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

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In Ori Brafman and Rod A. Beckstrom's book on leadership, The Starfish and the Spider,1 they explained that if a spider's leg is cut off, you have a 7-legged creature, and if you cut of its head, you have a dead one. However, this is not so with a starfish. If the starfish's arm is cut off, a new one will grow. In fact, the severed arm can grow an entire new body because a starfish is a neural network or just a network of cells.


Although Brafman and Beckstom used the analogy of the starfish to describe the differences between centralized leadership (spider) and decentralized leadership (starfish), I think this also fits for the clinical nurse specialist. Brafman and Beckstrom (2006) explained that when a decentralized organization is threatened, it can actually become stronger, and one should never mistake starfish for spiders. Clinical nurse specialists (CNSs) are definitely starfish. For example, in the February 2006 draft vision paper of the National Council of State Boards of Nursing entitled "The Future Regulation of Advanced Practice Nursing," CNSs were not considered advanced practice registered nurses (APRNs). Through the outspoken advocacy of National Association of Clinical Nurse Specialists (NACNS) and other nursing organizations as well as individual CNSs, the future vision has changed and CNSs continue to be one of the four recognized APRN groups within the future regulatory model developed by the National Council of State Boards of Nursing and the APRN consensus work group (of which NACNS is a part) are CNSs. NACNS has also facilitated groups to develop core competencies for the CNSs who are prepared with master's degree and practice doctorate. NACNS is now responsible for maintaining and the periodic updating of these competencies. NACNS has also been asked by the American Colleges of Nursing to co-chair an initiative for developing consensus-based competencies for adult-gerontology CNSs, which is funded by the New York University Hartford Institute.


Consistent with our strategic goal to serve as the national authority for CNS practice, education, and research, the NACNS Board of Directors established an initiative that will culminate in nationally accepted educational standards for CNS programs that offer either master's degree or practice doctorate points of entry. The intent of this project, co-chaired by Drs Angela Clark and Peggy Gerard, is to ensure quality CNS education. A task force with representation from other major national organizations will develop and refine the standards before validation from other stakeholders.


Another exciting development is the engagement of a marketing firm to enhance NACNS's efforts to promote the contributions of the clinical nurse specialist and the importance of the role in healthcare delivery. This is one outcome of the work of a task force convened by the board and headed by Dr Pat Ebright, to make recommendations about optimum positioning of the CNS in the current environment.


This is my last column as NACNS president. I was told by one of the past presidents regarding the presidential year, "Don't blink or you will miss it!" and she was correct. I have always felt very fortunate to find a profession I love and about which I feel very passionate, and to have served as president of such an esteemed group of colleagues is a privilege. The NACNS Board of Directors is an exceptional groups of leaders-Susan Dresser (secretary), Melanie Duffy (president-elect), Pat Ebright (vice president), Pat Foster (treasurer), Carol Manchester (director at large), Ann Mayo (director at large), Theresa Murray (past president), Stephen Patten (director at large), Jan Fulton (ex officio member), and Patti Zuzelo (director at large). This incredibly bright, committed group of CNSs has given much of their time and talents to move CNS and NACNS forward.


Incoming President Melanie Duffy, RN, MS, CCRN, CCNS, is a critical care CNS at Pinnacle Health System in Pennsylvania. Melanie will bring her experience as a board member, as president-elect to the role of president, and as a CNS in clinical practice.


NACNS is also very fortunate to have Chris Filipovich as our chief executive officer. Chris is also a CNS entrepreneur who brings the expertise and knowledge to her role.


Because of you-our members, the NACNS board members, and Chief Executive Officer Chris Filipovich-we will never be mistaken for spiders!


News From our Affiliates

California and the CACNS Affiliate

The California CNS Network may be changing our name to the California CNS Association! The board continues to review our bylaws and make changes that reflect the needs of our growing organization. With strengthening representation from the entire state and a mandate to remove barriers to APN autonomous practice in the state, we feel that we are a working association. We will continue to network but have a larger obligation that would be reflected in the name change.


Our new chairperson, Paddy Garvin, has organized a board of more than 20 dynamic CNSs, all with varied backgrounds and representing Northern, Central, and Southern California. Our all-day conference entitled "CNSs: Leaders in Clinical Excellence" will be held on November 8 at the Rancho Las Palmas Resort. For more information about the board or our conference, visit our revised Web site at


On September 13, 2008, the first California Advance Practice Summit was held in Anaheim at the West Coast University. The summit entitled "APRN Removing Barriers to Prescriptive Authority" was hosted by the California Association of Psychiatric Mental Health Nurses in Advance Practice and American Nurses Association/California. California CNS Network board members who attended included Chairperson Paddy Garvin; Patti Radovich, legislative representative; Garret Chan, Northern California district representative; Ginger Pierson, Southern California district representative; Jim Stotts, mentor liaison; and Lubelle D'Luna O'Grady, student representative.


Elissa Brown, CNS Network member and president of California Association of Psychiatric Mental Health Nurses in Advance Practice, and her board coordinated the summit with American Nurses Association/California executive director, the Honorable Tricia Hunter. Approximately 40 APRNs including CNSs, nurse practitioners (NPs), certified registered nurse practitioners (CRNAs), certified nurse midwives (CNMs), and APRN faculty attended this summit. Dynamic presentations by Tricia Hunter; Terri Roberts, RN, JD, from Kansas, who successfully collaborated for prescriptive authority for APRNs in Kansas; Lisa A. Kalustian from the Los Angeles office of the governor of California, Arnold Schwartzenegger; California Board of Registered Nurses representative Elizabeth Dietz, EdD, RN, CS-NP, followed.


Susanne Phillips, MSN, RN, APRN-BC, FN, California BRN, APRN member; B.J. Snell, RN, NP, CNM; Tim Wolf, RN, CRNA; and Patti Radovich, RN, CNS, all discussed the scope of practice variance and barriers to practice that limit their ability to provide comprehensive healthcare.


For a summit prescriptive legislative activities, visit and click on "Legislative."


Submitted by Margaret Talley, affiliate liaison, California CNS Network

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New York State Affiliate

The central New York Affiliate is spearheading the effort to obtain CNS title protection. Clinical nurse specialists from across the state are beginning this process by meeting with New York State Nurses Association on November 7.


Submitted by Melanie Kalman, CNS, PhD


Oklahoma Association of Clinical Nurse Specialists

The Oklahoma affiliate of CNSs and the University of Oklahoma cosponsored the third Annual Clinical Nurse Specialist Recognition Day fall conference on October 10. This year's conference entitled "One Voice, One Vision" was held at Saint Francis Hospital in Tulsa, Oklahoma, and featured a wide range of educational sessions on topics such as geriatric population needs, pharmacology, the use of technology to measure CNS outcomes, and an overview of the Democratic and Republican presidential candidate views on healthcare reform.


Oklahoma Association of Clinical Nurse Specialists member Susan Goodwin, MS, RN, CPAN, has been serving on the core CNS examination committee. Members of this committee were selected jointly by the American Nurses Credentialing Center (ANCC) and the National Association of Clinical Nurse Specialists. These 11 CNSs from around the country have met face to face to develop a test blueprint and review and revise test questions submitted by item writers.


Submitted by Susan Dresser, MSN, RN, CNS-BC


Wisconsin Association of Clinical Nurse Specialists

The Wisconsin Association of Clinical Nurse Specialists (WIACNS) was formed in 2007 with 80 charter members. The purpose of WIACNS is to advance CNS practice in Wisconsin through educational, professional, and relational activities. In March 2008, we became an official affiliate of NACNS.


Throughout 2007, much of our time was spent creating a vision, bylaws, and direction for our organization. Our first WIACNS officers are Tim Heyse (chair), Sue Fuhrman (chair-elect), Brenda Larkin (treasurer), and Lisa Salamon (secretary). Half of our officers rotate off each year to create opportunity for more people to get involved while allowing for continuity. Elections are currently underway.


Our group (which has approximately 120 members as of October 2008) has been very active in holding general meetings with educational sessions on every odd month and steering committee meetings every even month.


Educational sessions included things such as a presentations on the DNP by Marquette University's dean of graduate nursing education, original research on CNS roles/activities by a University of Wisconsin-Milwaukee faculty member, efforts of Reduce Falls by several practicing CNS members, and open discussion.


We have made strides to promote clinical nurse specialists and our organization through poster presentations ata regional research conference ("Building Bridges to Nursing Practice") and at the Wisconsin Nurses Association Conference. An article describing our group was also published in a statewide Nursing Matters newspaper, which helped us spread the word about our organization and gain more members. We are presently planning our first WIACNS Educational Conference for fall of 2009.


People wishing to get more information about WIACNS are encouraged to go to our Web site at


Susan Fuhrman, MS, MSN, CCNS, RN-BC


Acute and Critical Care CNS


Member Recognition

2008 Nurse Week Southwest Region Nursing Excellence Awards

The 2008 Nurse Week awards gala held at The Buttes Marriott in Phoenix, Arizona, brought recognition to an outstanding CNS. Nancy Cisar, MSN, RN, CCRN, APRN, BC, clinical nurse specialist and assistant professor of nursing, Mayo Clinic Hospital, Phoenix, received the award for excellence in teaching. "Nancy Cisar has developed key policies and procedures for teaching nurses to care for complex, high-acuity patients. Cisar has developed orientation classes for new nurses and regularly invites staff nurses on daily rounds so they're exposed to what's going on in other areas of care." In expanding patient services, Cisar made sure that nurses in the cardiovascular, telemetry, and heart transplant units received extensive education and ongoing support. This included teaching registered nurses to use ventricular assist devices and pulmonary artery catheters and hone their skills for postoperative care. "I provide nurses with the opportunity to learn and use critical thinking, and when I hear their'ahha's!' I know I'm making a difference," Cisar says. Nancy is a member of NACNS and the Arizona CNS affiliate.


Association of Rehabilitation Nurses Award

Kathleen Dunn, clinical nurse specialist and rehabilitation case manager for the Spinal Cord Injury Center of the Veterans Affairs San Diego Healthcare System, received the 2008 Advanced Practice Nurse of the Year Award from the Association of Rehabilitation Nurses. Kathleen will also receive the honor of being inducted into the Spinal Cord Injury Hall of Fame (category Disability Educator) by the National Spinal Cord Injury Association on November 17, 2008, at their annual meeting in New Orleans.


Update on CNS Core Certification Examination

National Association of Clinical Nurse Specialists and the ANCC are developing a core examination to test competencies expected of all CNSs, regardless of specialty. This examination will be available in September 2009.


ANCC Clinical Nurse Specialist Core Examination Review Course

National Association of Clinical Nurse Specialists and ANCC are pleased to offer this review course that will prepare participants for the CNS core certification examination, which will be available in September 2009. The course is also open to individuals who do not plan to take the examination but are interested in obtaining continuing education contact hours and information about CNS practice. Tuesday, March 3, 2009, from 8:00AM to 5:00 PM PREREGISTRATION IS REQUIRED.


To register, contact ANCC at or e-mail at


CNS Core Competencies Updated

Through the work of a national task force, NACNS core CNS competencies and CNS practice competencies developed by specialty nursing organizations were reviewed. The outcome is an updated set of core CNS practice competencies that are now being circulated for endorsement by stakeholder organizations. Contact NACNS for a copy of the competencies.


Plan Now to Attend the 2009NACNSConference, March5to7in St Louis

The annual national conference is a wonderful learning and networking opportunity for experienced and novice CNSs as well as students. Information about the conference can be found at


Preconference sessions on Wednesday, March 4, will focus on the recommendations for future regulation of APRNs recently released in the Joint Dialogue Report and the future regulatory model. The Joint Dialogue Report is available on the Resources section of the NACNS Web site. The morning session will focus on the implications of the future regulatory model for CNS licensure, certification, and regulation. The afternoon session will be devoted to the implications for the future of CNS education.


CNS Program Consultation

In response to frequent requests from faculty responsible for developing new CNS programs or revising the CNS curriculum, NACNS offers a consultation service. Experienced CNS educators provide consultation using either a self-assessment model or a more direct on-site curriculum review. Contact the NACNS office for more information.


Please contact NACNS Chief Executive Officer Christine Filipovich if you have questions or need more information.


2090 Linglestown Rd Suite 107 Harrisburg, PA 17110 Telephone 717-234-6799 Fax: 717-234-6798


E-mail: Web site:


1Brafman O, Beckstrom RA. The Spider and the Starfish. New York, NY: Portfolio/Penguin Group; 2006. [Context Link]