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

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What is happening out there in the advanced practice nursing world? I am happy to tell you that the leaders from the National Association of Clinical Nurse Specialists (NACNS) are at the table on your behalf whenever issues of advanced practice nursing are being discussed and decisions made. Being able to see firsthand these leadership activities is one of the true joys and rewards of serving as your president.


As you will recall, the National Council of State Boards of Nursing (NCSBN) released in February 2006 a vision paper outlining recommendations for advanced practice licensure, education, credentialing, and education. This vision paper eliminated clinical nurse specialists (CNS) from consideration as advanced practice nurses because the CNS role is not one that is traditionally associated with prescriptive authority. Thankfully, because of formidable feedback from the larger nursing community and NACNS, NCSBN tabled the vision paper until at least August of 2008. The new vision paper promises to be more inclusive of all 4 advanced practice nursing roles: certified nurse midwifes, certified registered nurse anesthetists, nurse practitioners, and CNSs. During the past year, a Joint Dialogue Group has been meeting to address the confusion and variability seen in advanced practice nursing. This group is composed of representatives of the 4 advanced practice roles, accrediting and certifying bodies, and NCSBN. The group is addressing issues related to advanced practice licensure, education, credentialing, and education. The larger mission is to protect the public by establishing curricular and recognition requirements for all advanced practice nurses according to role. Thus, barriers to advanced practice nursing services would be reduced and public safety would be ensured.


As your leaders, we have also been actively working with the American Nurses Credentialing Center to develop a core examination for CNSs, for whom there is no specialty advanced practice examination. This work is important because many states now require certification at the advanced practice level in order to obtain recognition and/or licensure as an advanced practice nurse. This requirement, coupled with the absence of an appropriate certification examination, has placed some CNSs in a situation where they cannot be recognized as a CNS in the state in which they live and work. Therefore, CNSs have relocated to states where they can obtain recognition, and others have taken on roles with titles other than CNS, such as "outcomes managers" or "nursing practice specialists." Although these other roles are important, it is problematic when CNSs cannot use the title for which they have been educated. These CNSs may feel devalued and "less than." Therefore, the plan will be to have a core CNS examination that will test basic knowledge of the CNS role. This core examination will be coupled with another mechanism, such as portfolio or simulation, that will demonstrate specialty competencies. We hope that this combination of a core exam and competency assessment will open the door to recognition for all CNSs.


To better represent CNS interests in every state, it is important for NACNS to have valid and reliable data about CNSs in this country. Therefore, representatives from NACNS, Dr Ann Mayo, Dr Jan Buelow, and Christine Filipovich, have been working with Dr Geraldine Bednash and Dr Di Fang from the American Association of Colleges of Nursing to obtain information regarding CNS program enrollment, graduation, and areas of specialty. These leaders have been very effective in obtaining more accurate data about CNS education in this country.


These endeavors are just a few of many that NACNS has been undertaking on behalf of you and every CNS in the United States. We are committed to representing CNS interests at the national level. We are also committed to promoting the CNS as essential to today's healthcare delivery system.


In my opening address as your president, I remarked that this work takes a village. We want to continue to grow our village by seeking bright, committed, energetic, passionate, and enthusiastic future leaders. Could you be one of these future leaders? Just ask yourself:


* Are CNSs recognized and regulated appropriately in my state?


* Are there schools of nursing available in my state that prepare CNSs?


* Is there an affiliate group of NACNS that is available to CNSs in my state?


* Is there a CNS on my state Board of Nursing?



If you find that you answer any of these questions with a "no", then I challenge you to use your passion and enthusiasm to address areas of need in your state. If your state does not have a gap in any of these areas, I encourage you to seek out membership on one of our committees or task forces to further the work of CNSs.


I believe that this work does take a village and that it must be continued on behalf of all CNSs. Doing so will ensure that CNSs can continue to exert their positive influence in all areas of CNS practice.


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


NACNS Updates

Updated National Association of Clinical Nurse Specialists Member Benefits

Membership in the National Association of Clinical Nurse Specialists (NACNS) has always been an exceptional value. Now, membership has become even more valuable with the addition of new benefits. Following is a list of all current and new benefits that are available to NACNS members.


* A subscription to Clinical Nurse Specialist: The Journal for Advanced Nursing Practice


* The NACNS Newsletter, published in the Journal, providing an update of the organization's activities


* Quarterly e-newsletter delivered via e-mail to provide updates on health policy and practice issues (new!)


* An online NACNS membership directory


* Reduced registration rates for the annual NACNS conference


* Opportunities to be involved on a national level in activities that directly impact NACNS and, ultimately, clinical nurse specialist (CNS) practice across the country


* Assistance in the development of regional and local NACNS affiliates


* Expert consultation to support effective CNS influence on state legislative and regulatory initiatives


* Discounted fees for American Nurses Credentialing Center CNS examinations


* A subscription to JBIConnect, through which members access an array of Web-based resources of the Joanna Briggs Institute (JBI), designed to support the use of evidence in clinical decision making at the point of care (new!)



JBI Subscription is New NACNS Member Benefit

Have you spent hours searching for evidence to support current practice or proposed practice changes? Do you mentor new nurses and need a reliable source for best practice? If so, here is an excellent opportunity for you. A subscription to the JBI is now a member benefit. The JBI is an international collaborative, based in Australia, whose mission is to facilitate evidence-based healthcare practice globally through being a leading international organization for the translation, transfer, and utilization of evidence of the feasibility, appropriateness, meaningfulness, and effectiveness of healthcare practices. As a subscriber to the JBI, you will have access to a wide variety of resources to support evidence-based practice. Examples of these resources include a clinical information system composed of a wide variety of evidence-based patient care procedures and protocols; systematic reviews; and several journals, including Worldviews on Evidence-Based Nursing, Value in Health, and the International Journal of Nursing Practice, to name a few.


To access JBIConnect, the portal to the Joanna Briggs resources, all you will need to do is log into the NACNS members-only page,, and click on the "JBI Connect Portal" image/button. Clicking this button will forward and log you in to the JBIConnect Web site.

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NACNS is Now a Member of the Interagency Collaborative for Nursing Statistics

In October 2007, NACNS was accepted for membership into the Interagency Collaborative for Nursing Statistics (ICONS). As a new member, NACNS joins other leading nursing organizations that belong to the collaborative. The purpose of ICONS is to promote the generation and the use of data and research in the nursing workforce. The goals of ICONS are to enhance collaboration among member organizations/agencies regarding data, information, and research; promote evidence-based decision making; promote the use of standardized definitions and terminology in data collection and reporting; systematically identify needs and gaps in knowledge; and encourage coordinated, focused, quality research effort. Membership in ICONS is very exciting and gratifying for all and will be extremely beneficial for CNSs across the country. For further information about ICONS, visit the organization's Web site at


News From our Affiliates

Montana Affiliate News

The Montana Association of Clinical Nurse Specialists (MACNS) grew by 2 members this fall when practicing clinical nurse specialists (CNSs) Deanna Brame and Edie Ellsworth, both experts in palliative care, joined our group. We welcome them to MACNS and look forward to their contributions!


Susan Luparell, MACNS member, has been named an inaugural member of the National League for Nursing's (NLN's) new Speaker/Consultant Bureau. Dr Luparell speaks frequently to healthcare faculty around the country about how to manage incivility and other difficult student situations. She is also the first nursing educator in Montana to be certified by the NLN. Dr Luparell, an assistant professor at Montana State University College of Nursing, teaches in the Adult Health CNS track. Congratulations, Susan!


Members of the Montana affiliate are looking forward to a productive spring. Our goals include increasing our membership, developing networking opportunities among CNSs, continuing the collaborative relationships established with other advanced practice registered nurse groups and professional nursing organizations in Montana, and promoting the contribution that CNSs make to rural healthcare.


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


Member Recognition

Rhonda A. Scott, PhD, RN CS, National Association of Clinical Nurse Specialists (NACNS) member and nominee and chief nursing officer and senior vice president of Patient Care Services at Grady Health System in Atlanta, was recently approved by the Secretary of the US Department of Health and Human Services for a seat on the Nurse Advisory Council on Nurse Education and Practice (NACNEP). The NACNEP advises the Secretary of the US Department of Health and Human Services and the US Congress on policy issues related to the Title VIII programs administered by the Health Resources and Services Administration Bureau of Health Professions Division of Nursing. These programs include nurse workforce supply, education, and practice improvement.


Margaret Talley, RN, CNS, CWCN-AP, a CNS for Palomar Pomerado Health in California, recently won the prestigious Cherokee Inspired Comfort Award. She won the award for taking an existing wound care program to the next level, dramatically reducing the percentage of patients with hospital-acquired pressure ulcers. She is 1 of 10 honorees nationwide in 2007. The award is granted annually by Cherokee Uniforms to recognize nurses and other nonphysician healthcare professionals who demonstrate exceptional service, sacrifice, and innovation and have a positive impact on others' lives. Most recently, her skin team program was published in the American Nurses Association publication Transforming Nursing Data Into Quality Care. She has also presented at the national conference of the Wound, Ostomy and Continence Nurses Society.


Juliet Mock, a research nurse in the Cardiovascular Clinical Trials Center (CTC) and an NACNS student member earning a master's degree as an adult health CNS, won the Nursing Spectrum Heartland Region Nursing Excellence Award in Mentoring. Ms Mock was the only Minnesota nurse to earn the award. "In over 40 years of practice, I have never seen a more skilled mentor," said Mary Ellen Berman, the nurse manager in the University of Minnesota's CTC Department of Medicine. The Nursing Spectrum Award is given by NurseWeek magazine each year. The magazine honors nurses in 13 separate regions of the country. The Heartland region, where Mock was chosen, features 11 states and 6 award winners.


Jeffery Jones, MSN, CNS, BC, a psychiatric CNS, was selected as the recipient of The University of Akron's Distinguished Alumni Award for 2007. He received the award at a dinner on October 10. Among the reasons cited for Jones' receiving the award were his dedication to the nursing profession, his leadership and entrepreneurship in nursing practice, and his tireless efforts on the behalf of the mentally ill. Jones also recently conducted groundbreaking research into the phenomena of nurse-patient boundary violations with Drs Joyce Fitzpatrick and Virginia Drake. He is also a contributing author in a forthcoming book about CNSs due out in 2008 by Lippincott.


Kelly Goudreau, DSN, RN, CNS, immediate NACNS past president, participated in the Competency & Credentialing Institute's (CCI's) second invitational think tank entitled Continued Competency Leadership Forum: From Pieces to Policy. The think tank reflected CCI's ongoing commitment to convene thought leaders and scholars to advance thinking on topics of importance to patient safety. According to the organization's Web site, the goal of the think tank was to achieve a single, significant outcome: to reach a shared understanding of how nursing can ensure ongoing competence development that enhances both the profession and patient care. Visit for more information.


Kathleen L. Dunn, MS, RN, CNS, CRRN-A, a spinal cord injury CNS at the VA San Diego Healthcare System, was recently nominated in the Disability Educator category for the National Spinal Cord Injury Association's Spinal Cord Injury Hall of Fame. Being nominated for this award was an honor. The results had not been announced at press time.


Susan Heath, MS, RN, movement disorders CNS at the VA San Francisco, coordinated the first Parkinson's caregiver class that was held in November 2007. The course was transmitted through teleconferencing to all VISN 22 VA facilities as well as the Hawaii, Salt Lake City, and Ann Arbor VA facilities. The goal of this program was to provide support for family and caregivers of people with Parkinson's disease. The course was designed to support those who are interested in learning how to better care for their family members or friends with this challenging diagnosis.


Angela P. Clark, PhD, RN, CNS, FAAN, FAHA, and Margo A. Halm, PhD, RN, APRN-BC, CCRN, who are both NACNS members, along with Cathie E. Guzzetta, PhD, RN, AHN-BC, FAAN, were selected as the editors for the new third edition of Presenting the Option for Family Presence. They have just completed the project for the Emergency Nurses Association. The third edition includes an extensive review of research on the topic, along with toolkit materials for clinical and research settings.


News Briefs

PEPID(TM) Launches New Software to Help Nurses Treat Older Adults

PEPID, the innovative medical information software developer, recently announced that it is launching a new product, PEPID(TM) Gerontological Nursing Suite (RN GERO). Developed with the National Association of Clinical Nurse Specialists, PEPID RN GERO provides instant clinical answers on thousands of conditions, disorders, and diseases that afflict older adults. Specialty focus includes geriatric assessment, pharmacology, multisystem syndromes, and palliative care. It also integrates a drug database with a drug interactions generator, an interactive intravenous drug compatibility tool, weight-based dosing calculators, and medical calculators. Released for online, Palm, PocketPC, Windows Mobile, BlackBerry, iPhone, and Smartphone devices, nurses can now carry specialty-focused medical information with them virtually anywhere. Whether "bedside" is in a patient's home, a care facility, or a hospital, nursing professionals will have, in hand, the decision support they need to care for older adults.


Cardiac Societies Release First Cardiac Rehabilitation Performance Measures to Help Bridge Gaps in the Delivery of Secondary Prevention Services

The first performance measures to increase cardiac rehabilitation (CR) referrals and establish standards of excellence for this highly effective but vastly underutilized service were jointly released by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA).


More than one-and-a-half years in the making, the "AACVPR/ACC/AHA Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services" was published in the September/October issue of the Journal of Cardiopulmonary Rehabilitation and Prevention and the October 2 editions of Circulation and the Journal of the American College of Cardiology.


The measures call for proper referral of all eligible patients and set performance standards for CR programs themselves and will be a major part of the solution to the CR utilization issue. The more than 70% of patients who currently are not receiving the CR they should receive can only benefit if these measures are adopted and supported by the multidisciplinary teams and hospitals, practices, and insurance companies that serve cardiovascular disease patients. The Preventive Cardiovascular Nurses Association and the National Association of Clinical Nurse Specialists, along with multiple medical associations, have endorsed the measures.


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.