1. Erickson, Jeanette Ives MS, RN

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Dear Colleague,


It was an honor to have been asked to present to you at the 2005 NACNS Conference. And, it was with regret and disappointment that because of inclement weather and grounded planes in Boston's Logan Airport, I was unable to travel to your conference to present the keynote message.


Prior to the conference, I had given significant thought to what I wanted to share with you. In short, I wanted to leave you with the important message that exerting your influence as a clinical nurse specialist (CNS) is key to preserving and strengthening your role.


To provide you with examples to guide you in exerting your influence, I had planned on sharing work that I have been doing to create an environment that supports and promotes professional nursing practice, including clear role definition for the CNS role, translating key quality and safety report findings into practice, and identifying common patient problems to drive clinical and educational priorities, to name a few.


A number of lessons have been learned over the years that illustrate the components of a "culture shift" that needs to occur if one truly wants to create a practice environment that attracts and retains nurses.


It is my belief that the CNSs add a dimension of nursing expertise that would otherwise not have been available to patients and their families. Clinical nurse specialists, because of their advanced knowledge and skills, are valuable resources to the clinical staff as well as enrich the practice environment.


Paying keen attention to creating a culture of excellence takes vigilance and commitment. Marlene Kramer notes that "culture drives both the quality of nurses work lives and the quality of patient care. It's the normative glue that preserves and strengthens the group and provides the healing warmth essential to quality patient care."


As CNSs, it is your role to shape these shared beliefs and understandings. I believe that if every one of you approached your day as if you were a magnetic force, patient care would be safer. In addition, nurses would work in the environment they deserve- an environment where practice can flourish for the benefits of the nurses and their patients.


Your responsibility to implement this culture change can be summed up with the quote by Edwin H. Freedman, "Leadership can be thought of as a capacity to define oneself in a way that clarifies and expands a vision of the future." I believe that you, as a CNS, are up to the task-leading important change that benefits patients and those nurses who do their best to provide care every day.


Another key topic I was going to touch upon when I spoke to you was the "Clinical Nurse Leader" (CNL) role proposed by the American Association of Colleges of Nursing (AACN). I was recently asked to write a guest editorial about the CNL role, which provided me with the opportunity to voice my concerns. It was published in the March issue of the Journal of Nursing Education and can be accessed at


In this guest editorial, I echoed your association's concern that the proposed CNL competencies are duplicative of CNS competencies. For example, the AACN proposed that population-level care outcomes are the measure of quality practice for the CNL. But, isn't that every nurse's role?


While I do not think the CNL role is what we need, I do agree with AACN in the call for a more highly educated nursing workforce. It is the right thing to do for patient safety, ensuring quality care, and for enhancing the image of the profession. Strengthening professional nursing education for new graduates and seasoned nursing veterans is the work of a CNS. I believe as leaders we would be better served to identify new models to prepare more BSN- and MSN-educated clinical nurses and masters- and doctoral-prepared CNSs to address the complex clinical issues of our patients.


Lastly, I want to personally thank you for your participation in the extension of Massachusetts General Hospital CNSs' study of common patient problems to include perspectives of CNSs across the nation. The findings of this survey will be presented at your national conference next year.


I wish you continued success in your practice.


Jeanette Ives Erickson, MS, RN


Senior Vice President, Chief Nurse, Massachusetts General Hospital, Boston