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

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NAME: Nancy M. Albert

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CURRENT POSITION: Director, Nursing Research and Innovation, and Clinical Nurse Specialist, Heart Failure; Adjunct Associate Professor


CURRENT AFFILIATION(S): Cleveland Clinic; and Case Western Reserve University, Bolton School of Nursing, Cleveland, Ohio


AREA(S) OF SPECIALIZATION: Cardiovascular medicine and surgery with focus in patients with heart failure


PROFESSIONAL EDUCATION: Diploma, Huron Road Hospital School of Nursing, East Cleveland, Ohio; BSN, Cleveland State University, Cleveland, Ohio; MSN and PhD, Kent State University, Kent Ohio






Dr Nancy Albert was selected as the CNS Nurse Researcher of the Year by the National Association of Clinical Nurse Specialists (NACNS) at their annual 2007 conference in Phoenix, Arizona. The purpose of the award is to nationally recognize an NACNS member for outstanding professional achievement as a clinical nurse specialist (CNS) who has conducted original nursing research that has significantly enhanced the science of autonomous nursing practice, patient and family outcomes, and/or healthcare systems. The award acknowledges a nurse for an accomplished program of research that has significantly contributed to advancing the nursing profession.


Dr Albert was nominated by Mary Beth Modic, MSN, RN. Ms Modic describes Dr Albert as "inquisitive, energetic, and prolific." She states that Dr Albert has truly integrated the myriad of roles of the CNS-consummate clinician, gifted educator, dynamic consultant, and passionate researcher. It is, however, in the role of nurse researcher that this nominee excels and is deserving of recognition. She is the nursing literature in caring for patients with heart failure, especially related to disease management and acute care nursing management. She has conducted 22 research studies in patients with heart failure, 16 as a principal investigator and 6 as a coinvestigator or site investigator. Her extensive experience and research in the area of heart failure and cardiovascular health have contributed immensely to the benefit of patients and to the application of research and science by nurses to the delivery of nursing care to this population.


What first motivated you to become a CNS?

I was drawn to the role after working with a CNS who was hired about 3 years after my graduation from nursing school when I first worked in a mixed medical-surgical intensive care unit at a community hospital in Cleveland, Ohio. She quickly became a role model and my first CNS mentor. She was energetic, effective in making change happen, and an innovative thinker who facilitated me in meeting new challenges. I was impressed with the potential in the role, the ability to work autonomously and also to collaborate with healthcare colleagues. Before the term "evidence-based practice" was coined, she focused on reviewing the literature, keeping abreast of nursing and medical research results, and changing practice to match current evidence. She made a difference not just for nurses but also for patients and families. Through her mentoring, I also learned that I enjoyed teaching others, both formally and informally. Ultimately, she inspired me to return to school to obtain my masters degree in nursing.


What do you perceive are the key issues for CNS practice today?

The role of the CNS will remain powerful (in the face of other new nursing programs such as clinical nurse leader and doctorate of nursing practice) if practicing CNSs formalize their job expectations to focus on working at the highest level based on their education. To me, this means that CNSs must carve out time to conduct research and mentor others in conducting research. They must keep abreast of medical and nursing literature in their patient populations and assertively lead others in developing, implementing, and evaluating new programs that promote evidence-based practices and advance nursing science or clinical systems or processes. They need to disseminate their findings in peer-reviewed journals and communicate findings internally and externally. Clinical nurse specialists must distinguish themselves as the clinical leader and expert, the person to go to for advanced care issues and patient needs, and create a strong presence and value. To meet these role requirements, CNSs may need to develop systems that promote optimization of job roles. A continued focus on day-to-day unit issues, nurse education and orientation, and covering when staff nurses are off the unit could lead to role extinction. Clinical nurse specialists should use mentoring opportunities (locally, regionally, or nationally) to overcome barriers to professional growth, push administrators to understand their capabilities, and demand performance at the highest level of role functioning.


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

I am proud of my collaborative work with our physician staff that led to the implementation of many nurse-mediated programs in acute and chronic heart failure. It has been truly rewarding to move new clinical ideas forward and help sustain and develop them so that patients live fuller and higher quality lives.


Knowing I can make a difference to others is gratifying. The main way I learn of this is when people I have educated or provided consult services to meet me again and communicate how our discussion led to changes in professional practice or in systems or processes that affect professional practice/patient outcomes.


Finally, my role as a nursing research mentor, including the foundation I have set (and continue to adapt) to make research happen at our facility, has been both a challenge and a great accomplishment. It is very inspiring for me to learn how answers to a simple research question can have such a huge impact on the lives of the patients we serve or the nurse professionals we work with. I am awed by the research ideas presented by nurses and hope that the work I am doing helps others achieve success with their goals.


How has your CNS role prepared you or contributed to your research agenda?

My research agendas are related to quality of life, self-care adherence, and improving clinical outcomes in patients with chronic heart failure. My previous role as the CNS of "heart failure, transplantation, and dysrhythmia" in an acute care environment and my current role as CNS in a heart failure disease management clinic provide me with ongoing patient communication. Patients' stories and questions are a continued source of new research ideas. Also, through networking with CNSs, opportunities were created for me to work with talented nurse researchers who also specialize in similar research agendas. I have learned so much through these relationships.


What do you see as the most significant areas of research now and in the future for the nursing care of patients with cardiovascular disease?

There are so many opportunities for growth that I am sure my response will be the tip of the iceberg:


1. Developing national performance measures that facilitate patient safety and quality care through nursing care and focus on outcomes, not processes. The current performance measures (ie, core measures for acute myocardial infarction and heart failure) are immature from a nursing perspective. They focus on processes rather than outcomes. While processes are important because they can be the framework toward moving outcomes forward, they do not directly reflect outcomes. Just because a nurse documents "smoking cessation counseling" does not mean that patients learned anything that will help them when they leave the healthcare system. Through research, we have an opportunity to develop performance measures that may advance nursing care and patient outcomes.


2. Quality of life: atrial fibrillation, heart failure, adult congenital heart disease, and refractory coronary ischemia are 4 areas in which we need to learn more about quality of life-how to improve it, what factors influence it, and how traditional treatments mediate it.


3. Psychological and psychosocial issues: depression and social isolation are just 2 important factors in morbidity and mortality in patients with cardiovascular disease. We know that depression prevalence is high, but there is so little evidence on what works to treat it, if it is stable or unstable, and what factors precipitate it.


4. Self-care: most chronic cardiovascular diseases require self-care to optimize health and prevent decompensation. The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission have focused on documenting patient education in the medical record; however, that is just one small piece of ensuring self-care education, understanding, and adherence by patients. There is much work to be done, including learning what interventions are effective in promoting long-term self-care adherence and how well monitoring devices (telehealth and Web devices) work in promoting outcomes.


5. Genetics and technology (internal and external devices-especially those used in monitoring and assisting a poorly pumping ventricle). Need I say more about these topics?!


6. Complementary medicine: as Americans age and are more likely to develop chronic cardiovascular diseases, I believe they will look beyond Western medicine to learn what they can do for themselves to become and stay healthy.



What strategies would you propose to CNSs to help them incorporate actual research in their usually already busy schedules or practice?

The most important step is being motivated to want to get answers to research questions! Without personal motivation, facilitators available to promote research will seem meaningless.


The second step is to pick a topic that you will want to stick with over time, one that you find intriguing and exciting. Research takes time and work; if you are truly excited about the topic, you will prevail when roadblocks emerge. You do not want to get bored or want to "move on" before you get answers to your questions.


Third, involve key team members who have a desire to see the research completed. Their motivation might be in attending (presenting) a national conference with you, being a member of the writing team, doing something new and different, or meeting a professional goal that will help with promotion, but whatever it is, use it to help you both succeed. The key member might be a CNS peer, a nurse manager, or a motivated staff nurse.


Fourth, prevent wasting time if you are a novice; seek support and advice. A research mentor can help you fine tune your ideas, develop a theoretical model (as needed), discuss the literature review, write the proposal, submit a grant, develop a database, analyze data, write an abstract and article, and much more. Use the mentor as a sounding board when issues arise. A good mentor will steer you in the right direction, offer resources to aid your progress, and keep your energy level up when the work becomes tedious. If the chemistry between you and your mentor is not good, then seek out someone new.


Fifth, develop realistic timelines (your mentor can help, as needed), and push forward to meet them. It is so easy to get bogged down with other duties, and the "appraisal" part of research can be intense and uncomfortable, especially if writing the proposal and completing the institutional review board application and paperwork are new to you. Most CNSs enjoy the data collection phase of research the best, but even that can be slow depending on inclusion and exclusion criteria and time issues. Thus, when developing the research plan, you need to be realistic about what you can (and cannot) do and prevent the project from getting too big. Again, a good mentor can help here.


Sixth, use resources when available! If you have a librarian who can do the literature search, let them help. They might pull the articles you need as well. It never hurts to ask. A local college might have students who need "research hours" to complete the requirements in their master of science in nursing studies. You might be able to use them to help you with your research. Call a nurse expert in your field of interest (can be local or national) and ask questions that might help you get started or help you move forward. They may know the author of a perfect tool you can use, or they might be able to direct you to other resources. Most researchers are happy to discuss their program of research/patient population and may be willing to provide ongoing support. Do not be shy about looking for ways to simplify processes and avoid land mines. Collaborate, collaborate, collaborate! Research is a community activity-input from others always enriches the project.


Finally, keep key stakeholders aware of your progress and show progress (do not stagnate), so that key stakeholders are willing to continue supporting your efforts.


You have authored many articles in your specialty, what practical tips on writing for publication would you share with CNSs?

Writing takes practice. Good writers develop over time, they generally do not emerge instantaneously. The best practice is to submit manuscripts to peer-review journals because reviewers will critique your work and give you feedback, which is so important in improving writing skills. The following tips should ease the process:


1. Choose your topic wisely. You should be an expert in the field before putting pen to paper. If you are not, do your homework before attempting to write a manuscript. Remember, the peer reviewers are experts, and one or more will know if you are accurate.


2. Narrow the scope of the topic/theme you are writing about so that the manuscript does not become overly long.


3. Choose the journal you plan to submit to before you begin writing, then read carefully to make sure your proposed manuscript is a good match for the journal. Follow the author guidelines explicitly as this will save you rewrite time and aggravation.


4. Create an outline if you are writing a review article and you are a novice or have poor organization skills. This will keep you focused and help your work to have an improved flow and organization.


5. Use tables and figures to tell the story when possible.


6. Everyone has his or her own style of writing and rewriting, but my system is to reread what I wrote in my prior session before putting new words on a page. Therefore, the beginning of my manuscript may have been reread and edited multiple times before I am ready to submit the final version. You would be amazed at your self-critique when you reread your words after getting some distance.


7. Include all the headers proposed by the journal editors, but do not work in the order of placement in the journal. Save the abstract for last and the conclusions/summary next to last. Prepare tables and figures early so that your written words are synchronous and not redundant.


8. If English is not your first language, find someone to edit your work before submission. If you are a new writer, either collaborate with peers to get the manuscript completed or ask a peer (whom you trust to give you a brutally honest critique) to review. The more you review and edit up-front, the better your chances for acceptance and publication.


9. When you get reviewers' comments from the journal editor, address each one. Remember, they are experts and are trying to help you get published. They review at their own time as a professional courtesy. After taking time to give you feedback, do not ignore, even if it seems difficult to read the critique or you disagree with the feedback. Try to make revisions soon, while the topic is still fresh in your memory.



While I could go on, I will stop here.


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

Think about where you want to be in 1 and 5 years-think BIG! Find 1 (or more) CNS to mentor you in reaching goals. Choose people who are experts in the areas you want to excel at, whether it is public speaking, publishing, conducting research, developing a business plan, overcoming obstacles to change, or dealing with difficult people. Do not be shy about asking for support and guidance, and make sure you follow through with plans you put in place to reach goals. Also, do not feel that you cannot begin a journey in 1 arena (research) because you are a "new" CNS. You learned to multitask as a new staff nurse right from the moment of being hired. Clinical nurse specialists must develop competency in all role expectations, and by multitasking, you can weave various roles into daily activities (for example, you can collect data for your research study while making rounds).


About 6 years ago, a peer from Texas found me at a meeting, introduced herself, and said that she wanted to author an article with me. We discussed the topic, and she agreed to seek me out 1 month later at a national meeting we were both attending, with a proposed outline. She followed through; we determined writing duties and created writing deadlines. While we were working, a colleague of hers asked if she could join the team. It took 4 months to get the manuscript to the publisher and another 5 months before it was accepted for publication in a peer-reviewed journal. Their assertiveness aided their personal growth and development, and I met 2 wonderful people in the process.


What has it meant to you both personally and professionally to receive this award?

I am truly honored to receive this award, especially in its first year of presentation! On a personal level, I truly enjoy all research processes-probably because I am a consummate learner looking for new truth. Even when research answers do not match hypotheses, there is so much to be gained. Being recognized for accomplishments that were achieved through "love" of my work is an added bonus. I cannot easily express how thankful I am to Mary Beth Modic for nominating me, to NACNS for selecting me for this award, and to my husband and children for allowing me the time and freedom to do the work I so thoroughly enjoy. My achieving this award would not be possible without the advice, consultation, collaboration, and mentorship I have received from countless others who oftentimes inspire me, encourage me, and revitalize me.


Professionally, you have given me a forum to encourage CNSs to become actively involved in nursing research and dissemination. We need to enlarge the scientific foundation of nursing through evidence, a large challenge, but if we all carry out a piece of the work, we could gain much new knowledge. Such a worthy undertaking should be acted on by all CNSs, even when working in a nontraditional CNS role.