1. Duffy, Melanie MSN, RN, CCRN, CCNS

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President's Message

The President's Message in the July/August issue of the National Association of Clinical Nurse Specialists (NACNS) journal described the work that the organization, in collaboration with the American Nurses Association, embarked upon on the journey for healthcare reform. Advanced practice nurses (APNs) recently had the opportunity to participate in Congressional briefings. The APNs described the work they do and how their nursing expertise serves the public interest. NACNS participated in the briefings and demonstrated the value of the clinical nurse specialist (CNS). I described how NACNS supported funding for nursing programs, pursued the addition of the CNS as a healthcare provider in the list of Standard Occupational Classifications, and pursued the recognition of the CNS as an important APN component in nurse-managed health centers.


This issue will focus on the major themes discussed at a recent forum on healthcare reform titled "Nursing Workforce Solutions for 21st Century Health Care: How Do We Get There?" presented by Health Affairs and the Center to Champion Nursing in America, a joint initiative of the American Association of Retired Persons (AARP), the AARP Foundation, and the Robert Wood Johnson Foundation. The forum focused on 3 specific ways that nursing can be an active participant in healthcare reform.


The first panel discussion focused on nursing's importance to healthcare reform and workforce development implications. The participants were Elaine Ryan, vice president, Government Relations, AARP; Peter Buerhaus, director, Center for Interdisciplinary Health Workforce Studies, Vanderbilt University Medical Center; and Jonathan Weiner, professor, Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health. The panelists pointed out that quality outcomes are driving the system. Chronic care management, continuing care, and broader healthcare coverage are needed. The healthcare system should address provider payment reform, quality, chronic care, wellness, and prevention. Business, labor, and health professionals are all engaged for the first time. And the central figure in the picture is the nurse. The nurse wants to improve the health of the society. A controversial interplay still exists between the APN and the physician. Dr Weiner stated that a study is being conducted by the American Association of Colleges of Nursing and the Tricouncil of Nursing to review 28,000 articles regarding outcomes of APNs. This systematic review will prove the science of APN effectiveness. Vacancy rates for nurses are decreasing, but the nursing shortage is not a thing of the past. It is recession driven. Many nurses are approaching retirement age. Who will replace them?


The second panel discussion focused on nursing solutions for 21st century healthcare. The participants were Linda Aiken, director of the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing; Brenda Cleary, director, Center to Champion Nursing in America; and Chris Tanner, Youmans-Spaulding Distinguished Professor, Oregon Health and Science University School of Nursing. The panelists stated that now is the time to change nursing education. Funding needs to be made available now to solve the nursing shortage. And the nursing shortage would not be affected if the faculty shortage is not addressed. Dr Tanner described a new nursing curriculum that incorporates health promotion, chronic illness management, and transitional care. Community college and baccalaureate faculty work together to make the curriculum effective. The nursing workforce with specific skill sets will drive outcomes. A deliberate financial investment, not one that waxes and wanes, needs to be made.


The third panel discussion focused on policy reactions. The participants were Wendell Primus, Senior Policy Advisor on Budget and Health Issues to Speaker of the House Nancy Pelosi; Erik Rasmussen, Minority Professional Staff, Committee on Ways and Means; Mayra Alvarez, Office of Senator Richard Durbin; and Ellen-Marie Whelan, Center for American Progress. The panelists asked the question, "How do we implement the changes?" The current healthcare system is fiscally unsustainable. We need to be more efficient and avoid unnecessary costs. Spending more does not necessarily result in better return. Nursing will play an important role not only in primary care but also in transitional care; the nurse will coordinate care from hospital to home. The knowledge, skills, and abilities of the nurse and others in healthcare need to be maximized. Address workforce issues and payment reform; however, do not talk in extremes. Keep the message positive.


NACNS is at the forefront of representing CNSs in healthcare reform. A very successful 7th annual NACNS summit was held in July at the Sigma Theta Tau International headquarters in Indianapolis, Indiana. Representatives from 23 nursing organizations met to discuss the CNS doctoral competencies (currently being circulated to nursing organizations for endorsement), CNS education standards (in the beginning stages of development), and visioning of the role of the Clinical Nurse Specialist in a reformed health care system. A draft of a document outlining the role of the CNS in a reformed healthcare system was distributed for comment. Suggestions made will be incorporated into the document and a final version will be shared with the representatives who attended the summit as well as other interested parties. The document outlined 6 major points in which CNSs play a vital role: (1) Increase the effectiveness of transitioning care from hospital to home and preventing readmissions. (2) Improve the quality and safety of care and reduce healthcare costs. (3) Increase the availability of effective care for those with chronic illness. (4) Improve access to wellness and preventive care. (5) Increase access to community-based care. (6) Increase the number of nurses to meet the needs of an aging population and the needs of a reformed healthcare system. NACNS encourages all CNSs to contact representatives of their specialty organizations, as well as NACNS, to obtain a copy of this document outlining the role of the CNS in a reformed healthcare system. Please share it with your colleagues, employers, local, state, and federal representatives, and the public. Clinical nurse specialists make an impact in healthcare now. Just think what we can do in the future as leaders, developers, coaches, facilitators, and researchers. The possibilities are endless!


Member News

Charlene Winters, PhD, ACNS-BC, associate professor at Montana State University College of Nursing, has been active in the American Association of Critical Care Nurses for nearly 25 years. Beginning July 1, she assumed a new role with the American Association of Critical Care Nurses as a contributing editor for academic education for the journal Critical Care Nurse.


Tina M. Cox, MSN, perinatal clinical nurse specialist (CNS), recently published an article in the June issue of the Journal of Nursing Education entitled "Evaluation Tool for Clinical Nursing Textbooks: Bridging Content Analysis With Evidence."


Christine Swartzkopf, gerontological CNS in nursing education at the Dayton VA Medical Center, has written a chapter on "Caring for the Patient With Dementia" in Kristen L. Mauk's new book Gerontological Nursing: Competencies for Care (May 2009).


Ann Busch, Liver Transplant Program CNS at the Portland, Oregon VA Medical Center, has been selected for induction as a Fellow in the American Academy of Nursing. The induction will take place in November 2009.


California CNS member Patricia Perry published in the June edition of Journal of Nursing Informatics. Patricia coauthored an article entitled "Course Development: Nursing Informatics."


Yvonne Dobbenga Rhodes, CNS member from California, recently had an article published, "Responding to Amniotic Fluid Embolism," in AORN Journal [June 2009; 89(6):1079-1092]. This was featured as the month's CE offering.


Joyce Tanaka, RN, CNS, CDE, in Fremont, California, presented to new diabetes care managers, "Diabetes Update, Insulin Tactics, and Case Studies," sponsored by Kaiser Northern California. She also gave a presentation on "Insulin and New Devices in Diabetes" to internal medicine physicians at Kaiser. Joyce is developing a 1-hour presentation via WebinAir to be offered on October 20-22, 2009, for diabetes care managers in Northern California, sponsored by Kaiser Regional Health Education.


Marlene Nadler-Moodie has a new publication in print: "Clinical Practice Guideline: 1 Hour Face-to-Face Assessment of a Patient in a Mechanical Restraint" [Journal of Psychosocial Nursing. 2009;47(6)].


Web-Based Program Available for Developing Clinical Nurse Specialist Preceptors

As clinical nurse specialist (CNS) programs grow, the need for CNS student preceptors is increasing. Indiana University is pleased to announce a new, Web-based program: "Developing Your Skills as a Clinical Nurse Specialist Preceptor." This program introduces participants to the role of clinical preceptor working with graduate students and faculty at a school of nursing. The course is based on a preceptor model in which the student, faculty, and preceptor work together to facilitate student acquisition of course competencies. The self-paced format allows participants to enroll and proceed through the content on an individual schedule and is designed to be completed without instructor facilitation or discussion. The course is composed of several modules and a multiple-choice posttest.


The course is recommended for CNSs interested in becoming a CNS student preceptor or for CNSs looking for ideas to update or expand preceptor knowledge and skill. Faculty teaching in CNS programs and supervising CNS student clinical experiences may be interested in recommending the course to CNS preceptors. Each module contains discrete topics related to precepting. Learning activities throughout the course provide opportunities to apply concepts learned or to expand knowledge in selected topics. Suggested readings are provided. The course is endorsed by the National Association of Clinical Nurse Specialists and linked on their Web site at, or go to For more information, contact the Indiana University Office of Lifelong Learning at (317)274-7779 or by e-mail at The cost is $35 per participant; group rates are available.

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Affiliate News

Oklahoma Affiliate

The Oklahoma Association of Clinical Nurse Specialists (OACNS) hosted its annual conference this past April 2009. We had a special evening session with a brief history and advancement of OACNS and then a special presentation by Susan Dresser, MS, APRN, CNS, on the proposed APRN Regulatory Model and implications for clinical nurse specialist (CNS) practice. The conference included 2 full days of pharmacology-related presentations. In June, we held a membership meeting and a successful presentation on acute stroke management. In September, we plan on celebrating National CNS week and having a birthday cake in honor of Hildegard Peplau.


We continue to strive to increase our membership numbers and are constantly on the watch for opportunities to represent our CNSs in Oklahoma.


April Merrill, MS, APRN, CCNS


President, OACNS


California Affiliate

The California affiliate had a spring conference on Saturday, April 18, at California State University at San Marcos. The conference title was "Process Improvement and EBP: Taking It to the Next Step." Once again, we had a great slate of speakers that included Ann Mayo, Caroline Etland, Liz Budek, and our own chair Paddy Garvin. We thank Margaret Talley and Palomar Pomerado Health for hosting this meeting. The summer educational offering is slated again in Santa Barbara. It will be held on Saturday, July 18, and our hostess, once again, will be Vicki Lekas and Cottage Hospital. The topic is "Clinical Nurse Specialists: Ensuring Clinical Excellence throughout the Magnet Journey and Beyond." We are still planning for our November 2009 Annual Conference to be held in Northern California Stanford University Medical Center. Garrett Chan and Jim Stotts will be hosting.


The California clinical nurse specialist board continues to be very active. Former chair Evelyn McLaughlin revised our membership brochure. Patti Radovich has distributed a first draft of our white paper on clinical nurse specialist prescriptive authority and has also been named a contributing editor for Critical Care Nurse. The board, led by Paddy Garvin, is expanding our conference calling board meeting so that we can capitalize on technology. Our recent board meetings have used Web-based online meetings and we are planning future videoconferencing.


Submitted by Margaret Talley


Wisconsin Affiliate

Wisconsin Association for Clinical Nurse Specialists


Our association continues to grow with more than 100 members. We offer a general meeting for all members on the odd-numbered months that includes an educational offering. Offerings for 2009 have included studies on the effectiveness of hourly rounding, a panel on DNP education from area universities, and a panel on various clinical nurse specialist/advanced practice nurse models. We also have a steering committee meeting on each even-numbered month where details raised during the general meeting are worked out.


Membership in our organization is free. We recently had a graphic artist design a logo for our organization. A task force had pins made with our logo, which are available for purchase for $20. Funds raised will be used to promote the mission of our organization.


Our organization has also joined the WI Nurses Coalition, which consists of various nursing groups and organizations around the state. This participation may allow us to have a voice in big picture nursing activities.


We are also planning to hold our first clinical nurse specialist daylong conference on November 12, 2009. Several outstanding speakers having already been confirmed, and a call for abstracts is out.


Current officers include Sue Fuhrman, president (ProHealth care); Stephanie Kraus, president-elect (UW Health); Brenda Larkin, treasurer (Aurora Healthcare); Michel Hardwick (Wheaton Franciscan Healthcare); and Tim Heyse (Aurora Healthcare). Nominations for president-elect and treasurer will take place later this summer, with elections to follow this fall. New officers are installed in January each year.


To find out more about our organization or any of the information described above, please google WIACNS to get to our Web site and find the details.


Oregon Affiliate

Oregon Council of Clinical Nurse Specialists


It is my pleasure to welcome Mary Waldo, PhD, RN, GCNS-BC, as incoming chair to the Oregon Council of Clinical Nurse Specialists (OCCNS). The OCCNS has been very fortunate to have Mary involved as an executive member for the past 5 years, and we look forward to her leadership starting in Fall 2009 through 2011.


Mary Waldo is a clinical nurse specialist (CNS) at Providence St Vincent's Hospital in Portland, Oregon, and is PhD prepared with her national certification in gerontology. Mary has been a CNS for 9 years. She is looking forward to connecting with and encouraging increased participation with CNSs in the state.


For many years, Mary has been a member of the Research Council for the National Association of Clinical Nurse Specialists (NACNS) and participates in planning for the NACNS National Conference and the Northwest Clinical Nurse Specialist (NWCNS) Conference. In addition, she reviews abstracts for the NACNS National Annual Conferences.


Mary will provide great leadership for the OCCNS and the CNSs in Oregon.


Respectfully submitted by Jane Sawall, MS, MPH, RN, CNS-BC


Chair, OCCNS


National Association of Clinical Nurse Specialists Updates

Are You Familiar With the Following Terms?

And more importantly, are you using them frequently in conversations, discussions, planning and work surrounding safety, quality, and improvement efforts in your role as a clinical nurse specialist?


* QSEN-Quality and Safety Education for Nurses


Program funded by the Robert Wood Johnson Foundation to address the challenge of preparing nurses with competencies surrounding quality and safety in the healthcare systems in which they work. In addition to the Web site (, more can be found in the Nursing Outlook Special Issue on Quality and Safety Education, May/June 2007;55(3).


For faculty, watch for information on 9 QSEN Educational Consortiums across the United States to be held in 2010 starting in January. Each will be a 21/2-day workshop on the QSEN competencies developed for faculty teaching in prelicense nursing education programs.


In addition, the first QSEN National Forum is scheduled for June 2 to 4 in Denver, Colorado. The forum is designed to attract innovators and nurture faculty leaders for the improvement of quality and safety education.


* TCAB-Transforming Care at the Bedside


A national program developed and managed by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement to engage frontline hospital nurses and leaders at all levels to improve quality and safety, retain nurses, improve patient experiences of care, and improve the effectiveness of the healthcare team. A total of 67 hospitals have participated in the phase 1, 2, and 3 of the program, and what are called TCAB principles are being applied across the country and internationally. You can learn more about the program at And you can print a TCAB toolkit for free from Most of the terms listed below can be found there.


* LEAN techniques




* Push/Pull


* Spread


* Deep Dive


* Snorkel


* Adopt, Adapt, Abandon



These are just some of the current specific topics and focus at national conferences on quality improvement, education, and practice.


If you are leading or participating in activities related to what is on this list, stay involved. If you are familiar with some but not all of these terms, learn more about those that are not familiar. If none of them are familiar to you, and you are in any way accountable for safety and quality improvement in your organization, you need to get up to speed. These are the areas others in your organization are probably talking about, and what your Chief Nursing Officer (CNO) and Chief Executive Officer (CEO) are hearing about from other CNOs and CEOs. Clinical nurse specialists bring basic knowledge and competencies important for the work related to these areas.


NACNS Convenes Seventh Annual CNS Summit

Representatives of 18 clinical nurse specialist (CNS) stakeholder organizations gathered for the seventh annual CNS Summit on July 9 to 10 at Sigma Theta Tau headquarters in Indianapolis. The summit is an invitational meeting that provides the opportunity for NACNS to share information with specialty nursing organizations with significant numbers of CNSs in their membership, certification agencies, and others such as ANCC, CCNE, NLN, and NLN-AC. This year's agenda included a presentation by Diane Thompkins of ANCC about the CNS certification and the core CNS examination as well as NACNS' practice doctorate competencies and the work of the NACNS Education Standards task force. Participants also discussed the role of CNSs in healthcare reform.


Core Practice Doctorate Clinical Nurse Specialist Competencies

The National Association of Clinical Nurse Specialists' (NACNS) newly created Core Practice Doctorate Clinical Nurse Specialist Competencies were approved by the NACNS Board of Directors on June 12, 2009, and were sent to stakeholder nursing organizations for endorsement on June 23rd. The core doctoral competencies are entry-level competencies for CNSs prepared in practice doctorate programs. Representatives from 18 invited professional nursing specialty organizations participated in a Task Force charged with developing the competencies over the last 2 years. NACNS is pleased to announce that specialty nursing organizational endorsements have already been received!


NACNS Award Nominations Due

National Association of Clinical Nurse Specialists is presenting five awards this year: CNS of the Year, CNS Educator of the Year, CNS Preceptor of the Year, CNS Researcher of the Year, and Affliate of the Year. Applications for these awards are due November 15, 2009. There is a separate application form for each award. Go to HYPERLINK "" to obtain a copy of the application and award criteria.


National CNS Recognition Week

At our March 2009 conference, the National Association of Clinical Nurse Specialists proudly announced that the first week of September has been established as National CNS Recognition Week. This important celebratory event coincides with the September 1, 2009, 100th birthday of Hildegard Peplau, who established the first clinical nurse specialist (CNS) program at Rutgers University in 1954. Please join together with your fellow CNSs and celebrate this accomplishment!