1. Sitterding, Mary MSN, CNS

Article Content


Forces of magnetism (McClure et al, 1983) have been identified as those elements that contribute to an organizational culture that allows patients to receive excellent care from nurses practicing in an excellent health care environment. Those forces include (1) quality of nursing leadership; (2) organizational structure; (3) management style; (4) personnel policies and programs; (5) professional models of care; (6) quality of care; (7) quality improvement; (8) consultation and resources; (9) autonomy; (10) community and the hospital; (11) nurses as teachers; (12) image of nursing; (13) interdisciplinary relationships; and (14) professional development (McClure, & Hinshaw, 2002). In 1992, the the chief nursing officer (CNO) of a regional organization set out to develop a professional nursing practice model that included the development of a differentiated nursing practice model that included CNSs.



The development of the professional nursing practice model began with a needs assessment. The objectives of the needs assessment included the following: (1) examine professional nursing practice within the organization; (2) identify nursing services authority within the organization; (3) identify nursing service position of influence within the organization; (4) identify differentiation between nursing roles; (5) identify the bedside nursing contribution to the interdisciplinary practice team. Findings were remarkable. What followed was the development and implementation of strategies aimed at advancing the practice of nursing and patient care within the organization. Strategies included the following: (1) establish a Professional Nursing Steering Committee including CNSs; (2) identify, educate, excite, and embed professional nursing practice standards; (3) examine better performer practice models integrating differentiated nursing practice; (4) build and measure the effect of differentiated nursing practice; (5) design interdisciplinary practice teams led by the CNS; (6) implement and measure the effect of the first-generation practice teams; (7) enhance and measure the effect of the second-generation practice teams; (8) design and implement shared governance led by bedside (sharp-end) nursing and facilitated by CNSs; (9) measure the effectiveness of this model; and (10) based upon measurement findings, raise the bar.



To measure the effectiveness of this 10-year journey toward professional nursing practice, a small group of nurses led by the CNO, the director for clinical practice and the lead, CNS came together to write summaries and pull evidence of what was perceived to be a professional nursing practice model. The outcome experienced was that we were the first and only hospital in the state to achieve Magnet designation. Additional outcomes experienced included, but were not limited to, bedside nurse (sharp-end) activation to raise the bar!!


Conclusions/Implications for Practice

On multiple occasions, the CNO for this organization shares that the CNS competencies were integral to achievement of a professional nursing practice model resulting in Magnet designation. CNS competencies within the patient, provider, and system spheres influencing the design, testing, and evaluation of strategies toward a professional practice journey are expertly described in the Statement on Clinical Nurse Specialist Practice and Education (NACNS, 2004).


Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.