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

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NAME: Ann Mayo, DNSc, RN, CNS

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CURRENT POSITION: Post-Doctoral Fellow


CURRENT AFFILIATION(S): University of California, San Francisco




PROFESSIONAL EDUCATION: Doctorate in Nursing Science


CERTIFICATIONS: State of California, Clinical Nurse Specialist


Dr Ann Mayo received the Sue B. Davidson Service Award from the National Association of Clinical Nurse Specialists (NACNS) at the 2007 conference in Phoenix, Arizona. This award is given to a NACNS member who has generously donated time and energy in service to NACNS and clinical nurse specialists (CNSs). Dr Mayo represented NACNS on the collaborative design of the advanced practice nurse (APN) portion of AACN's annual survey, "Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing." Collaborators included representatives from the American Association of Colleges of Nursing (AACN), National Organization of Nurse Practitioner Faculties, and NACNS. Her work helped to clarify the process for capturing CNS specialties. Representing NACNS, she has also met with the Interagency Collaborative on Nursing Statistics. This is an organization that comprised individuals representing organizations from across the country that is responsible for developing, compiling, and analyzing data on nurses and the settings in which they practice. Her work on The National Sample Survey of Registered Nurses included updates to the data collection instrument and educating the team on the educational requirements for CNSs. Before this update work, she provided clarification to the data analyst regarding the interpretation of CNS data from the 2004 survey. Dr Mayo has also served as chair of the NACNS Research Committee.


What current specialties are captured for CNS programs at schools of nursing in the Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing annual AACN survey?

The AACN survey captured a wide variety of specialties. Some examples include Critical Care/Trauma, Behavioral Health, Gerontological Psychiatric, and Health Promotion and Wellness. Capturing the true breadth of specialties in this report is important because the findings demonstrate that schools of nursing across the country are responding in specific ways in order to meet their community needs for advanced practice nurses.


What did you learn about the status of CNS programs from the annual AACN survey of schools of nursing?

First, I was very impressed with the response rates from the schools of nursing for this lengthy survey. The 2006 over all response rate was 84.5%. Second, I learned that operational definitions are as important in survey work as they are in research work. In this survey for example, by definition major specialty categories were linked to being "eligible to sit for a national certification examination." Not all CNS specialties have a national certification examination, and so an agreement was reached that an additional table in the report would be designed to display those specialties for which a national examination did not exist.


Based on your experiences doing this work, what do you see as the biggest professional or career issues facing CNSs today?

As for all APNs, there are issues around minimum (education) entry level into advance practice, regulation including mandatory second licenses, autonomous practice, and reimbursement for services. These are complex, multidimensional, and interrelated issues linked to state laws and regulations as well as historical and political view points. Strong coordinated efforts are needed to address these issues.


What can CNSs do to address these issues?

I suggest that anyone interested in learning more about these issues or wanting to get more involved contact NACNS. As a researcher, I believe one of the first steps is to evaluate the impact of our practice on (a) the patients we care for, (b) the nurses we precept, mentor, or educate, and (c) the healthcare systems we support. This needs to be done in a thoughtful, systematic way so that we can begin to carefully address the challenges we face. For example, what evidence is available to support or refute the idea that CNSs need a second license to practice nursing or that CNSs do or do not need a doctorate to practice nursing?


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

Across my career, I've had the fortunate opportunity to work with many nurses during my career and have been privileged to be in a position to share my experience and knowledge with them. I believe I have contributed to their professional development, as others have done for me. Many of those I have worked with are accomplished CNSs, nurse educators, nursing professors, and researchers.


What do you see as the important research areas for CNSs today and into the future?

Patient safety is an important issue for all of healthcare. By virtue of their positions within healthcare organizations, CNSs have access to safety data and can collect additional data in order to develop cutting-edge interventions to protect our patients from unintended medical errors. Although somewhat global, I believe that an additional area for research is around developing valid and reliable measures to better understand the impact of the CNS within the 3 spheres of influence. A key challenge is to develop these measures so that they are sensitive to CNS-level practice and work. Where differences exist, it is important to differentiate CNS practice from other healthcare providers. Interdisciplinary and collaborative work is not possible until each member of the team can articulate his or her role and impact to desired outcomes. This is the first step in building a truly interdisciplinary team, the future vision of a safer healthcare environment.


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

Develop a 3- to 5-year professional plan for yourself. This plan should include a few broad goals with specific measurable objectives for each goal. Then begin your job interviews. Ideally, you should interview with senior nursing leadership first. While you may be answering many questions during this interview, you should ask one very important question: "How do you envision my contributing to this organization?" The response to such a question can put much of the organization and your future work processes into perspective for you.


Next, as you go to additional interviews and tour the organization, take time to evaluate the work environment, leadership, reporting relationships, staff, and patient population(s) for a match to your goals and objectives. For example, if you believe you need to attend 2 professional conferences per year (ie, critical care and NACNS) in order to accomplish one or more of your objectives, it is important to know how much support you will receive from the organization. You will want to ask other CNSs about time off, travel paid, support for conference registrations fees, and other support for professional development. Ask about obligations you have upon your return-many times details such as these become job dissatifiers and contribute to CNS turnover. CNS turnover is costly to individual CNSs as well as to organizations.


A very important area of concern for new CNSs should be around novice-to-expert advancement for CNSs. Does the organization have mechanisms in place for new-to-CNS role development? Are there mentors for you in the organization? And, does leadership recognize that although new CNSs come with a wealth of nursing experience, the CNS role is new and requires supportive development? Evidence of such recognition may be found in CNS job descriptions and annual performance evaluation matrices. Ask to see these documents.


New CNSs are the future clinical practice leaders of tomorrow. Ensuring a good fit between the organization and the CNS is the responsibility of organizational leadership as well as the new CNS.