1. Fulton, Janet S. PhD, RN, ACNS-BC, FAAN

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Health care reform presents new options for expanding the clinical nurse specialist (CNS) role and practice. Now is a good time to reexamine your career and take inventory of strengths and gaps compared against a changing health care landscape. Continued employability cannot be taken for granted; the job that always was soon will look very different. Educational programs prepare students for entry-level practice. Skills and abilities are easily eclipsed by the next scientific or technical wave and the waves are coming faster. Managing a career requires a life-long commitment to being the best provider possible for the job at hand even when the job seems to morph overnight.


A traditional career development model was linear and included steps like self-awareness, performance assessment, development activities, opportunity identification, planning and implementation, and so forth, until achievement of a goal or stage. To continue moving a career forward, repeat the process. Expertise develops across time and with achievement of new goals. Ensuring employability in the near future and beyond will require a new kind of career development model, one that focuses on being out in front of opportunities and shaping a career in conjunction with, not in response to, changes in health care. Now, the key to success is being keenly aware of abilities while scanning the landscape for matches and partial matches. Be the first provider to suggest an innovative approach such as a new program for fixing a problem or a partnership that complements the organization's mission. Do not wait for an invitation; do the inviting. Be bold. Develop a proposal including description of the problem, purpose of the program, measurable goals, the activities to be performed, and a data-based evaluation plan. Include required resources, projected costs, and anticipated benefits. Send the proposal forward. Put your name on your work! Be confident. As the program evolves, fill in any gaps in your abilities by seeking mentors, networking with peers, or attending strategic professional conferences and meetings. Mentors can come from any profession. For example, 1 mentor may be needed to help with budgeting, and another for using technology. Network with colleagues to find out what was tried in similar situations and with what results. Use the best evidence available to support decision making, but remember that being ahead of the curve means being a pioneer. No paved roads. The best information may come from the field, so develop a broad network of colleagues with diverse expertise. Read a wide variety of literature and news reports to identify emerging trends and gaps in services, which means reading outside nursing. Monitor the health administration literature and pay close attention to economics and politics. Ugh, politics. Don't like politics? Get over it. Now more than ever, health care and politics are bed partners. Failure will be swift and sure for those not paying attention to the politics of health care. Put at least 1 major newspaper or news magazine on your routine reading list. Public libraries make these items available on most e-reader devices at no charge to patrons. Find a credible blog site or two for keeping up to date with public opinion. It's especially important touch base with all viewpoints and competing sides of an argument. Your career and continued employability will depend on moving quickly to be ahead of the curve.


Every CNS should belong to 2 or 3 professional organizations to stay current and be networked within the CNS role, clinical specialty, and the profession at large. Don't just belong, be engaged in the work of the organization. Serving on a committee or a board can greatly improve networking options. Don't limit yourself to nursing or health care organizations. Engage with public service groups and organizations at the local or state level; it's a great way to meet leaders in the community with similar interests but different backgrounds. And here's 1 more consideration for a continued career in chaotic times. Publish! Nothing says credibility to employers, other providers, and the public like peer-reviewed publications. Make time, and that means make time, to publish the outcomes of your innovations, programs, and interventions. Publication gives your career validation and authority.


Most importantly, invest in yourself. Spend time and money. Gone, long gone, are the days of attending professional conferences with the sponsorship of an employer. Never miss a critical conference or important professional meeting because it is not being funded by someone else. As always, negotiate for benefits such as professional develpment monies, but don't stay home because a hospital isn't funding attendance. Take vacation time and write the check yourself. It's for your career. What is your personal annual career development budget? Plan to invest a minimum of 5% to 8% of annual salary in professional career development, a career for which you have already spent much time and money to establish. Career maintenance isn't free. And besides, the next great opportunity may be at the hospital or clinic system across town. Don't be beholding to 1 health care system. Be ready to move with emerging opportunities. Career development for the future will go hand in hand with early recognition of opportunities for meeting public demand for services. The job of the future is the job you invent!