1. Rust, Jo Ellen MSN, RN

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Name: Brenda L. Lyon, DNS, CNS, FAAN

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Current Position: Professor


Current Affiliation(s): Indiana University School of Nursing


Area(s) of Specialization: Adult Health, Stress-related Physical Illness


Professional Education: BSN, MSN, DNS


In 2004, the National Association of Clinical Nurse Specialists (NACNS) Executive Board established the Brenda Lyon Leadership Award. This award recognizes an individual who has attained national recognition as a CNS leader. Through publications, presentations, and participation in national forums, the individual has helped improve health care delivery, especially as it relates to CNS practice. The individual has been successful in mentoring others to become successful leaders. Dr Brenda Lyon was asked to share her thoughts regarding leadership, mentorship, and CNS practice.


Dr Lyon, what is your definition of leadership?

Leadership is the ability to draw people to a vision and influencing them to commit to contributing to making the vision a reality. Leaders are able to "lift up" people to higher levels of motivation and morality. Although related individual purposes in a group might have started out separate, a leader helps focus activity to make it purposed toward accomplishing a shared vision. For me, leadership ultimately becomes moral in that it raises the level of conduct, social responsibility, and ethical aspirations of everyone, including those who lead, in essence helping to elevate and transform everyone.


What are your suggestions to CNSs who wish to develop their leadership skills?

I'm not one who believes that people are born to lead-that leadership competencies are innate. I believe there are attributes of a leader that can be developed. Ten of the most important are


* Passion about the cause or goal


* Knowledge power about that which you want to lead


* Ability to clearly articulate ideas/vision


* Honesty/high level of integrity/trustworthiness


* A positive/hopeful perspective


* Positive self-esteem


* Ability to listen, listen, listen


* Ability to relate to others in a caring fashion/relationship skills


* Emotional intelligence and ability to tolerate ambiguity/uncertainty


* Persistence [horizontal ellipsis] viewing problems or obstacles as opportunities



I call these the "Power of Ten." Therefore, CNSs or CNS students who wish to continue to develop their leadership skills should first do an honest personal assessment of these attributes to find areas that they believe need particular attention. I think every leader is constantly working on all of these, I know I am. But I know from personal experience that early in a CNS's career, there are typically a few of the 10 that need particular focus for development. For me, the first one I specifically worked on was listening-this can still be a challenge, particularly in an emotionally charged situation-but it is of paramount importance and I'm still working on it!!!! Additionally, the ability to articulate ideas requires knowledge, practice, and feedback!!!! I strategically planned demanding experiences for myself such as being President of the Indiana State Nurses Association and a lobbyist for the association to challenge my development in this area.


I think some people confuse leadership with position power. That is, if I hold a "leadership" position and have position power, then I must be a leader. For me, leadership has nothing to do with "position power." That's a good thing since the vast majority of CNSs do not have line authority!! Leadership is influence power, and the "Power of Ten," for me, pretty much captures what that means.


You have been identified as a strong mentor, someone who develops successful leaders. What do you consider the important attributes of a mentor and the key role of the mentor in creating future leaders?

For me, mentorship is facilitation/enhancement of someone else. It involves sharing expertise but more important, it is about assisting the other person to "become"-to accomplish their goals. The attributes of a mentor are pretty much the same as the "Power of Ten" except there is an additional one for good mentor and that is the ability to establish lasting relationships with mentees and that is selflessness. What I mean by that is that for a good mentor, it is not about "me," and the accomplishments of the mentee are truly celebrated. Frankly, there are people that I have mentored that have far surpassed my accomplishments and I'm proud to say that I know them and that they remain good colleagues and many have become very good friends.


Mentors play a critical role in the development of leaders. My mentors were Dr Lois Meier, Chairperson of Medical-Surgical Nursing at Indiana University School of Nursing; Emily Holmquist, first Dean at Indiana University School of Nursing; and Dr Martha Rogers, Dean at New York University School of Nursing!! Now, how fortunate was I? This was not, however, an accident. I identified early on that these individuals possessed attributes that I wanted to develop and I sought out their wisdom, advice, and counsel. Obviously, I believe that having mentors is essential for aspiring future leaders. I would emphasis that successful mentor-mentee relationships are not an accident, they have to be deliberately sought and nurtured.


You are considered one of, if not the primary, founders of the NACNS. How did the vision of this organization come about and how did it get started?

Early in the 1990s, after the American Nurses Association abolished the Clinical Nurse Specialist Council and created in its place the Council of Advanced Practice Nurses in the context of a movement to create a "blended role" that would be known as an APN, I became very concerned. My concern was that the unique and important nursing contributions of CNSs would be lost. And, frankly they were. In fact, when Norma Chaska, PhD, FAAN, asked me to write a chapter about the nursing profession in her book The Nursing Profession: Turning Points (1990), I wrote the chapter titled "Getting Back on Track: Nursing's Autonomous Scope of Practice." In the mid-1980s, the exclusive emphasis on nurse practitioners and defining nursing diagnoses as problems that had disease-based etiologies (eg, congestive heart failure, diabetes) spurred me on to put together a planning group to form the Indiana Nursing Diagnosis Association. We were loosely affiliated with the North American Nursing Diagnosis Association and put on several conferences emphasizing the importance of etiologies that were amenable to nursing therapeutics/interventions. In the late 1980s, I chaired with Jan Bingle a planning committee that put on national conferences for CNSs every other year under the auspices of Indiana University School of Nursing. During this time frame, the University of California at San Francisco and the University of Cincinnati were also hosting conferences with good attendance. It was apparent by the late 1980s that the CNS's voice was totally missing from the national policy table. Thus, it was clear that we needed a national association to make the unique contributions of CNSs visible, both to the discipline and to the public. So, during the 1992 National CNS Conference, I asked the participants how many of them thought we needed a national association. The response was nearly unanimous. I asked Jan Bingle, JoEllen Rust, Julie Painter, and Rhonda Scott to join me in putting together the framework and bylaws for what would become the National Association of Clinical Nurse Specialists. We worked diligently over several months, meeting many times in my IU office. At the next CNS conference, we shared our work with an enthusiastic audience and asked for a larger planning committee representing other areas of the country. Several people joined that effort and paid their own way to come to Indiana University School of Nursing to put the finishing touches on the mission and bylaws (the names of all of these incredible individuals are in NACNS archives). In particular, I want to mention Sue Davidson, Kathleen Volloman, and Rhonda Scott who were also instrumental during this summer planning meeting and in subsequent meetings. We presented the bylaws during the 1994 CNS Conference in Indianapolis and on that day, we had 69 Charter Members from around the country sign up!!!! However, we had no management group. In 1995, our small group, including Jan Bingle, Sue Davidson, Pauline Beecroft, Nancy Dayhoff, were meeting at my house, working on identifying core CNS competencies and we all agreed that we should ask a higher power for help and we each silently did just that. Miraculously, the next week, I received a call from Cathy Brown, the Executive Director of Innovations, an arm of the American Association of Critical Care Nurses. She said, "We hear that you're starting a national association for clinical nurse specialist, we think this is critical and we want to help!!" I was, needless to say, touched and energized by their generous offer to provide management services free of charge for 1 year. All we had to do was pay direct expenses. So, in 1995, a group of individuals dedicated to this new organization met in Jan Bingle's basement (Cathy Brown, Jan Bingle, Pauline Beecroft [founding editor of the CNS Journal], Sue Davidson, Kathleen Vollman, Pat Bielecki, JoEllen Rust, and myself) and NACNS was officially born and incorporated first in the state of California. AACN changed its strategic plan with respect to Innovations and after the first year and a half and we needed to find a new management company but we were well on our way. So, that was the beginning of NACNS and thank God for AACN!!!! The rest is recorded history of NACNS and thanks to outstanding leaders such as Jan Bingle, Rhonda Scott, Pat Bielecki, JoEllen Rust, Sue Davidson, Angela Clark, Pauline Beecroft, Kathleen Vollman, and many other board members and committee chairs who have the "Power of Ten" we're celebrating the organization's 10th birthday this year!!


And how does the organization as it exists today support the initial vision of NACNS?

NACNS is doing a great job!! We are still, relatively speaking, a young organization. We have grown substantially and I'm confident that we will continue to grow. Our challenge is that there are still thousands of CNSs out there that don't know we exist-I think this situation is improving but in most states, there is no database on CNSs, and therefore, it's difficult to find them.


The vision of the organization is embraced in the mission, which is roughly to enhance and make visible the unique contributions of CNSs to society as well as to ensure the public's (employers and patients) access to the full range of CNS services. This is happening at national policy tables and our collaborative work with other national associations. I'm very excited about the "kick off" of the new national CNS Foundation, which will support CNS-related research and CNS education at our national conference in Orlando, Fla, in March of this year. Many thanks go to Jan Bingle for providing the leadership to this effort on top of being the chief nurse officer for a 4-hospital system!!


What are the most important national forums affecting CNSs today and why?

Currently, our most important national forums are in the regulatory arena and education arena. Specifically, we still face many challenges in the regulatory arena because of a view on the part of many that a necessary component of advanced nursing practice is the diagnosis and treatment of disease with prescriptive drugs. In other words, there isn't such a thing as nursing's unique and autonomous scope of practice at an advanced level. This limited perspective has been causing considerable harm to many CNSs in several states because of the regulatory requirements to be recognized and to practice as a CNS. In addition to the unnecessary economic harm to some CNSs in several states, critically important CNS services are being denied to a public in need. So, we have to get this fixed!!


In addition to the regulatory forum is education. Specifically, it is essential that master's programs preparing CNSs ensure that graduates have adequately attained the CNS core competencies along with specialty knowledge at an advanced level. To that end, we need more uniformity in the approach to CNS education, not a prescriptive curriculum by any means, but common outcomes. It is essential that NACNS continues to work with NLNAC and CCNE to help make this a reality. NLNAC has already endorsed the NACNS Statement on CNS Practice and Education. CCNE has yet to do so. I also believe that NACNS's education-focused preconferences will go a long way to help in realization of this goal.


What can today's practicing CNS do to influence decisions occurring in these particular forums?

With respect to the regulatory arena, individual CNSs and NACNS affiliates must get to know members of their respective state boards of nursing members, and when there are existing or proposed statutes or regulations that create unnecessary barriers to CNS practice, they must work to get these fixed. Oftentimes, it is helpful to work in collaboration with their respective state nurses association to get accomplished a change in statute or regulation. Our partnership with the American Nurses Association has been wonderful!!


Additionally, I believe that when CNSs are precepting CNS students, it is important to have input into the CNS curriculum. More often than not, graduate programs preparing CNSs request and should get systematic feedback from CNS preceptors and chief nursing officers in their communities. I think it is important to acknowledge here that the American Association of Nurse Executives has enthusiastically endorsed the NACNS Statement on CNS Practice and Education.


What do you see as the major contributions a CNS makes to today's and tomorrow's future healthcare delivery systems?

Every day, CNSs are saving lives or preventing troublesome complications through their work with patients who have complex problems and/or their work with staff nurses in bridging the gap between what is known (evidence) and what is done at the bedside. I can give you numerous examples where a CNS working with staff saved the life of a patient through state-of-the-knowledge nursing care!! This is where the CNS Foundation will really help us accomplish our dream by funding research and quality improvement studies to demonstrate systematically the impact of CNS work.


CNSs also make an incredible contribution to healthcare facilities' bottom line through revenue generation, cost savings, and cost avoidance. In fact, we're hearing more frequently that CNSs are beginning to receive bonus pay based on their economic contributions.


What other "words of wisdom" would you like to share with the readers?

Wow!! I think I've said enough, maybe too much. I've never been accused of being at a loss for words!!!! (laughter) I just thank God for NACNS because I know that NACNS as an organization, and each of its committed members, is making a difference in the lives of people and making important contributions to the public good.