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

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President's Message

This is the time of year when our thoughts turn to snow and cold, at least for some of us. Others may think about the get-togethers with family and friends that usually accompany "the holidays." Wonderful dinners, smiling laughing, gift giving. Others are missing family members in another country or continent. Some are safe and secure, while others may be in harm's way.


Something else that occurs at this time of year from a professional perspective is graduation. Numerous undergraduate and graduate nursing students will finally receive the diploma that signifies several years of hard work, sacrifice, and financial investment. They will embark upon the journey to a new career or enter a new phase of an existing career. How will the new members of the nursing profession be greeted, precepted, and mentored? The first few months of a new job often determine if a person remains or leaves. How can we as clinical nurse specialists (CNSs) impact the new graduates' decision to remain in nursing and become contributing members to the profession?


The CNS has a significant impact on the senior staff nurse as well as the new graduate. The CNS is a role model for verbal and nonverbal behavior, communication, knowledge, skills, and abilities. The inexperienced as well as the experienced nurse observes the CNS's every move and interaction. A big responsibility! Because the CNS is the role model for so many things, the CNS is also the role model for creating a "culture of civility." This is a relatively new term used to describe how nurses (and those in other professions) should treat each other. The phrase, "nurses eat their young," has been used for a long time. The time has come to eliminate that statement from the nursing vocabulary and replace it with a culture that incorporates professionalism and civility.


The CNS plays a role in orientation in many healthcare organizations. The CNS may even develop, implement, and evaluate the orientation program. Regardless of how much involvement the CNS has in the program, the CNS is still aware of the knowledge and skill level of the novice nurse. The CNS is the person that is a role model for patience when the novice does not know the scientific rationale for an intervention and is the coach when the novice needs to place a call to the physician. The more experienced staff nurse will observe the interactions between the CNS and novice nurse and, hopefully, adopt the same behaviors.


You may be wondering why I chose this particular topic for this month's column. Well, I recently attended a conference that included several sessions on critical care nursing. But one session especially caught my attention. That session discussed how nurses need to be more patient with each other. As soon as the speaker began, I remembered a recent conversation I had with an experienced nurse regarding a novice nurse. The senior nurse could not understand why the new nurse did not "know anything." The new nurse graduated from a nursing program 6 months earlier and had just completed the critical care course. I did what any CNS would do and gave a very detailed explanation why the novice did not "know anything" and what the experienced nurse could do to help improve the new nurse's knowledge, skills, and abilities.


I know this is just one example, but consider other encounters between experienced and nonexperienced staff. The new nurse today comes to the work setting with exceptional computer skills, a focus on technology, and different ways to do things. The novice may read the rationale for an intervention on a handheld personal computer rather than reaching for a book. The novice may communicate differently and may take less time to perform certain tasks, but that does not infer that the nurse is lazy or does not "know anything." The role of the CNS is to model an accepting behavior for the changes seen in the new graduate of today. Please understand, I am not inferring that the CNS should permit the novice to engage in unsafe practices; however, I am recommending that we, as advanced practice nurses, be in the forefront when the novice and the experienced nurse needs a patient and knowledgeable preceptor and mentor. Be a role model for professional and civil behavior. Then perhaps the nursing shortage will someday be a thing of the past.


Affiliate News

Virtual VA Affiliate

Kathryn Davies, clinical nurse specialist (CNS) at the Indianapolis Veterans Affairs Medical Center, participated with a group of advanced practice nurses who volunteered for a day in August at a local Habitat for Humanity project, building a home for a couple, both of whom are Veterans patients at their facility.


Submitted by Kathleen L. Dunn, MS, RN, CRRN, CNS


Clinical Nurse Specialist and Rehabilitation Case Manager


Spinal Cord Injury Center (128)


VA San Diego Healthcare System


Military Virtual Affiliate

After the national conference in March, members of various military services got together for the development of one of the newest affiliate to the National Association. LCDR Tina Cox and LTC Catherine Ryan are cochairpersons of the affiliate, whose current membership is 43. Members are composed of the Air Force, Army, and Navy. We are growing on a regular basis. The group is excited about all the new experiences that we are going to bring to our national association. As military clinical nurse specialists, we have various opportunities that our civilian counterparts do not. One of our members recently asked the question about studies being done on how the military CNSs are impacting the operational and deployed setting. That, along with other topics, is going to be the focus of our group in forwarding the advancement of all CNSs. We are honored to be part of this great association.


Atlanta Affiliate

The Atlanta Affiliate (Atlanta Area CNS Group) is hosting a fall conference entitled "CNS Perspectives: Driving Quality and Outcomes" on Friday, September 25, 2009, at Piedmont Hospital. Speakers will discuss clinical, legislative, and quality topics pertinent to CNSs.


Submitted by Monica Nelson


California Association of CNS

Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC, is an active member of the American Nurses Credentialing Center (ANCC) Content Expert Panel for Adult Clinical Nurse Specialists. The committee is currently working on the 2009 Role Delineation Study in Adult Psychiatric and Mental Health for clinical nurse specialists and for nurse practitioners. The group met in April in a combined forum, which included members from the clinical nurse specialist (CNS) group, the nurse practitioner group, and a core committee within the ANCC structure that worked on the combined examination, which will be offered in the future. The next meeting will be solely for the CNS Content Expert Panel: CNS in Adult Psychiatry and Mental Health to identify the knowledge and skill areas that are required to perform each of the task statements posed. This meeting will take place in September at the ANCC headquarters in Baltimore.


Ms Nadler-Moodie also recently published "Clinical Practice Guideline-1 Hour Face-to-Face Assessment of a Patient in a Mechanical Restraint" [Journal of Psychosocial Nursing 2009;47,(6):37-43].


Priscilla "Patti" Taylor MN, CNS, FNP, University of California, Los Angeles (UCLA) School of Nursing, and member of the California Affiliate, is helping America's Wounded Warriors by serving as a nurse case manager for Operation Mend, a new program that provides free reconstructive facial surgery for servicemen and servicewomen wounded in Iraq and Afghanistan. Taylor, who is a retired Army nurse, also heads up a volunteer quilting group that sews handmade "Quilts of Valor," which are presented to each patient before their first surgery at UCLA. Operation Mend is a joint collaboration between the Division of Plastic And Reconstructive Surgery at Ronald Reagan UCLA Medical Center, Brooke Army Medical Center in San Antonio, and the VA-Greater Los Angeles. For more information, or to donate to Operation Mend, please visit


Montana Affiliate News

We want to share exciting news about 2 members from the Montana Association of Clinical Nurse Specialists. Sandra W. Kuntz, PhD, PHCNS-BC, was accepted into the Robert Wood Johnson Foundation Nurse Faculty Scholars program. The program was created to help nursing faculty advance in their careers by giving them the opportunity to develop a research program; engage in institutional and national mentoring, leadership training, and networking; and have protected time to gain the critical skills needed for a successful career in academic nursing. The program is directed by Jacquelyn Campbell, PhD, RN, FAAN, Anna D. Wolf Chair and Professor at the Johns Hopkins University School of Nursing. Congratulations, Sandy!


National Association of Clinical Nurse Specialists member, Charlene "Charlie" Winters, from Montana State University, and Tanis Hernandez, clinical social worker and outreach coordinator at the Center for Asbestos Related Disease, were one of 20 pairs of researchers selected for the National Institutes of Health Summer Institute on Community-Based Participatory Research Targeting the Medically Underserved, held in New Orleans, August 2-7, 2009. The weeklong institute served as a tutorial on the essential conceptual, methodological, and practical issues inherent in planning and conducting research in partnership between communities and academic researchers. The institute was sponsored by the Office of Behavioral and Social Sciences Research, National Cancer Institute, National Institute on Drug Abuse, and the National Institute of Environmental Health Sciences.

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Members of the Montana affiliate continue to work toward increasing the research base for clinical nurse specialists in Montana through the conduct of research studies, presentations, publications, and dialogue. We welcome the opportunity to partner with nurses and colleagues from other disciplines to achieve this goal.


Submitted by Charlene A. Winters, PhD, ACNS-BC


Member News

Charlene A. Winters, PhD, ACNS-BC, associate professor in the College of Nursing at Montana State University-Bozeman and member of the Montana Association of Clinical Nurse Specialists; recently published Rural Nursing, Third Edition. Concepts, Theory, and Practice (Charlene A. Winters, RN, PhD; and Helen J. Lee, RN, PhD, editors). Thoroughly updated and revised, this new edition of Rural Nursing provides the knowledge, skills, and insight nurses must acquire to meet the unique needs of rural populations. Winters and Lee present a broad overview of the perspectives of rural persons, the characteristics of healthcare in rural settings, and the requirements for effective nursing practice.


Melanie Kalman and Cindy Wetzel wrote "Clinical Nurse Specialist-Is It the Role for You?" to be published in Dimensions of Critical Care in January 2010. The article targets critical care registered nurses who may be interested in learning more about the clinical nurse specialist (CNS) role. The article provides insights and perspectives presented during an interview with Kathleen Vollman, CNS. Some of the questions addressed are the following: Why did you become a CNS? Describe the practice role of the CNS. What's important in nursing today? What do you value most about the CNS role? What are your words of advice for the registered nurse considering a CNS career? Cindy is a critical care CNS at Salem Community Hospital, Salem, Ohio. Cindy is also a member of the National Association of Clinical Nurse Specialists (NACNS) Marketing Committee and has more than 20 years' experience in critical care nursing. Melanie Kalman is an associate professor at SUNY Upstate Medical University, College of Nursing. She worked as a critical care nurse for 17 years before beginning her teaching career. She has authored articles and given presentations about CNS education.


Two NACNS members have been elected to serve on the Academy of Medical-Surgical Nurses (AMSN) board of directors. Jill Arzouman, MS, RN, ACNS, BC, was elected as treasurer for 2009-2012, a position she has held since 2007. She will be responsible for overseeing AMSN's financial matters, including budget preparation and ensuring sound fiscal management for the association. Arzouman is a CNS at University Medical Center in Tucson, Arizona.


Jane Lacovara, RN, CMSRN, MSN, CNS, was elected as AMSN director for 2009-2012. She will be responsible for helping to oversee the strategic direction and operations of the AMSN. Lacovara is a CNS, surgery, at University Medical Center in Tucson, Arizona. The new board members assumed their respective positions at the conclusion of AMSN's 18th Annual Convention, September 9-14, 2009, in Washington, District of Columbia.


Jan Fulton PhD, CNS, was recently awarded a 3-year Health Resources and Services Administration continuation grant to prepare CNSs for rural and underserved areas of Indiana. This award totals $1.5 million over 6 years for both the initial and continuation grants.


Ann Herbage Busch has been selected for the Fellowship in the American Academy of Nursing and will be inducted on November 7, 2009, in Atlanta. Ann recently coauthored the "official" guidelines for the management of liver transplant patients from the American Society of Transplantation, "Long-term Management of the Liver Transplant Patient: Recommendations for the Primary Care Doctor" (American Journal of Transplantation 2009;9:1-16). Ann was the only nurse coauthor.


Jackie Close was the recent recipient of the prestigious Excellence in Gerontological Nursing Award presented by the National Geriatric Nurses Association (NGNA). Ms Close is an active member of NGNA and a member of the NGNA CNS SIG. Ms Close's past and current work to promote the health and well-being of older adults positioned her to be selected for this award.



Springer Publishing Company is pleased to announce the October 2009 publication of Foundations of Clinical Nurse Specialist Practice (Janet S. Fulton, PhD, RN; Brenda L. Lyon, DNS, RN, FAAN; and Kelly Goudreau, DSN, RN, CNS-BC, editors).


This book discusses every aspect of CNS practice, from its historical foundations to designing and evaluating interventions for targeted etiologies. The book includes sections on client care, promoting innovation, program planning and evaluation, coaching, teaching, and leadership, product evaluation, mentoring, and evidenced-based practice.


Drug Enforcement Administration Recognition


The National Association of Clinical Nurse Specialists (NACNS) Board of Directors was recently made aware of a situation of concern to clinical nurse specialists (CNSs) who apply for Drug Enforcement Administration (DEA) controlled substance registration. The DEA application offers only one nursing category: MLP (midlevel practitioner)-nurse practitioner (NP). The CNSs who apply for DEA registration therefore are being registered as NPs. Many state laws and regulations distinguish between the prescribing authority of NPs and CNSs, and the scope and prescribing privileges of the CNS and NP are often incorporated into different chapters of nursing codes and regulations. When the DEA registration uses terms that are not consistent with the state registration by title, the terminology


* misleads the nurse and the public into believing that the scopes and practices are equivalent. Although the scopes and practices may be similar in some states; they are markedly different in other states[i]; and


* impedes accurate data collection related to prescriber categories.



For these reasons, the NACNS submitted a written request for changes to DEA forms 224 and 224a that


(1) expand the identifying terminology used for MLPs to include the term clinical nurse specialist and


(2) change section 1 of forms 224 and 224a to expand the educational degree choices to allow CNSs to properly list their terminal degrees. As the DEA obtains direction for determining who can prescribe from state law, we request that the DEA expand the choice of degrees to include nursing master's degrees and doctoral degrees and all degrees recognized by state law for nurse prescribers, so CNSs who are prescribers can accurately list their degrees.



Clinical Nurse Specialist Core Certification Examination Discount


$100 Early Bird Rebate if you take the test by December 31, 2009!


The American Nurses Credentialing Center (ANCC) is looking for qualified nurses to sit for the ANCC Clinical Nurse Specialist Core (CNS Core) examination between the dates of September 1, 2009, and December 31, 2009. Candidates who sit for the CNS Core examination during this period will receive a $100 rebate off of their application fee. This rebate is in addition to any other discounts you are eligible for as a result of your membership in the American Nurses Association or National Association of Clinical Nurse Specialists (NACNS)! Candidates who pass this examination will earn the credential CNS-BC. All rebates will be refunded based on the original form of payment. Candidates must first apply and be determined eligible by the ANCC to sit for the CNS Core examination, then must take the test by December 31, 2009, to qualify for the $100 rebate. You can expect to receive your score results sometime in February 2010.


This CNS core certification examination is the result of a collaborative project between the NACNS and the ANCC to address a barrier to practice for a significant number of CNSs in the United States: lack of CNS certification examinations for all specialties. The core examination will test competencies expected and required for the role of the CNS across the life span regardless of specialty. This examination provides recognition of the knowledge, skills, and abilities for the role of the CNS. For more information, go to:


Michael Nicol


Senior Education and Community Partnership Specialist


American Nurses Credentialing Center


Plan now to attend the NACNS Annual Conference in Portland, Oregon


CNS as Internal Consultant: Influencing Local to Global Systems, March 4-6, 2010 Hilton Portland & Executive Tower, Portland, Oregon Portland is a beautiful city of mountains, waterfalls, rivers, wetlands, and wildlife reserves. There is no end of opportunities for cycling, river tours, kayaking, shopping, hiking, rafting, visiting farmers' markets, rose gardens, wine tasting, and vineyard tours!