1. Sendelbach, Sue Ellen PhD, RN, CCNS, FAHA

Article Content

President's Message

In a study of nursing care processes conducted by Tucker and Edmondson, the authors identified 2 types of process failures within hospitals-problems and errors.1 Error was defined as an unnecessary or incorrectly performed task that was carried out, and a problem was a disruption in a worker's ability to execute a prescribed task because something the worker needs was unavailable.1 The authors found the majority of failures were problems (86%) as opposed to errors, and on average, it took 33 minutes out of an 8-hour shift to cope with system failures that could have been addressed and removed.1 Consequences of not addressing problems can lead to burnout and work time in trying to cope with systems failures of up to 8%, a shift that equated to $256,000 per year in lost nursing time for a 200-bed hospital.1


Although the authors cited literature supporting empowerment of workers as a solution for quality and productivity problems, they questioned if staff nurses have the time to address the issues because of providing direct patient care.1 I would challenge the authors that, if there was a clinical nurse specialist (CNS) as a part of the team, the nurse could be empowered by identifying clinical issues and working with the CNS to find the best solution. Clinical questions arise everyday about how we can better go about our day for providing the most optimal care for our patients. Staff nurses can utilize their CNS to help identify, address, and solve clinical questions or concerns to make a difference in patient care.


One example of a staff nurse utilizing a CNS was questioning the use of thigh-high graduated compression stockings (GCS) versus knee-high GCS as prophylaxis against deep vein thrombosis in patients undergoing open-heart surgery. There were patient complaints of the thigh-high GCS being uncomfortable. Nurses also complained of difficulty with putting on and taking off the thigh-high, ill-fitting GCS despite having measured it, and issues with skin integrity. The staff nurse partnered with the CNS and examined the literature. Although the literature supported the use of GCS for deep vein thrombosis prophylaxis, it also revealed no difference in patient outcomes if the patient wore the knee-high or thigh-high GCS.2,3 An interdisciplinary team including physicians, wound and ostomy nurses, and staff nurses came together to change practice to having knee-high GCS as the standard of care for patients after open-heart surgery.


The Statement on Clinical Nurse Specialist Practice and Education identified one of the outcomes of CNS practice in the Nurses and Nursing Practice Sphere of Influence as "Nurses are empowered to solve patient care problems at the point of service." This is one example of how a CNS can be a supporter, change agent, and colleague in hearing one bedside nurse's brilliant idea and making it happen. In addition to the staff nurse feeling empowered, other CNS outcomes include "Evidence-based practice [is] used by nurses" and "Desired patient outcomes are achieved through synergistic effects of collaborative practice."4


Problems and errors can and do happen in even the most successful organizations.1 Clinical nurse specialists are educated to address patient safety issues (including the errors and problems identified by Tucker and Edmondson1) and quality. The pivotal role CNSs contribute is being increasingly recognized by organizations and communities as evidenced by the many job openings for CNSs. It is not unusual for there to be bonuses associated with the CNS jobs. Clinical nurse specialists are now being seen as an essential part of the healthcare team.




1. Tucker AL, Edmondson AC. Why hospitals don't learn from failures: organizational psychological dynamics that inhibit system change. Calif Manage Rev. 2003;45(2):55-72.


2. Byrne B. Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh length graduated compression stockings. Heart Lung. 2001;30:277-284.


3. Sajid MS, Tai NRM, Goli G, Morris RW, Baker DM, Hamilton G. Knee versus thigh length graduated compression stockings for prevention of deep venous thrombosis: a systematic review. 2006;32:730-736.


4. National Association of Clinical Nurse Specialists. Statement of Clinical Nurse Specialist Practice and Education. Harrisburg, PA: NACNS; 2004.


NACNS Updates

Board Member Farewells and Introductions

The end of the spring conference marks the annual change in NACNS board leadership. The outgoing board members are Peggy Gerard, Kelly Goudreau, and Jane Walker. Peggy Gerard served on the board as treasurer since 2004. She served as the board liaison to the Education Committee and as cochair of the Doctoral Competencies Task Force. She also served as the CNS Foundation treasurer. Kelly Goudreau served on the board since 2004. She began her service as secretary and moved into the president-elect position in 2005. She served as president from 2006 to 2007. During her tenure, she initiated and directed the work of the NACNS Vision paper and is the NACNS representative to the Alliance for Advanced Practice Registered Nurses (APRN) Credentialing Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. Jane Walker served as secretary since 2005. As secretary, she also served as editor of the NACNS newsletter published in CNS and also served on the Marketing Committee from 2005 to 2007. The board will miss the contributions of all.


Other board members changed their positions from the past year into new roles. Theresa Murray left her position as president and now holds the position of past president. Sue Sendelbach is our new president after serving 1 year as president-elect. Melanie Duffy moved from her position as vice president after she was elected president-elect. Patricia Ebright is our newly elected vice president and leaves her director position. Patricia Foster leaves her director position and moves into the position of treasurer. Susan Dresser leaves a position as director after being elected to the position of secretary. Finally, the board welcomes new directors, Carol Manchester, Ann Mayo, Stephen Patten, and Patti Zuzelo.


Christine Filipovich Named NACNS CEO

Christine Carson Filipovich was named NACNS's first chief executive officer, effective January 1, 2008. Filipovich has served the organization since 2000, initially as CEO of the company that provided association management services for NACNS, then as the NACNS executive director from 2004 to 2007. NACNS past president, Theresa Murray, MSN, RN, CCRN, CNS, in her announcement of Filipovich's new position recognized Filipovich's executive leadership of the association. According to Murray, "Christine has provided the leadership essential for maximizing the efforts of 3 entities-the membership organization, the foundation, and the corporation-to meet the needs of CNSs. We are very fortunate to have a CNS with the professional expertise that Christine has brought to NACNS."


News From Our Affiliates

The California CNS Network

In California, there was unprecedented excitement generated by the January conference on prescriptive authority. We had an excellent program provided by our dynamic speakers that generated a lot of energy to move forward with prescriptive authority for the CNSs in California. We had 4 keynote speakers who presented different topics and perspectives on the issue of prescriptive authority. First, former NACNS president, Dr Sue Davidson, chronicled the successful process undertaken by the Oregon CNSs to obtain prescriptive authority. This information gave us ideas on what we may or should do to be successful in our journey. Second, American Nurses Association California executive director, Hon. Trish Hunter, RN, CNS, reviewed the nursing scope of practice and the legislative process. Third, Suzanne Phillips, RN, MSN, NP vice president with the California Board of Registered Nurses, presented the nurse practitioner and Board of Registered Nurses perspective. Finally, Elissa Brown, MSN, APRN, BC, CNS, Mental Health from the VA Greater Los Angeles Healthcare System, shared the psych-CNS perspective. The overwhelming message from the group was that we need to move forward with optional prescriptive authority for all CNSs in California. The final segment of our conference was a spirited interactive session consisting of brainstorming on how and what our organization needs to do to move forward with the issue of prescriptive authority. The California CNS Network Board will hold a teleconference on March 22, 2008, to follow up on the January 19 conference and discuss the next steps. The involvement of this organization as well as individual CNSs is critical in the successful journey to obtaining prescriptive authority for the CNSs in California. There were 72 participants preregistered for the event including CNSs from northern and central California. We thank our vendors and poster presenters who added so much to the excitement and success of the day.


In other news, Kathleen Mendez, CNS, was appointed to the Association of California Nurse Leaders 2008 Health Policy Committee. Anne Becker was selected to serve as a test item writer for the CNS Core Examination and attended the item-writing workshop at the NACNS Conference in March. She also published, along with her daughter, a CEU for Wild Iris Medical Education online entitled "Traveling with Disabilities."

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Submitted by affiliate advisor, Margaret Talley, and Evelyn McLaughlin, CNS, chair of CA CNS Network


The Illiana Lakeshore Affiliate

The Illiana Lakeshore Affiliate of CNSs held its first annual CNS conference on January 26, 2008, with more than 60 attendees. The conference was entitled "Clinical Nurse Specialists: Taking the Lead in Healthcare Safety and Quality." Theresa Murray was the keynote speaker and gave an address entitled "Role of the CNS in Leading Safety and Quality Initiatives." Mary Beth Navarra-Sirio, vice president, Patient Safety Officer from McKesson, talked about the role of the CNS in selecting and deploying information technology to promote and support a safe healthcare environment. Finally, a panel composed of CNSs, Shirley Ambutas, Lisa Hopp, and Kathleen Rich, related its experiences in making a difference in healthcare safety and quality. Kim Nagy, the chair of our affiliate, was instrumental in obtaining sponsorship from Lake Forest Hospital and McKesson. As a result, we were able to donate all of our proceeds to the CNS Foundation and the Katie Brush scholarship fund. The response to the conference was extremely positive, and we were very happy with the attendance and outcome of our very first conference.


Submitted by Jane Walker, member, Illiana Affiliate


News From Our Committees

Gero Task Force: A Subgroup of the Practice Committee

Members of the Gero Task Force have been continuing their level of commitment to gerontological nursing. Joanne Alderman, a member of the Gero Task Force, is currently serving on the American Nurses Association's Gerontological Nursing Revision Task Force and is representing NACNS and the National Gerontological Nurses Association (NGNA). She is currently serving as chair of NGNA's task force on Advancing Excellence in America's Nursing Homes and is a member of the 2008 Advancing Excellence Interchange Planning Committee. She is writing 2 chapters for the NGNA Core Curriculum for Gerontological Nursing and is coauthoring with Ron Walent, Wanda Borges, and Sheila Williams a manuscript they will submit for publication. She is serving on the planning committee for the 2008 NGNA fellows evidence-based practice preconference. Finally, she is serving as coordinator for the Nurses Improving Care for Health System Elders Program at the Ohio State University Medical Center and coordinator for the Gerontological Nursing Certification Review Course. Deborah Conley presented at the 2008 Nurses Improving Care for Health System Elders Conference. Her topic on acute care of elder unit principles used on a medical unit was very well received.


Submitted by Susan E. De Rosa, MS, APRN, BC


News From the Marketing and Communications Committee

At the 2008 CNS conference, the Marketing and Communications Committee sold coffee mugs, travel mugs, and T-shirts with the NACNS logo. They also sold pins that say "CNS." If you missed the opportunity to buy these items that declare your pride as a CNS, you can still order them through the NACNS Web site. In addition, the Marketing and Communicating Committee developed a brochure. The target audience for these brochures is chief nursing officer/CEOs. You can obtain these brochures free from NACNS.


Submitted by Melanie Kalman, CNS, PhD


News From the Clinical Nurse Specialist Foundation

CNS Foundation Update

The Clinical Nurse Specialist Foundation held its annual fund-raising reception at the NACNS annual conference on Friday, March 7, 2008. The foundation raised approximately $25,000. More than $14,000 was raised to honor Katie Brush, critical care clinical nurse specialist, Massachusetts General Hospital, Boston, Massachusetts. Ms Brush was the 30th critical care nurse in the world to become a fellow of the American College of Critical Care Medicine. She will be greatly missed by all her colleagues. The 2008 Gannett Healthcare Group Scholarship was awarded to Jeanne Marie Lahaie, RN, BS, BA, who is in the Gerontological Clinical Nurse Specialist Program at the University of San Francisco School of Nursing. She currently works at the San Francisco Veterans Administration Nursing Home. She plans to practice as a certified gerontological CNS in one of several healthcare settings. The 2008 Lippincott, Williams & Wilkins Scholarship was awarded to Pamela A. Minarik, PhD, APRN, BC, FAAN, who is a Betty Irene Moore Fellow at the University of San Francisco School of Nursing. She specializes in psychiatric nursing, and her research interest focuses on nursing interventions for depression. Her goal is to continue to teach at the graduate level in psychiatric nursing and in the preparation of CNSs. Congratulations to this year's recipients!


Member Recognition

Jeff Albaugh, MS, RN-APN, CUCNS, a CNS at Northwestern Memorial Hospital in Chicago, Illinois, received the Ron Brady Career Mobility Scholarship from the Society of Urologic Nurses and Associates at the organization's annual conference in October. Albaugh was recently involved with the work of developing competencies for CNS doctoral education.


Kathryn Ann Brush, MS, RN, CCRN, CCNS, FCCM, posthumously received the Preceptor of the Year award at the NACNS annual conference on Friday, March 7, 2008. Brush was an expert in both critical care nursing and the role of the CNS. She excelled at mentoring and tutoring, was a welcoming preceptor, and encouraged critical thinking. Her warmth, patience, and enthusiasm for advanced practice nursing were communicated to her preceptees. Ultimately, she served as an exceptional role model through her ongoing quest for knowledge, her participation in nursing organizations, her passion for best evidence, and dedication to her nurses.


Angela P. Clark, PhD, RN, CS, FAAN, FAHA, received the Lyon Leadership Award at the awards luncheon during the NACNS annual conference on Friday, March 7, 2008. This award is given to NACNS members whose leadership activities have had a major impact on CNS practice and the association. Clark served as president of the NACNS during 2004 to 2005. During her tenure, she worked tirelessly to represent NACNS in a number of national forums. Before serving as president, she chaired the task force that undertook the process of publishing the 2004 edition of the NACNS Statement on Practice and Education. She was also a long-term member of the NACNS Education Committee and served as a member of the NACNS Board of Directors.


Barbara Hazard, PhD, RN, FAAN, received the Sue B. Davidson Service Award at the NACNS annual conference on Friday, March 7, 2008. This award is given to NACNS members who have generously donated their time and energies in service to NACNS and CNSs. Hazard was an original associate editor of the CNS journal having served in this capacity for 22 years. She also served as a member of the NACNS Board of Directors for 2 years. She served on the NACNS Research Committee where she was able to share her extensive research expertise. Most recently, she was instrumental in evaluating the psychometric properties of the CNS Competency Validation Survey.


Susan K. B. Jones, MS, RN, APN, CCNS/Rx, CCRN-P, received the CNS of the Year award at the NACNS annual conference on Friday, March 7, 2008, in Atlanta, Georgia. This award is given to a CNS who demonstrates outstanding professional achievement and exemplary practice with respect to patient care, nurses, and healthcare delivery systems. Jones holds the position of CNS in charge of nursing research development and evidence-based practice implementation at INTEGRIS Baptist Medical Center in Oklahoma City. She is also deputy director of the Joanna Briggs Oklahoma Center. Jones was recognized by her nominators as an exceptional nurse and mentor and as a true change agent in her hospital. She revolutionized the way that nurses practice and provide patient care and was instrumental in helping her hospital achieve Magnet designation.


Cathy Thompson, PhD, RN, CCRN, received the Educator of the Year award at the NACNS annual conference on Friday, March 7, 2008, in Atlanta, Georgia. This award is given to a CNS educator who demonstrates excellence and innovation in CNS education. Thompson is a professor in the CNS program at the University of Colorado in Denver. She was nominated by her students who commented on her exceptional teaching abilities and on her ability to inspire excellence. Thompson's students also commented on her commitment to the CNS role and her ability to instill that commitment in her students. All are grateful that they had the privilege of having Thompson as their professor.


Arizona Association of Clinical Nurse Specialists Chosen as Affiliate of the Year

The Arizona Association of Clinical Nurse Specialists received the Affiliate of the Year award at the 2008 NACNS conference. The award was presented to the Arizona Affiliate by last year's winner, Oklahoma Association of Clinical Nurse Specialists. The Arizona Association of Clinical Nurse Specialists was recognized for its substantial growth, use of guest speakers and distance technologies at chapter meetings, member involvement at the state and national levels, extensive member publication/presentation activities, and for selflessly volunteering to assist with the 2007 NACNS convention in Phoenix, Arizona.


News Briefs

Clinical Solutions, LLC, is an Official Registered Vendor for the Indiana State Department of Health-Certified Wellness Program for Small Business

Clinical Solutions, LLC, has received notification from the Indiana State Department of Health that its work site wellness program, Wise Health Decisions, has been certified as a qualified wellness program for small employers in Indiana. The Wise Health Decisions wellness program has been providing services to manufacturing, construction, and professional service companies of all sizes since 2003. "Our clients have astounding results when they provide the Wise Health Decisions wellness program for their employees. We have an outstanding record of employee participation and retention," states Nancy Dayhoff, EdD, RN, one of Clinical Solutions' founders. "Our clients have seen an overall improvement in employee health, translating into reduced claims and lower premiums," adds Patricia Moore, MSN, RN, CDE, also a cofounder of Clinical Solutions. Wise Health Decisions offers unique programs including wellness clinics at the work site on a regular basis throughout the year, use of translators at the monthly health-related newsletters written to health literacy criteria, on-site tobacco cessation, and weight loss programs. Both Dayhoff and Moore are members of NACNS. In addition, Dayhoff is a past vice president of NACNS and former board member.