1. Muller, Anne C. RN, MSN, BC-CNS

Article Content


This presentation describes a novel use of regulatory agency recommendations strategically translated for sustained improvement in diabetes mellitus (DM) care. As a patient advocate capable of system-wide influence, the diabetic clinical nurse specialist (CNS) at a quaternary care facility overlaid the Joint Commission's (JC) disease-specific certification guidelines to current nursing processes to evaluate existing practice and identify gaps. The CNS then implemented technologic innovations to ensure sustained global improvement throughout multiple clinical care areas. Applying select aspects compelled system improvement while supporting the individual priorities of several health system entities.



In the United States, 8.0% of the total population is diagnosed with DM, with 1 in 3 of people born in 2000 projected to develop DM in their lifespan. The economic costs are estimated at $174 billion, with higher costs portended due to longitudinal data demonstrating an association between glucose level in middle age and future costs. The inclusion of "glycemic excursions" in the never events adds further urgency to developing integrated programs focused on successful strategies to control glucose levels throughout a hospitalization while demonstrating that patients understand and are able perform self-care following transition to the outpatient setting.



DM disease-specific certification guidelines can establish a foundation for improved care processes. Technologic tools augment processes, ensuring sustained practice improvements are embed.



Certification programs link specific management processes with long-term success in improving outcomes. Elements include education, tracking of outcomes using technology, evidence of patient adoption of self-management techniques, and more. This presentation will discuss examples of institutional performance measures, systematic analysis of outcomes, and data entry for cross analysis and comparative performance evaluation.



Selective application of certification criteria assists CNSs in improving the health of patients with chronic illness.



Process improvement strategies reduce the frequency of blood glucose serum excursions.


Implications for Practice:

CNS practice must move from the translation of research to adopting effective, efficient methods to improve practice. Acute care innovations must ensure high-quality care and safe patient transitions. The direct cost and lost productivity concerns of employers and purchasers looking to control costs must also be considered.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.