1. Goudreau, Kelly A. DSN, RN, CNS

Article Content

CNSs are Back!!

Approximately a year ago, the National Council of State Boards of Nursing Advanced Practice Registered Nurse Advisory Panel (NCSBN APRN Advisory Panel) wrote a paper that detailed their vision for the future. At that time, the future did not include Clinical Nurse Specialists (CNS). That has now changed, and CNSs are back!


Many of you responded in a very visceral way to the NCSBN Draft Vision Paper on Future Regulation of Advanced Practice Nursing. Thank you for your energy and passion. What you did is assist us as your national representatives to clearly describe that CNS practice DOES exist and will continue to exist far into the future. The discussions this year have been many and have sometimes been difficult, but it is a great pleasure to report to you that the NCSBN APRN Advisory Panel clearly heard all of us and have moved to support us in our efforts.


At a meeting with the NCSBN APRN Advisory Panel on December 1, 2006, in Chicago, your Executive Director, Christine Filipovich, and I were able to clearly state and hear in return from them that the CNS is indeed an advanced practice role and will be clearly articulated as such in the next iteration of the vision that is produced. Congratulations to all of you for that significant accomplishment this year! As an organization, we thank the NCSBN APRN Advisory Panel very sincerely for their efforts as well.


As I stated in my very first president's column in this journal, I anticipated that although the discussions would be difficult, seemed very inappropriate, and felt very hurtful at the time, we would be able to move beyond that stage and that something good may come of the discussions. We have indeed been able to move beyond that pain and frustration and into a very professional dialogue that needed to occur in order to move our practice forward. We now need to do just that[horizontal ellipsis]move our practice forward as time moves forward.


At the conference this year (February 28-March 3, 2007, in Phoenix, Ariz), we will be providing for your review the latest draft of the NACNS position paper on the future of the CNS. We now have a document that has been developed by past and present leaders of NACNS, had significant feedback from a member task force, and is now available to you for public comment and feedback before it becomes a standing document of our organization. This document will enable us to share with other organizations our view of the future for CNS Practice, Education, Certification, and Regulation. It can and will be used as a template for future policies at a national level that will move our practice into the future.


Although these are both significant accomplishments in and of themselves, the greatest accomplishment this year has been to clearly define the role of the CNS in the implementation and maintenance of Patient Safety initiatives. Clinical Nurse Specialists in the practice environment will be sharing at our conference the excellent work that they have done over the last year to improve safety for patients in all care settings. That is the greatest achievement of all and speaks most directly to the value of the CNS in every environment where they exist and are supported by their employers. The good work that will be showcased at our conference has saved countless lives and immeasurable costs to the healthcare system[horizontal ellipsis]that is the true value of a CNS.


Why am I being so retrospective and perhaps a bit maudlin? This is my last column as your president. At our conference, I will turn over the presidency to Theresa Murray[horizontal ellipsis]CNS extraordinaire! In a previous column, I looked back at the halfway point and reviewed accomplishments to date. This is my last look back but also a look to the future. I leave the presidency knowing that our organization is stronger than it has ever been before, has the largest number of members in the history of the organization (more than 2,000 now), and a stronger voice than ever before at the national table. The documents we have worked on together will form a framework for the future, and I know that Theresa Murray will carry that vision forward on your behalf. She was the CNS of the year this past year, recognized not only by the board but by a committee of her peers as an exemplary individual who presents the best of what a CNS can be. It is with heartfelt appreciation, undying support, and great respect that I turn the presidency over to her in the coming year.


It has been my pleasure to serve your needs as the president of the national organization that represents CNSs in all specialties and all walks of life. I have learned far more than I have been able to share and have an undying respect for all that each of you does in the care of your patients, patient population, aggregate, or community. My very best wishes to each of you as I take on the new role of being your "Immediate Past President!"


Incoming President's Message

Theresa M. Murray, RN, MSN, CCRN, CCNS


How can I speak to the honor and responsibility of being your leader? For those of you who do not know me, I am a practicing, in the trenches CNS. I know the work, I do it daily in an acute care center, and my specialty is critical care. I also have had the honor of being named the CNS of the year for 2006, as many of you may know.


As I sit here preparing a few remarks for the March/April issue of the journal, I am contemplating this wonderful upcoming journey as your President. This issue will coincide with the NACNS conference and the transition of board officers for 2007. I am thinking what a whirlwind of a year NACNS has just had on top of several others and thinking about taking over as your President. I am humbled, excited, scared, hopeful, yet resolute. I have the luxury of a tremendously strong board and staff. And of course, the previous leaders in NACNS will not be far. I often say about a project or task "It does take a village," shamelessly stealing from a well-known New York senator. I am grateful, as you should be, as I have a village in the board and previous leadership of this organization. I am particularly grateful to Kelly Goudreau, our president this past year, for the excellent leadership that she has provided and will continue to provide as immediate past president. The village we have in this organization is composed of many resources: faculty, deans, faculty/service joint appointments, and of course the wealth of knowledge from a strong and diverse membership.


The theme of this year's NACNS conference is safety and quality. When asked to articulate the role of the CNS, I always say that it all boils down to safety and quality. Yes, we work within 3 spheres of influence and within 5 traditional subroles, but our work is inherently about safety and quality at the patient level, the nurse/department level, and of course the organizational or system level.


In looking at the work that this organization provides for its members, and indeed for all CNSs, I believe the focus is on preserving the integrity of the CNS role. NACNS works across the country representing the role and articulating the necessity to keep it active, recognized, and available, for the health of our patients and the healthcare delivery system in general. The Institute of Medicine report speaks to the broken healthcare delivery system and the need to thoughtfully repair it. This is where I see the work of the CNS as the absolute perfect fit. In addition, the educational and regulatory system in which we are taught and recognized as advanced practice nurses is also in need of some work to bridge gaps in knowledge, as well as acknowledgment of CNSs. We are working with multiple groups, including the National Council of State Boards of Nursing and the American Association of Colleges of Nursing, to assure that the critical work that you do, that we all do, is available to the public. This is a daunting challenge, and although we are not there yet, we continue to bridge relationships and articulate who we are and who we are not in terms of the contribution to system level safety and quality. I can assure you that this organization is working hard at the ultimate system level for our role and our continued recognition as advanced practice nurses.


What can you do? Make sure that you know who your state board of nursing members are. Do you have a clinical nurse specialist on the board representing the CNS? If not, learn how to place a CNS on your state board and make yourself available to provide information and advice to the board about matters pertaining to CNSs. There are many other activities that we can all be involved in to positively represent the work, the role, and each other. I will be bringing some of these forward as 2007 goes on.


News From Our Affiliates


The California CNS Network has been very active this year. Our November 4 all day conference, "CNS Outcomes, Ensuring Safety and Quality," was a huge success, thanks to all our hard-working board members and CNS attendees. The Rancho Las Palmas Resort and Spa was very luxurious and accommodating. Our speakers were fantastic and our vendors very generous.


Our membership's geographical spread presents us with many challenges. We hope to unify and support our members by adopting the revised bylaws to include representation from Northern, Central, and Southern California "regions." Cheryl Westlake Canary drafted the revisions to our bylaws, and Member Director Paddy Garvin sent them electronically to our membership. We hope to have revisions complete by our January Educational program.


Practice issues and challenges continue to challenge us as a group. On December 20, 2006, we responded to the Standard Occupational Classification Committee in response to their exclusion of CNSs as Advanced Practice Nurses for the proposed 2010 revisions. CA CNS Network sent a strong collective response as we represent 278 CNSs in the State of California who need to be identified as Advanced Practice Nurses. Many e-mailed us that they were sending their individual responses as well. I believe we have power in this type of action. This is one of the reasons our organization and collective voice are so important.


In addition, we may revisit the issue of optional prescriptive authority for CNSs in California. It is important to support all our CNS colleagues in their efforts to provide comprehensive seamless care to their populations. The lack of prescriptive privileges is a barrier to practice for many CNSs in private and group practice. Many CNSs are taking a closer look at their practice to identify areas where they could provide more comprehensive, less fractured care if we had prescriptive (including durable medical equipment) authority. If we look to make any changes, we will need all the wisdom, unity, and strength that our professional organization is capable of providing.


We are looking forward to the NACNS conference in Phoenix, February 28 this year. Hope to see you there.


Submitted by Margaret Talley, RN, MN, CNS CWCN; Chair California CNS Network


Central Indiana

The Central Indiana Organization of Clinical Nurse Specialist continues to meet on a quarterly basis. At the quarterly meetings, we have a brief educational offering and share information regarding NACNS events and regulatory information as well as have discussions on issues directly affecting the CNS role. The most valuable part of the meetings is the opportunity to network and interact with our CNS colleagues from all across Central Indiana.


Many notable awards and events for 2006 included the following:


* Theresa Murray received the CNS of the Year award in 2006 at the National meeting. Theresa is the critical care clinical nurse specialist for Community Health Network.


* Juanita Keck has recently retired after a long and meaningful career as a professor and department chair at IU School of Nursing. Juanita has been an instrumental mentor, colleague, and friend to most of the CNSs in our area. We wish her well.


* Mary Jane Fleener has won the American Association of Colleges of Nursing (Critical Care) Excellent CNS Award for 2007. The award will be presented to her at this year's National Teaching Institute in Atlanta. She is currently the Director of Clinical Education and Practice at Bloomington Hospital, and her specialty is Critical Care/Cardiovascular.


* Jan Powers will be inducted into the American College of Critical Care Medicine as a Fellow in Critical Care Medicine at the Annual Congress for the Society of Critical Care Medicine. Jan is currently the Director of Clinical Nurse Specialists and the Critical Care CNS at St Vincent Hospital in Indianapolis.



Submitted by Jan Powers, RN, MSN, CCRN, CCNS, CNRN, Central Indiana Affiliate



Membership in the Montana Association of Clinical Nurse Specialists has grown by 5 members in 2006. Joining us are 3 nursing faculty, 1 practicing CNS, and 1 CNS student. We welcome them to our group and hope to continue to grow our membership in 2007. This fall, members were very active in research and scholarship. Linda Torma received a grant from Zeta Upsilon Chapter of Sigma Theta Tau International to study "The influence of resilience on pain and self-reported physical function in older adults." Charlene Winters and Sandy Kuntz et al received funding from the Office of Rural Health Policy at the Health Resources and Services Administration to explore the health status and healthcare needs of persons exposed to asbestos. Susan Luparell, Jean Shreffler Grant, and Charlene Winters et al received funding to survey rural nurses in 3 states regarding their access and use of research in their practice. Three members had articles published in refereed journals: Jean Shreffler Grant reported on the use of complementary therapy in older rural women (Nursing Research), Dale Mayer wrote about symptom interpretation in women with diabetes and myocardial infarction (The Diabetes Educator), and Charlene Winters reported on rural women's management of chronic health conditions (Chronic Illness). At our next meeting, members will plan the annual educational conference.


Submitted by Charlene A. Winters, DNSc, APRN, BC, CNS

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News From the Clinical Nurse Specialist Foundation

The Foundation will be meeting on a quarterly basis to continue its work in many areas, including fund-raising, scholarship, and Board development. We are sorry to announce that Linda Urden has resigned from the Board and are welcoming Jo Ellen Rust, MSN, RN, as a new member.


The third annual CNS Foundation Gala is planned for Friday, March 2nd, at the annual conference in Phoeniz, Ariz. This year's theme is Foundation Fiesta Fun. The crowd will dress in colorful attire! The program will include an update on the Foundation's progress, announcement of awardees of Foundation scholarships (yes, as hoped we will be offering more than one scholarship this year!), and special honors to those CNSs who have advanced the Foundation's progress toward the $1,000 at 1,000 campaign. Scholarship awardees will be recognized in the next CNS Foundation update.


We encourage you to visit the NACNS Web site,, for more information on the Foundation. Please go to the Foundation section of the Web site where you can view our case statement. There is also the opportunity to make donations to the Foundation through the Web site. We are in the process of new Web site developments for the CNS Foundation. Stay tuned to these changes within the NACNS Web site!


The Foundation management is with Professional Nursing Resources, Inc, the same company that manages NACNS. Please let us know if you, or someone you know, are interested in the Board or one of its committees. The Foundation address is


Clinical Nurse Specialist Foundation


2090 Linglestown Road, Suite 107


Harrisburg, PA 17110






We look forward to serving you throughout this year and in the future. Please help us to support Clinical Nurse Specialists through your participation and financial support.


News From Our Committees

The Education Committee

The paper, entitled "Comparison of National Association of Clinical Nurse Specialist Statement Competencies with DNP Essentials: What is the Fit?" was selected as a featured presentation at a general session of the "First National Conference on The Doctor of Nursing Practice: Meanings and Models" in Annapolis, Maryland March 28-30, 2007. The paper was authored by Ann F. Jacobson, PhD, RN, Camille Stern, PhD, RN, Phyllis M. Gaspar, PhD, RN and other members of the NACNS Education Committee including: Judith A. Spross, PhD, RN, AOCN, FAAN; Mary Heye, PhD, RN, APRN, BC; Nancey E.M. France, PhD, RN; Sally Crim Tibbals, MS RN APRN-BC; Peggy S. Gerard, RN, DNSc; and Laila Sedhom, PhD, RN. This presentation reflects the Education Committee's work on developing clinical practice competencies for doctorally prepared CNSs.


Member Recognition

NACNS members Maj Lisa M. Cole, RN, MSN, CNOR, USAF, NC, and Maj Theodore J. Walker, RN, MSN, CNOR, USAF, NC, were 2 of 5 coauthors who published an article entitled "Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review." The article was published in AORN in December 2006. In the article, the authors reported the results of a systematic review of the literature addressing the delineation of the CNS role. The authors identified several factors that contribute to CNS role confusion and recommended future research addressing the CNS role. Both authors are perioperative CNSs. Maj Cole is with the 96th Medical Group, Eglin Air Force Base in Florida. Maj Walker is at Mike O'Callaghan Federal Hospital, Nellis Air Force Base, Nev.


Susan Phillips, RN, BC, MSN, published an article entitled "Ethical Decision-making When Caring for the Noncompliant Patient." This article was published in the September/October 2006 issue of the Journal of Infusion Nursing. She also spoke on the topic at the Infusion Nurses Society Annual Meeting in Reno, Nev, held in May 2006. The purposes of the article were to present some strategies for managing noncompliant patient behaviors, to reduce nurses' feelings of frustration and stress while preserving the patient's autonomy, and to change nursing practice to meet the multidimensional needs of patients living with substance abuse. Ms Phillips is a Behavioral Health Clinical Nurse Specialist on the Medical-Surgical Service at Banner Good Samaritan Medical Center in Phoenix, Ariz. She has been in this role for 41/2 years and has 20 years experience in psychiatric mental health nursing. Her role as a CNS involves facilitating patient-centered nursing care for patients with complex psychosocial and/or safety needs and her expertise is in the management of disruptive behaviors in the medical-surgical setting.


Mary Sitterding, MSN, CNS, CNRN, was recently selected by the American Nurses Credentialing Center to be a Magnet appraiser. Ms Sitterding is a Clinical Nurse Specialist at Columbus Regional Hospital in Columbus, Ind. Columbus Regional Hospital was the first hospital in Indiana to achieve Magnet status.


News Briefs

The Agency for Healthcare Research and Quality (AHRQ) has created a new healthcare Web site. Featured on the AHRQ Web site is a new audio newscast series designed to help keep people informed of the Agency's latest healthcare research findings, news, and information. The mission of AHRQ is to improve the quality, safety, and effectiveness of healthcare for all Americans. They are the lead agency in the effort to improve patient safety and reduce medical errors. You may go to to hear the newscasts through your computer or download them to a portable digital player such as an iPod.


Section Description

NACNS Statement on Clinical Nurse Specialist Practice and Education, Second Edition.


This document articulates the core competencies requisite to CNS practice, outlines the outcomes of CNS practice, and provides direction to schools of nursing regarding the preparation of CNSs. Endorsed by the National League For Nursing and American Organization of Nurse Executives (AONE) as "a comprehensive reflection of the contemporary role that Clinical Nurse Specialists play in the delivery of quality nursing care," this updated version contains information for contemporary clinical nurse specialist practice and education. You can purchase your copy through the NACNS Office at a cost of $25 per copy for members of NACNS and $45 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.