented by the National Association of Clinical Nurse Specialists (NACNS) at its annual meeting held on March 10-13 in San Antonio, Tex. This award was made possible by a grant received by NACNS to improve and celebrate competence in gerontological nursing by our members. The Nurse Competence in Aging is a 5-year initiative funded by The Atlantic Philanthropies (USA), Inc, awarded to the American Nurses Association (ANA) through the American Nurses Foundation (ANF), and represents a strategic alliance among ANA, the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, The Steinhardt School of Education, Division of Nursing. NACNS is one of several organizations to receive a 2-year grant to improve competence in CNS care of older adults. Ms Conley was selected based on her more than 26 years of experience in this specialty. She has a joint appointment between the Nebraska Methodist Hospital, where she works as a CNS on multiple units, including an ACE, or acute care for elders unit, and the Nebraska Methodist College of Nursing where she teaches gerontological nursing. She is the immediate past vice president of the National Gerontological Nursing Association and a nationally known speaker on care of older adults. According to her colleagues, Deborah has worked tirelessly in an effort to increase the numbers of gerontological certified staff nurses by mentoring, coaching, and teaching review courses at her institutions. She has completed numerous research projects, presented at national conference, and her work is well published. Her peers describe her as dedicated, enthusiastic, knowledgeable, energetic, and innovative, serving as a role model to the other 6 CNSs with whom she works. Her research interests include comparing the outcomes of certified vs noncertified nurse care providers, using foot massage as a relaxation intervention for patients with dementia, improving attitudes and increasing knowledge of health care professionals caring for patients with Alzheimer's disease, and the validity and reliability of telephone-administered Mini-Mental Status Examination and the Geriatric Depression Scale for geriatric outpatients. Deborah received a plaque and a $250 cash award from the SNAP-G Grant and Hartford Foundation. Congratulations, Deborah!!!!


What first motivated you to become a CNS?

I had the desire to combine clinical practice, teaching, and research as the major focus of my practice. I enjoy program development and the opportunity to collaborate with peers and work as a part of an interdisciplinary team. In particular, I enjoy the complexity and variety in the CNS role. Specializing in this clinical arena has allowed me to express passion for gerontological nursing while developing expertise.


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

As we hear many CNSs state so often, I believe it is important to explain the role of the CNS to peers, other healthcare providers, and to the consumer. I use every opportunity to describe the unique role of the CNS and its implications for practice and patient outcomes. For me, discussing performance improvement indicators to enhance patient outcomes has always been a good way to describe one aspect of CNS practice. Describing case studies and presenting at nursing lectures and conferences informs others of the role. Integrating evidence-based practice concepts and being available as a resource for staff nurses and other disciplines has been an effective strategy to model the role of the CNS. Consultation with staff and/or providing direct care to complex patients has helped nurses and physicians understand the CNS role. The CNS focuses on using clinical practice guidelines or other research-based types of nursing in practice and incorporates teaching these same concepts.


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

I believe reimbursement issues, confusion about certification for CNSs, and the lack of educational programs and qualified nursing faculty to educate CNSs for the future are today's challenges. The lack of understanding between the role of the CNS and the NP is problematic. I support 2 distinct roles in healthcare.


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

I enjoy being an enthusiastic voice for older adults and gerontological nursing as a whole. Aging is a natural process and just because someone is getting older, does not mean they are "sick or may not improve." Nurses and other health professionals need to know that gerontological nursing is a specialty and scientific knowledge has evolved over the past 25 years to guide our practice.


Gerontology has not always been viewed as the "specialty of choice"As a gerontological CNS, I have-had a very positive impact on nursing students, nursing staff, physicians, and patients over the years. I share my love of my work in many ways. One thing I believe makes a huge impact is to view older people as living resources and a source of wisdom, honoring older people, instead of viewing them as people unable to contribute to society. I encourage the use of terms such as older persons, elders, and seniors and not degrading terms such as old people and elderly. I promote a positive outlook when it comes to caring for older adults and their families.


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

The availability of a CNS to be a resource to physicians, colleagues, interdepartmental staff, patients, and families on a day-to-day basis is a highly value-added role. Having the opportunity to "research the literature" about clinical issues and provide mentoring and coaching to staff nurses is one of my most enjoyable activities. I am blessed to work in an organization that not only strongly supports the CNS role but also encourages the CNS to grow both professionally and personally.


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

Becom active in professional organizations, including the NACNS, read professional journal, and network with other CNSs and advanced practice nurses. It is important to market your unique CNS skills and knowledge to various organizations in order to impact patient outcomes and system changes. Do not be bashful!!!! It's wonderful to be a CNS. I found the following organizations helpful in my CNS practice and/or the specialty of geriatrics.


* National Association of Clinical Nurse Specialists


* National Gerontological Nursing Association


* Midwest Nursing Research Society


* Nurses Christian Fellowship


* Sigma Theta Tau International


* Nebraska Methodist College Nursing Honor Society


* University of Nebraska Medical Center Nursing Alumni Association


* Gerontological Society of America



What do you see as the current most pressing healthcare issues for the gerontology population and how are you working to address those?

One major concern is caring for individuals with dementia (particularity Alzheimer's disease) and the financial and emotional toil it places on the patient, family, and society. Payment for services for individuals with Alzheimer's disease is deplorable. From a payment perspective, it is considered a "maintenance/custodial" type of care, not skilled nursing. I disagree. Today there is research that supports patients with Alzheimer's disease benefit from the knowledge and skills of professional nurses. Families need professional nursing advice and consultation to learn the skills necessary to care for these patients, and dementia care should be covered under Medicare or insurance companies.


Another issue is both the cost of medications for older patients and the number of drugs prescribed. Adverse drug reactions occur as much as 20% to 25% in hospitalized elders and almost as often in the home setting. I recommend that clinicians do comprehensive medication reviews every time an older patient presents to the office, community, or hospital setting. Fewer drugs can be a beneficial treatment for many patients.