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Happy New Year, and may it be a good one!! As you read this, it is already the new year, but as I write, it is December, and A Charlie Brown Christmas is playing on television. It's a particular favorite of mine. Who among us is not inspired by the wisdom of Charles Schultz, the creator of the lovable Peanuts comic strip with its cast of unforgettable characters-and wisdom, much wisdom. In economy of word and simplicity of drawing, Schultz demonstrated an understanding of the fundamental truisms of life, tempered with common sense and good judgment. Over the 50 years he produced the comic strip, Schultz became part of our culture. We recognize the trials and tribulations of his characters as our own and are comfortably familiar with his story lines. We know about Charlie Brown's baseball failures, Snoopy's flying ace fantasy, Schroeder's love of Beethoven, and Lucy's psychiatric help. Schultz, who died in 1999, was a keen observer of human nature, and I need to lean on a little of his wisdom a la Lucy.


Lucy Van Pelt is no wallflower. She is opinionated, outspoken, and self-directed. If you ever doubt her, she will set you straight!! Grounded in confidence, she established and staffed a roadside enterprise. The sign on top of her booth reads PSYCHIATRIC HELP 5[cents]. The sign posted on the front of the booth announces, "The doctor is in." Here's a sample of her services: "I have deep feelings of depression," said the ever-insecure Charlie Brown. He asked, "What can I do about it?" "Snap out of it," advised Lucy ( Good advice? We may never know, but this we do know: Lucy was an autonomous provider. She sold her expertise. Free enterprise at its finest. Of course, in the non-cartoon world, free enterprise in the delivery of mental health or any other health service is highly regulated for protection of the public-no self appointed "doctors" allowed. Lucy gets away with her bogus credentials because she is fictitious, although I say this with a cautious respect for her wrath.


To announce, "The nurse is in", the provider must have a license to practice nursing. It is the law; it is how the practice of nursing is regulated to protect the public. Before the 1970s, a license to practice as a registered nurse was fairly narrowly defined and limited to tasks directed by a physician. In the 1970s, however, there was a concerted effort to revise state nurse practice acts-the laws that define nursing's scope of practice-in all 50 states. The revisions created an autonomous domain of nursing practice-what nurses could do with self-directed authority. As a result, nursing's scope of practice now includes independent practice-decision making about nursing interventions, including what, when, where, how, and for whom nurses can engage in free enterprise. We may want something a little different than a roadside booth with a makeshift sign, but clinical nurse specialists (CNSs) are, by the authority granted under every registered nursing license, independent health care providers for services related to relieving symptoms and improving functional status-comfort, hygiene, mobility, nutrition, and a host of related interventions that are completely under the discretion and direction of the nurse. Nursing services delivered by a CNS are at a different level than those delivered by a nurse without an advanced nursing degree, but the authority to deliver these services is granted under the same legally created scope of practice.


We tend to lose sight of our autonomous domain of practice because most CNSs, like most nurses, are employees, lulled into thinking our efforts should be directed by others. Snap out of it. It's time to take a lesson from Lucy-to be more outspoken, more self-confident, bossy, crabby and selfish, and to set things straight. We have the right to free enterprise. Let us renew our commitment to nursing practice by loudly proclaiming our existing independence in our autonomous domain. Make it your New Year's resolution to read your state's nurse practice act, know the boundaries of your legal authority, and declare free enterprise alive and thriving. As for the fee-National Association of Clinical Nurse Specialists and others are working on mechanisms to support reimbursement from clients and third party payers. It will come. For now, "The CNS is in."