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

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"Good ideas are not adopted automatically. They must be driven into practice with courageous patience." Admiral Hyman Rickover


I frequently use this quote in presentations to illustrate the need for focused, deliberate, intentioned, goal-directed actions. Working toward a common goal with shared vision and values is what the NACNS Board of Directors and leaders do for the membership. As we think about nursing in the national healthcare delivery scene-with the nursing shortage, aging nursing workforce, and faculty shortage-it is clear that the workforce challenges for nursing are enormous, and the needs of the delivery system are great. As workforce issues continue unfolding, the environment for advanced practice nurses continues to evolve as well. Regulation and recognition are the common topics at many national dialogues and among many other advanced practice nursing organizations. NACNS is working tirelessly to assure that regulation and recognition of the CNS are well matched with CNS practice competencies and that education prepares CNSs to competently practice. CNSs in every state deserve recognition to practice and to provide the services that are so needed by the public. NACNS continues to advocate for changes into the regulatory system with courageous patience.


Last spring, the National Council of State Boards of Nursing launched a vision paper regarding advanced practice. It was clear from this initial draft that there are inconsistencies in the language used to describe the CNS role and CNS practice. Likewise, inconsistent use of language across all advanced practice groups creates challenges in discussions. As NACNS continues to dialogue with NCSBN, particularly around their initial notion that prescriptive authority is the defining characteristic of the advanced practice nurse, we are arriving at a much better understanding of our CNS role in the landscape of advanced practice, and we continue to work in earnest to craft appropriate guidelines for the regulation of the CNS. Much progress has been made. Most recently, Massachusetts and Florida have written language into their practice acts to recognize and regulate the CNS as an advanced practice nurse; however, much work remains. Yet, there remain gaps as illustrated by the lack of uniformity in state regulation of CNSs.


NACNS and our leaders have been patient, and we have been courageous in our leadership, never wavering in the face of very daunting challenges. We have been present, and have led, as we represent you with courage, integrity, wisdom, and patience. We have kept our door open to work with and dialog with all the stakeholders in this work. As has been pointed out, we are making great strides in this work, closing this gap of understanding and the resulting regulatory language and recognition for CNSs. Much has been done, but much more is needed to accomplish our goal.


The work of the CNS is being the glue in the white space in the delivery system- the knowledge gaps, the process gaps, the intradepartmental gaps, the gaps in what we do compared with what we know we should do. All this work, the bridging of these gaps, is the work of the CNS-creating a safer environment for patients and the nurses caring for those patients; creating protocols to operationalize evidence-based practice, and so forth; never being satisfied with the status quo and constantly looking at ways to improve the care we deliver and how we deliver it; and creating an environment where all caregivers can practice excellence. The CNS bridges these gaps so that patients and nurses do not fall through, with the result of possibly experiencing personal or professional harm.


The landscape for CNS practice is ever changing. We continue to work with the larger nursing community in the area of CNS legislation, regulation, and certification to find the right fit for CNSs in the advanced practice nursing universe. When I am asked about the role of the CNS, I always say that our work can be boiled down to safety and quality, regardless of the setting. Now, of course, we are not the only group of professionals interested in these efforts. The public has been infused with the knowledge that we have a healthcare delivery system that is broken. In many instances, we are the glue that pulls the broken pieces of the healthcare system together, creating a safer system. The stakes are high, the outcome remains uncertain, but we are getting closer each and every day to the reality of all states recognizing the CNS as an advanced practice nurse. We recognize the need for our work and will continue to focus on this goal until it is attained.


Making certain that our role is recognized and available to patients and to the systems that we work within is critical. With the rapid emergence of new technologies, in an environment that is turbulent, this remains a major focus of our work as your leaders. As we work to close these gaps and drive changes, we will continue to do so with the same steady, patient hand that has guided us to this point.


NACNS Updates

Plan Now to Attend the 2008 NACNS Conference

It is not too early to plan to attend the 2008 NACNS conference. Next year's conference will be held from March 5 to 8 in Atlanta, Georgia. The conference always provides an excellent opportunity for CNSs from all specialties to meet and learn from one another. Keynote speakers for the 2008 conference will feature Anna Gawlinski, DNSc, RN, FAAN, Director, Evidence-Based Practice, UCLA Healthcare and Rhonda Scott, PhD, RN, Chief Nursing Officer/Vice President, Patient Care Services, Grady Health System. Thirty concurrent sessions and continuing education poster sessions will provide a variety of learning experiences. In addition to the regular conference, there will be 2 preconference sessions on March 5 that will include the annual Educators' Summit for CNS program faculty and other educators, and the annual legislative/regulatory, health policy session. On March 8, during a postconference session, Dr Gawlinksi will present, "How to Implement an Evidence-based Fellowship Program for Staff Nurses."


It's Time to Nominate Your Colleagues for NACNS Awards

It is time to nominate your colleagues for one of several NACNS awards. Available awards include CNS of the Year, CNS Educator of the Year, CNS Preceptor of the Year, and CNS Researcher of the Year. All nominations are due on October 15, 2007. Further information and nomination materials are available at


News From Our Affiliates

The California CNS Network

We completed our prescriptive survey and plan to look at the results at our next board meeting. We will have our next Quarterly Education Meeting at Santa Barbara Cottage Hospital on July 27. The topic will be "Transitioning to the CNS Role: From Novice to Expert."


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


Montana Affiliate News

Four members of the Montana Association of Clinical Nurse Specialists (MACNS) presented papers at the Western Institute of Nursing Communicating Nursing Research Conference held April 12-14, 2007 in Portland, Oregon. Charlene Winters (MACNS Chairperson) presented her research on the impact of rural living on women's ability to self-manage chronic illness; Jean Shreffler-Grant's paper detailed her research on the availability and use of complementary therapies by rural and urban hospice providers; Sandy Kuntz presented on the process of conducting research in Tribal communities; and Linda Torma's paper focused on conceptualizing the influence of resilience on pain and physical function.

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Student member Rebecca Echeverri was named the 2007 Outstanding Graduate Student in the College of Nursing at Montana State University. Rebecca is a recent graduate of the Adult Health CNS Program, which prepares nurses for practice with adults facing complex acute and chronic health problems. Congratulations Rebecca!


Susan Luparell presented 2 national Web casts for the National League for Nursing in relation to her work on incivility in nursing education. She will be providing faculty development on this topic at several universities and keynote addresses at state association meetings throughout the summer and fall.


Members of the MACNS held a special meeting with representatives from the Montana Nurses Association (MNA) Council on Advanced Practice. The purpose of the meeting was to explore ways to increase collaboration and understanding among MACNS and COUNCIL members. We look forward to continuing our efforts to work with the Council on Advanced Practice and other professional groups in the state to address education, practice, and regulatory issues facing APRNs in Montana.


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


Oklahoma Affiliate News

The Oklahoma Association of Clinical Nurse Specialists and the University of Oklahoma College of Nursing will host the Second Annual Clinical Nurse Specialist Recognition Day on September 28, 2007. The conference will take place at the Integris Baptist Medical Center Conference Center in Oklahoma City, Oklahoma. The title of the recognition day is, "Clinical Nurse Specialists: Coming Together & Moving Forward." The recognition day will feature presentations by CNSs on a variety of topics.


Oregon Council of Clinical Nurse Specialists Affiliate News

The Oregon Council of Clinical Nurse Specialists (OCCNS) is honored that the 2007 CNS of the Year recipient is from our organization. Sherri Atherton, MS, RN, CNS, CIC, was nominated by her peers and colleagues in Portland for her outstanding commitment to the profession of nursing. She has an extensive list of accomplishments that address the 3 spheres of the CNS role and is modest about her achievements.


Sherri has been a CNS since 1994. She is an Infection Control CNS at the Portland VA Medical Center and has been certified in her role since 1998. She is an active member of the national and local chapter of the Association of Professionals in Infection Control (APIC). She is a member of the Oregon Nurses Association (ONA), a member of the National Association of Clinical Nurse Specialist (NACNS), and has served for the past 2 years as the Chair of the OCCNS.


Sherri has achieved far more than the listed criteria for CNS of the Year. She was a driving force for her organization's achievement of Magnet status in 2006; an exemplar in advanced practice nursing through the creation of Evidence Based Fact Sheets-presented at NACNS National Conference in 2007; a role model for new CNSs; and has been described by her peers as a "nurses' nurse." Her level of respect echoes throughout the state.


The OCCNS Executive Committee would like to thank Sherri for her contribution as Chair of OCCNS over the past 2 years. She has bridged communications across the state through teleconference and conference calling. The OCCNS looks forward to her continued achievements as she assumes the role of Immediate Past-Chair.


Submitted by Jane Sawall, MS, MPH, RN, CNS-BC; Chair, OCCNS


News From the Clinical Nurse Specialist Foundation

Correction to an Item from the May/June, 2007 Issue of the NACNS Newsletter

On page 135 in Volume 21, Number 3, May/June, 2007 of Clinical Nurse Specialist, the name of a CNS Foundation Award recipient was mispelled. The correct spelling of the award winner's name is Randi Lee Norby. We apologize for this error.


CNS Foundation Update

The CNS Foundation would like to recognize the 2007 Foundation scholarship winners announced at the CNS Foundation Fiesta and Fun Reception at the March 2007 National Association of Clinical Nurse Specialists Annual Conference in Phoenix, Arizona:


Clinical Nurse Specialist Foundation Award ($1,000): Randi Lee Norby


Ms Norby is the second recipient of the Foundation's award. She lives in Montevideo, Minnesota. In 2003, as Lead Nurse working for State Operated Services for Children and Adolescents with mental illness, she implemented a system-wide change to reduce restraint and seclusion in her facility. This successful theory-based project has included educational interventions and training of staff and follow-up. She is currently enrolled in the University of Minnesota School of Nursing CNS track in Psychiatric Mental Health Nursing; her goal is to become a primary care provider with the Child and Adolescent Behavioral Health Services. Her position brings her in contact with individuals and families from many different cultures, some of who have fled wars and violent conflicts in their country of origin. Her practice has included viewing situations with "[horizontal ellipsis]new eyes to see the solution[horizontal ellipsis]" and working with cultural interpreters.


Silver Oak Clinical Nurse Specialist Award ($1,000): Kathie A. Kobler


Ms Kobler is the first recipient of the Silver Oak Search Consultants CNS scholarship award. She lives in Buffalo Grove, Illinois. She is enrolled in the University of Illinois at Chicago, Pediatric Clinical Nurse Specialist/Advanced Practice Palliative Care Nursing Program. Her practice focus is providing bereavement care to dying babies, children, and their parents in the Labor and Delivery, NICU, PICU, Pediatric and Adolescent care units at Advocate Lutheran General Hospital. Within this context she designs, through a program known as KAYLA's Hope, individualized support from the time the diagnosis is known, during end of life, and throughout the first year of bereavement. This followup bereavement support program has over 1,100 families enrolled. Her work at the system level has included service on a committee which wrote for and received a $100,000 grant to develop and implement pediatric and adult palliative care programs in her facility. She serves as the coordinator for the programs. At the national level, she is vice president of the National Perinatal Death and Infant Alliance (PLIDA) and recently served as the chair of the 2006 National Perinatal Bereavement conference with over 350 attendees.


Donald Dayhoff Clinical Nurse Specialist Award ($1,000): Eleanor S. Johnson


Ms Johnson is the first recipient of the Donald Dayhoff CNS Scholarship Award. She lives in Muncie, Indiana. She is enrolled in the Master of Nursing Science Community Health Program of Indiana University School of Nursing, Indianapolis, Indiana. The focus of Ms Johnson's nursing practice for over 25 years has been the provision of prenatal care assistance and professional education. She has coordinated several programs in support of young families, has assisted in writing the breastfeeding policy and procedures for the state's WIC program, has participated in the development of the Indiana State Plan for Breastfeeding, and has participated in community health initiatives. These initiatives include Healthy Mothers, Healthy Babies and the Health Committee of Teamwork for Quality Living and Circles of Support to enable individuals and family to get out of poverty. She obtained funding and has completed 2 projects in her focus area. Her poster related to this work received the outstanding graduate student poster award, Public Health Nursing Division, American Public Health Association.


Congratulations to this year's exemplary winners! We look forward to watching your careers as clinical nurse specialists and await your continuing contributions to the health and well-being of individuals, families, groups, and communities, as well as to promote and advance the practice of nursing.


Member Recognition

Chiquita (Chic) Denney, MS, RN, CRRN, has been selected to serve on an American Nurse Credentialing Center (ANCC) panel to set the passing score for the new CNS Gerontology examination. The standard setting study (also known as a passing score setting) involves the collective judgment of a panel of 8 to 10 CNSs who are certified in Gerontological Nursing. Panel members review each question on the certification examination and make judgments about the percentages of entry-level CNSs in Gerontological Nursing who are likely to answer the question correctly. Ms Denney is the Medical-Surgical CNS at Deaconess Hospital in Oklahoma City. Her focus in graduate school was gerontology and she is certified by ANCC in gerontology.


Theresa Murray, MSN, RN, CCRN, CCNS, along with Caryl Goodyear-Buch, PhD, RN, recently published an article titled, "Ventilator-Associated Pneumonia Improvement Program" in AACN Advanced Critical Care. In the article, the authors detailed the program and processes they undertook in their facilities to reduce the incidence of ventilator-associated pneumonia.


Following a national search, NACNS member Demetrius Porche, DNS, APRN, FNP, CS, was selected as permanent dean of the School of Nursing at Louisiana State University Health Sciences Center in New Orleans. He has served as the acting dean since last December. Under his tenure, the School has enjoyed Dr Porche's steady guidance through the challenges of transition, response, and recovery. Dr Porche's previous appointments include associate dean for Nursing Research, Evaluation and Graduate Studies; director of the Office of Nursing Research and Evaluation; and director of the Doctor of Nursing Science Program. At the national level, Dr Porche is the current president of the American Assembly for Men in Nursing. He also serves as the associate editor of the Journal of the Association of Nurses in AIDS and chief editor of the American Journal of Men's Health.


Linda D. Urden, DNSc, RN, CNA-BC, FAAN, recently received the Author Hughes Career Achievement Award from the University of San Diego. She is the executive director of Nursing Quality, Education, and Research at Palomar Pomerado Health in North County San Diego; and clinical professor and coordinator of the Executive Nurse Graduate Program at the University of San Diego.


News Briefs

ABC Coding Solutions Launches to Support Claims and Document Outcomes

After 11 years of coding and legal research, ABC Coding Solutions launched, a revolutionary and affordable Web-hosted claim filing tool that saves all providers and insurers time, administrative costs, and paperwork.


ABC Coding Solutions now offers more than 20 underserved healthcare practitioners, including nurses, an online tool to gain visibility within the insurance industry by creating a means for them to bill insurers. is revolutionary because, in addition to supporting claims from conventional physicians, it also supports claims from over 3 million healthcare practitioners who, unlike physicians, are governed by different scope of practice laws in each state. Differences in scope of practice laws and lack of standard descriptions of care previously made claims from advanced practice nurses, behavioral health, alternative medicine, and many other practitioners difficult to process. ABC Coding Solutions solved this complicated problem by tracking laws in each state for these underserved professions, developing care transaction codes, and integrating this information in The NACNS has worked with ABC Coding Solutions in the code development process.


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.