1. Section Editor(s): Rust, Jo Ellen MSN, RN, Column Editor

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NAME: Carol Brueggen, MS, APRN-BC, AOCNS


CURRENT POSITION: Oncology Clinical Nurse Specialist, Associate Professor of Nursing


CURRENT AFFILIATION(S): Saint Marys Hospital, Mayo Clinic Rochester




PROFESSIONAL EDUCATION: MS in Adult Health Nursing with an Oncology Focus, Winona State University, Bachelor of Science in Nursing, Viterbo University


CERTIFICATIONS: Advanced Oncology Certified Clinical Nurse Specialist (Oncology Nursing Certification Corporation) and Clinical Specialist in Medical-Surgical Nursing (American Nurses Credentialing Center)

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Carol Brueggen is the 2006 recipient of the Advanced Oncology Certified Nurse of the Year Award, presented by the Oncology Nursing Certification Corporation at the Oncology Nursing Society Congress held in Boston, Mass, in May 2006.


The award is presented yearly to an advanced practice oncology nurse who demonstrates leadership and accomplishments in the promotion of oncology nursing certification and oncology nursing service, as well as at least 2 of the following areas of advanced oncology nursing practice: clinical practice, education, administration/case management, consultation, or research.


Ms Brueggen has been a certified oncology nurse since 1989, taking the Oncology Nurse Certification examination and then the Advanced Oncology Nursing examination. She has been very active in Oncology Nursing Society Chapters in Wisconsin and Minnesota holding numerous Board of Director positions, including 3 separate terms as Chapter President.


Ms Brueggen serves as an assistant professor of nursing, Mayo Clinic College of Medicine. She has presented locally, regionally, nationally, and internationally on such topics as end-of-life care, cancer and ethics, safe handling, cancer basics, clinical trials, symptom management, bereavement, psychosocial care, and clinical nurse specialist (CNS) collaboration. Brueggen has also authored book chapters, articles, poster presentations, and patient education pamphlets. At Mayo Clinic Rochester, Ms Brueggen chairs the Oncology Review Course Planning Committee, which assists nursing staff in preparing to take the oncology certification examinations. She also serves as a preceptor for CNS students.


To help assure high-quality safe care for cancer patients, Ms Brueggen provides support to nursing staff and CNS colleagues working with oncology patients admitted to nononcology units. For patients on these services, she also provides information and decision-making support regarding diagnosis and treatment, supportive care programs, adaptation to illness, and discussions regarding palliative care and hospice.


Ms Brueggen shared that receiving a national award from her peers is a very humbling experience. She acknowledges and thanks her nursing colleagues who submitted her nomination: Sue Stirn, Hematology/Oncology Nurse Administrator; Tammy Klaus, Hematology/Oncology Nurse Manager; and Allison Meisheid, Oncology Nursing Education Specialist. Carol also wishes to thank the members of the South East Minnesota Oncology Nursing Society Chapter for their friendship and support. In recognition of her selection, Ms Brueggen received a crystal award and a monetary gift from the Oncology Nursing Certification Corporation.


What first motivated you to become a CNS?

My nursing career has been highlighted with nevers-those things I thought I would never do, starting with graduation from my BSN program when I said I would never work in oncology and I would never go back to graduate school. Working in oncology came about unexpectedly. Sometimes it takes the wisdom of others to see things in us that we don't see in ourselves. In the mid-1980s, Sr Joyce Bantle and Dr James Novotny from Franciscan Skemp Health Care in La Crosse, Wis, presented me with the opportunity to assist in developing an inpatient oncology program. It was a challenging opportunity. The learning curve seemed immense, but with their mentorship and the support of all of the wonderful nurses I worked with, I believe we succeeded in developing a program that gave quality cancer care to our patients and families and support for the nursing staff caring for them. During this time, I became an Oncology Certified Nurse. Yet, I felt that there was more that I could bring to my role not only for patients, families, and staff but also for the institution. The characteristics and skills of a CNS-clinician, educator, consultant, researcher, collaborator, and clinical leader-seemed to encompass all that I needed to enhance my practice. I became more aware of Oncology CNSs who were members of the Oncology Nursing Society and utilized them as mentors both directly and indirectly. I will always be grateful to them, especially Debbie Boyle, whose mentorship and publications about Oncology CNS practice helped me develop a framework for my own practice.


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

I became a CNS on the unit where I had worked as a staff nurse. Being involved in the development of the oncology program gave me the opportunity to take on more of a leadership role on the unit. At times it was difficult for my colleagues to understand my new role and my involvement with nursing departmental and systems issues. I was 1 of only 3 CNSs at the institution. We had all been hired within a year's time and had the responsibility of educating those we worked with about the full spectrum of CNS practice beyond working directly with patient/families and staff.


What do you perceive are the key issues for CNSs today?

The CNS role is still filled with ambiguity. As we practice within the CNS spheres of influence (patient, nurses and nursing practice, and organization systems), one of our challenges will be to determine ways to preserve our presence at the bedside yet assist with the monumental challenges faced by institutions. At the 2006 National Association of Clinical Nurse Specialists conference, Gladys Campbell described CNS work as routine, responsive, and rewarding. Today's healthcare environment mandates that much of our time is spent being responsive. We need to find ways to be sure that while responding to all of these other demands, we aren't pulled so far away from the bedside that we loose our clinical focus. The core of CNS practice is expertise in patient care. Interactions with patients and families provide the opportunity to intervene at an advanced practice level, identify practice issues, and support nursing staff. I believe these 3 elements are crucial in sustaining the integrity of the role.


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

As a novice CNS, I would certainly have to say that the development of the inpatient oncology program at Fransciscan Skemp was one of my greatest accomplishments. Although I certainly did not do this alone, it taught me the importance of multidisciplinary collaboration and mentorship. I learned a lot about what is important to cancer patients, families, and staff. I also learned the challenges of working within systems and the need for patience and perseverance.


Since coming to Saint Marys Hospital, Mayo Clinic, one of my greatest challenges has been how to stay visible in a 900-bed hospital. In covering the house, I go to where the patient need is; thus, I'm constantly working with new staff and physician groups. This can, at times, be challenging. There is a sense of accomplishment when patients/families and/or staff acknowledge that my contributions have been helpful. Anytime I can reduce the stress being experienced by a patient, family, or staff, I consider the consultation a success.


Another accomplishment has been the development of the Mayo Clinic Clinical Nurse Specialist Collaborative. CNSs from Mayo Clinic Rochester and Arizona and from locations within the Mayo Health System (La Crosse, Wis; Eau Claire, Wis; and Mankato, Minn) meet by video conference quarterly to discuss issues affecting CNS practice and patient care. This has been a wonderful way to support and mentor each other in our work, develop relationships, and when possible, standardize approaches to various issues.


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

Many patients leave their homes, families, and support systems to come to Mayo Clinic Rochester for their care. It gives me satisfaction to know that in listening to their stories, answering their questions, quieting their fears, and showing them dignity and respect, I may have lessened their burden in some small way. I am very blessed to work with dedicated staff nurses and a wonderful group of CNS colleagues who on a daily basis strive to live up to our Mayo value, "The needs of the patient come first."


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

Participate in your professional nursing organizations. Membership in the Oncology Nursing Society and National Association of Clinical Nurse Specialists has given me wonderful opportunities to network and learn from my CNS colleagues across the country. Value the experiences of your CNS mentors. Many of them have experienced the same struggles that you will be challenged with, and they may be able to provide some insight into the do's and don'ts of the role. Share your enthusiasm-it is contagious and we all need a little of that once in a while. Be present and approachable. Keep your tool box filled with the ability to listen. Many days that will be your greatest asset.