1. Zuzelo, Patti Rager EdD, MSN, RN, ACNS-BC

Article Content

President's Message

Politicians are the same all over. They promise to build a bridge even when there's no river.


Nikita Khrushchev


This is my first President's message, and in preparation, I have been contemplating the sort of bridge I should promise to the National Association of Clinical Nurse Specialists (NACNS) members without fully knowing what the bridge will need to span. I do know that contrary to Khrushchev's observation, there is a river of sorts, a tumultuous river symbolizing powerful currents associated with recent events that will challenge the NACNS while potentially offering opportunities for rapid shifts in clinical nurse specialist (CNS) practice paradigms.


Have no doubt that there will be significant challenges over the upcoming year in response to national health reform, economic circumstances, regulatory and political challenges, and educational evolution. Although there may be new opportunities available to CNSs, perhaps including unique partnerships with healthcare colleagues in novel care arrangements, there will most certainly be challenges. For example, NACNS membership growth has flattened, consistent with national trends, particularly given difficult economic times. Growing membership is imperative for future success, not measured by economic growth per se, but rather measured by having the resources necessary to support critical endeavors. I believe that the NACNS must proactively evaluate its business model, critique structures and practices, and advantage new opportunities.


The doctor of nursing practice (DNP) degree continues as a hot button for many members, particularly for those who educate and those without time or inclination to pursue a degree sometimes perceived as having little tangible benefit. The passionate positions are clearly evidenced via review of electronic discussions.


It is worth sharing that I direct a newly developed DNP program. I also coordinate a master's degree CNS track. Why is this background information relevant? First, transparency is important for authentic leadership. My activities are informed by my belief system, and this belief system cannot help but influence how I represent the NACNS in my role as president. The NACNS needs to support all its members, regardless of educational preparation, while appreciating that not all CNS programs are taught in colleges and universities with charters, faculties, or administrators amenable to awarding the DNP. Also noteworthy, master's degree-prepared CNSs demonstrate excellent clinical outcomes. These CNSs cannot be disenfranchised, nor should those who educate these clinical experts.


The number of schools engaged in DNP education is striking. Very few DNP programs, if any, have dedicated CNS tracks. It seems to me that this is the area that the NACNS needs to address. It is imperative that nurses enrolling in BSN-DNP programs to become CNSs or in post-master's degree DNP programs experience learning opportunities that are relevant to CNS practice. These nurses should be supported, nurtured, and encouraged. The 2009 Board of Directors issued a statement in reinforcing that the NACNS is currently DNP-degree neutral. The organization will do its part to collaborate with other professional groups to ensure that regardless of the type of degree awarded in a CNS program of study, the educational experience develops a graduate prepared to meet the competencies of CNS practice within each of the spheres of influence.


Collaborative efforts will be important during the year, and I anticipate that the NACNS will have many opportunities to partner with other national organizations. Halldorsdottir's theory of caring1 provides an analogy for the partnership work required of the NACNS. This theory identifies a continuum of caring to uncaring behaviors that apply to the caregiver in the nurse-patient relationship. Halldorsdottir identified 5 forms of being with another that may be relevant to organizational partnerships. These relationship forms include life giving (biogenic), life sustaining (bioactive), life neutral (biopassive), life restraining (biostatic), and life destroying (biocidic). Since its inception, the NACNS has been the subject of and partnered with organizations that have interacted in caring relationship forms varying from biogenic to biocidic. The dark side of human encounters, perhaps of organizational partnering, is characterized as an interaction bereft of caring.2,3 The NACNS will seek partnering opportunities with organizations that are positive and strength enhancing, while recognizing that threats are real and biocidic partnerships must be identified and managed.


Halldorsdottir2 characterizes caring encounters as a metaphorical bridge representing the connection between the caregiver and the care recipient. The bridge symbolizes mutual trust and respect.3 Perhaps, the bridge that I should promise is better linked to Halldorsdottir's metaphor rather than to Khrushchev's observation.


During the upcoming year, I commit to bridge building with affirming partners, including expert and enthusiastic NACNS members, over rivers formed from known and unknown political and social tributaries while doing my best to navigate treacherous waters.


I encourage you to participate in this bridge building. Volunteer for the NACNS work, and, if you believe that you lack access, be persistent. Involve yourself in some way whether by contributing to the listserv, writing for the journal, reviewing conference abstracts, participating in a local or regional affiliate, representing the NACNS at your specialty meetings[horizontal ellipsis] whatever your level of involvement, it is important.


I look forward to working with you.


Affiliate News

California Affiliate

We are planning our all-day conference in Palo Alto (Northern California) for April. Dr Garret Chan, our Northern California director, is hosting and coordinating the efforts. We look forward to an exciting program. Thanks to our Web mistress and former chair, Paddy Garvin, and our membership director, Barbara Switzer, the California Association of Clinical Nurse Specialists membership renewal for 2010 is in progress. Barbara reminded members that we are their key connection to educational programs, legislative updates, and general information regarding CNS activities in the state of California. Thanks to Paddy and Barbara, the renewal application is on our Web site. The Web site can be accessed through or (The CACNS Network name will be officially dropped after May 2010.)


Margaret Talley, RN


University of San Diego


Florida Affiliate

Our affiliate, Association of Central Florida Clinical Nurse Specialists, added in-services to each meeting to increase our membership participation. Those of us who were eligible have applied and received our CNS licensure from the Florida Board of Nursing. Two of our members were involved with CNS Core Competency pilot examinations, Patricia Barry, MSN, CNS, RNC, CNS in OB, and Barbara Hatfield, MS, CNS, ACNS-BC, OCN; both took the first pilot test (paper version), and Barbara took the second pilot test (computerized).


Barbara Hatfield, ACNS-BC, MS, OCN, ACRN


Emergency Department, Tampa General Hospital


Oklahoma Affiliate 2010 OACNS Advanced Pharmacology Conference: Influencing, Empowering and Elevating Practice

The Oklahoma Affiliate is pleased to announce that the 3rd Annual OACNS Advanced Pharmacology Conference will be held April 15-17th 2010 at INTEGRIS Baptist Medical Center in Oklahoma City. For more information on topics, speakers or to register for the conference visit our website at:


VA Virtual Affiliate

Kathy Dunn, CNS at the VA San Diego, has written a practice exemplar chapter in the new book, Foundations of Clinical Nurse Specialist Practice. She also was granted the CNS-BC (Core) certification by ANCC in November 2009.


Kathleen L. Dunn, MS, RN, CRRN, CNS-BC


Clinical Nurse Specialist & Rehabilitation Case Manager


Spinal Cord Injury Center (128)


VA San Diego Healthcare System


Wisconsin Affiliate

The Wisconsin Association of Clinical Nurse Specialists was organized in 2007 and with much excitement is pleased to share that only 2 years later, our first all-day conference was very well received. The conference entitled "CNS Influence: The 'HOW' of Advanced Nursing Practice" was held November 12, 2009, at the Aurora Conference Center. Poster topics included fall prevention strategies, pet therapy, venous thromboembolism prophylaxis, sitter utilization, communicating the CNS role to staff nurses, advanced practice nurse case management reflective practice, pain assessment, nursing grand rounds, and electronic health record-driven case management referrals. The keynote speaker, Patricia Schroeder-Kashou, RN, MSN, MBA, FAAN, started the day with an intriguing, thought-provoking session on "What Is Your Elevator Speech?" Clinical nurse specialists interact with many different customers, and it is critical to be able to succinctly communicate our role. Participants were challenged to consider various models to construct an elevator speech within the context of the current economy, healthcare industry, workforce issues, technology revolution, and consumer expectations. Teri Vega-Stromberg, MSN, RN, AOCN, ACHPN, then followed with a unique session on "Clinical Nurse Specialist: Developing an Unwritten Role," which not only provided neophyte CNSs and CNS students with goals/benchmarks for role development, but also gave strategies for the veteran CNS self-appraisal and renewal for continued role development within the current changing healthcare arena.


A panel of Susan Nuccio, MSN, RN, ACNS-BC, CGRN; Lee Jeske, RN, GCNS-BC; and Lisa Gorski, MS, RN, HHCNS, BC, CRNI, FAAN, shared examples of evidence-based practice implementation projects. Examples included development of a national evidence-based nursing Web site, using the electronic health record to assess and manage delirium, and infection prevention and indwelling urinary catheter management in home healthcare. Panel discussion gave participants additional ideas for personal practice implementation.


Breakout sessions included Sheryl Scott, MSN, RN, on "Health Literacy: A Threat to Patient Safety"; Mary K. Trudell, MS(c), RN, on "Not Just Another Education Offering[horizontal ellipsis] Keeping It Fresh"; and Tim Heyse, MSN, RN, on "CNS Toolkit for Crucial Conversations." These sessions provided multiple strategies to support all roles that CNSs fill.


Our final speaker, Julie Darmody, PhD, RN, ACNS-BC, closed the conference with her research entitled "An Exploratory Study of the Work of Clinical Nurse Specialists in Acute Care: Structure, Process, Outcomes, and Cost." Data regarding CNS work activity, contact/interactions with others, and workload were shared, which also provided insight into developing one's various elevator speeches.


Conference evaluations were very positive, and plans are under way for our next conference to create unique sessions to meet the needs of all CNSs.


NACNS Members Inducted Into the American Academy of Nursing

The American Academy of Nursing fellows are recognized as nursing leaders in education, management, practice, and research. Invitation to fellowship is a highly regarded honor and recognition of one's professional nursing accomplishments. In November, 4 NACNS members were inducted into fellowship at the 36th Annual Meeting of the American Academy of Nursing.


Demetrius James Porche, DNS, RN, APRN, BC, is dean and professor at Louisiana State University Health Sciences Center in New Orleans School of Nursing. A consistent theme throughout his career has been the translation of research into advocacy, policy, and nursing practice, focusing on men's health and HIV prevention as a health disparities issue in underserved populations. His HIV-prevention efforts have resulted in the development of HIV-prevention curricula and prevention programs targeting the African American population.


He is the founder and editor-in-chief of the American Journal of Men's Health. He has developed a CD-ROM/DVD on male reproductive health that is utilized nationally to train physicians and advanced practice nurses in family planning clinics.


Kathleen M. Vollman, MSN, RN, CCNS, FCCM, is a critical-care CNS and owner of Advancing Nursing LLC. As a CNS for the medical ICUs at Henry Ford Hospital in Detroit, Michigan, she was involved in many quality and research initiatives to improve care. She is widely recognized for her contributions to critical-care nursing and CNS work. Through consultations, presentations, and publications, she has worked toward creating healthy work cultures, adoption of evidence-based nursing care practices, and shaping/promoting the role of the CNS nationally and internationally. Ms Vollman invented a support frame to position patients prone and received a patent in 1989. She conducted studies to evaluate the safety/function of the device and the effect of prone positioning on critically ill patients. She developed a care procedure and consulted on additional studies and multiple publications that set the standard for safe prone positioning worldwide. As a founding member of the NACNS, she helped develop the bylaws and infrastructure and served as a director on the initial board and membership chair for many years. In 2009, she received the NACNS's Sue B. Davison service award. She also worked on the American Association of Colleges of Nursing's Scope of Practice and Standards for Acute and Critical Care Clinical Nurse Specialists. In recognition of her professional contributions, Ms Vollman was inducted into the College of Critical Care Medicine in 2004.


Ann Herbage Busch, MS, RN, ACNS-BC, CWOCN, is the liver transplant CNS at the Portland Veterans Affair Medical Center in Portland, Oregon. Ms Busch pioneered the liver transplant CNS role at Portland Veterans Affair Medical Center and is an internationally recognized expert in liver transplant nursing. In addition to her clinical responsibilities, she provides leadership locally, nationally, and internationally to improve practice and policy related to transplantation. She is currently chair of the National Task Force, developing computerized transplant referral templates for the Veterans Health Administration.


Ms Busch is adjunct faculty at the Oregon Health Sciences University School of Nursing. Her passion for nursing and excellence as a mentor and role model make her a highly sought-after clinical preceptor. She has conducted funded research on end-stage liver disease and immunosuppressive medications and has published studies on vancomycin-resistant enterococcus and risks associated with herbal supplement use.


Ms Busch led policy efforts in Oregon to shape CNS scope of practice and establish CNSs as licensed independent practitioners with optional prescriptive authority. Her leadership contributions to the Oregon Nurses Association are ongoing. Ms Busch has been recognized for her outstanding contributions to the nursing profession with numerous local and national awards, including the first NACNS CNS of the Year Award (2002) and the AMSUS/Society of Federal Health Agencies 2004 Clinical Nursing Excellence Award.


Sharon D. Horner, PhD, RN, MC-CNS, is a professor at the University of Texas at Austin School of Nursing. Her research addresses the major childhood health problem of asthma. Her work focuses on populations that have traditionally been overlooked (eg, rural populations, Mexican Americans, many with lower health literacy). Grants from the National Institutes of Health and other sources support her research, which is designed to improve the health and quality of life of children and their parents. Dr Horner works with state (Texas Department of State Health Services, Texas Nurses Association), national (National Institutes of Health, Society of Pediatric Nursing, National Association of Clinical Nurse Specialist Legislative/Regulatory Committee), and local groups to improve healthcare services for children. As chair of the institutional review board of an 8-hospital community healthcare network, she increased the mission of the institutional review board from covering only oncology studies to covering all disciplines, thereby providing essential support for the department of nursing to achieve Magnet status.


Randall Hudspeth, MS, APRN-CNS/NP, FRE, FAANP, director of Advanced and Specialty Practice at Saint Alphonsus Regional Medical Center in Boise, Idaho, recently published Charting Idaho Nursing History.


Charting Idaho Nursing History relates the story of how nursing evolved in Idaho. Similar to a family genealogy, it begins with questions about where nurses came from, who they were, and what they did to establish the foundations for nursing practice in the new state. Since Idaho's beginning, nurses consistently contributed during wars, epidemics, and natural disasters. They built hospitals, established nursing schools, and introduced health departments and nursing homes. Searching old Idaho newspapers, sifting through community historical society records, and perusing beautifully hand-scripted minutes from the early nursing board meetings and learning from oral histories all helped to tell this story. The chapters link the significant events of the time, the nurses who shaped the profession during the decade, and also share interesting historical photos. The end result is a book that hopefully keeps the readers interested and, for the first time, documents the incredible events of nursing in Idaho.




1. Halldorsdottir S. Five basic modes of being with another. In: Gaut DA, Leininger MM, eds. Caring: The Compassionate Healer. New York: National League for Nursing Press; 1991:37-49. [Context Link]


2. Halldorsdottir S. Caring and Uncaring Encounters in Nursing and Healthcare-Developing a Theory. Linkoping, Sweden: Department of Caring Sciences, Faculty of Health Sciences, Linkoping University; 1996. [Context Link]


3. Bailey D. Care defined: a comparison and analysis. Int J Hum Caring. 2009;13(1):16-31. [Context Link]