Year: 2021

A Few Minutes With ANA’s Vice President Of Innovation Oriana Beaudet

Oriana Beaudet DNP, RN, PHN started her position as ANA’s Vice President Of Innovation just as the pandemic was beginning to impact the world. Some would say that it was a tough time to start a new job focused on innovation for nurses. Weren’t all nurses busy with pandemic-related duties? When would they have time to “innovate?”

The pandemic forced nurses out of their organizational routine procedures. It changed the way they got things done making the environment a fertile ground for innovation.  It’s this fertile ground that Dr. Beaudet is sowing with the “seeds” of innovation. We caught up with her recently to find out more about innovation and creating innovation spaces for nurses.

Q. Can you share the innovation work happening at the American Nurses Association Enterprise and tell us something about yourself?

I am the Vice President of Innovation for the American Nurses Association Enterprise and the American Nursing Association. The American Nurses Association Enterprise consists of three different organizations. It is the ANA, our membership organization where we create the scope and standards for the profession. It’s also where we have the Center for Ethics and Human Rights and where we do our Policy and Government Affairs advocacy work on behalf of the profession. Then we have the American Nurses Foundation, which is our philanthropic and research arm, and the American Nurses Credentialing Center, which is focused on credentialing and accreditation of nurses and organizations.

My role in the innovation space is to work across the ANA Enterprise to support the growth and advancement of the 4.3 million nurses in the space of innovation and build and grow our capacity and skills.

Q. How can innovation improve the work and lives of nurses?

Prior to the pandemic every organization had a fairly structured process for how change occurred within their organization. When the pandemic started unfolding in early 2020, we saw organizations, facilities and nurses who had to completely change what they were doing. Almost overnight, they weren’t going through their normal organizational change processes. They were innovating on the fly. They were trying to figure out how to address an emerging pandemic. 

We were also dealing with supply shortages and had different COVID-19 hotspots around the country. Part of the innovation work that emerged from this situation was the realization that nurses could make positive, impactful change quickly within their organizations without having to go through lots and lots of steps. They were able to test and try new models, new care practices, new ways of working and communicating. Facilities and organizations had to turn on a dime to meet the needs of the people. We saw lots of innovations. We saw the changing clinical presentation of patients and how hospitals had to care for their staff differently related to COVID-19, the list is quite extensive. But the biggest takeaway is the fact that people were willing to jump in and navigate new things at every turn to get the work done and to take care of each other.

Q. How do ANA and NACNS work together? How can CNSs get involved in the ANA Innovation work?

The work of the CNS is so important because they’re the translators between practice and research. They bring the newest research to practice and cut down the length of time it takes for research to be implemented into practice. CNSs work to shrink that gap, and they’re bringing this new knowledge and research to practice which creates space for innovation to happen faster. 

As an affiliate, NACNS has access to our innovation resources. Information is posted on https://www.nursingworld.org/innovation We have an innovation newsletter that we put out monthly, the “See You Now” podcast, Innovation Award and Virtual Innovation Lounges. Please engage with any of our activities we would love to see and hear from all CNSs who are doing incredible work. One of the things we just launched is an innovation community for members with almost 13,000 nurses who are already have an interest in this space. 

Q. What are the biggest challenges and opportunities that nurses are navigating today?

The last 18 months we saw where our health care infrastructure and organizations struggled and where they shine. I would say the challenge is to not revert to old ways of thinking. Learn from what has transpired do better and to keep striving forward. I think the opportunity is recognizing how the pandemic has truly created a space for the profession to highlight their skills and their scientific training. Nurses are passionate about their careers and their work, so we need to make sure we are positioning them to truly step into innovation spaces to guide healthcare forward.

The University of Virginia Health (UVA Health), serving the Greater Charlottesville/Albemarle region of Virginia, took the important step this month to validate its 14 clinical nurse specialists (CNSs) as “credentialed providers.” This step formally recognizes CNSs as Advanced Practice Registered Nurses (APRN). UVA Health System includes a 631-bed hospital, level I trauma center, nationally recognized cancer and heart centers, and primary and specialty clinics throughout Central Virginia.

The entire credentialing approval process took four months and, today, CNSs at UVA Health can practice with full practice authority, ordering many services for patients based on their own professional assessment rather than relying exclusively on physician approval.

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN, lead clinical nurse specialist of UVA Health, coordinated the credentialing effort. According to Elgin, the other three APRN roles (nurse practitioners, nurse midwives, and nurse anesthetists) were already bundled underneath the credentialed provider structure and there was a growing need to recognize CNSs and align their level of responsibility and scope of practice with that of their APRN counterparts.

Beyond the interest in improving patients’ experiences, the ascension of CNSs to the status of credentialed providers means that UVA Health is in line with the CNS professional standards of practice. The change also will provide mechanisms for third-party billing of services provided by a CNS. At the same time, there is legislation in the Virginia General Assembly to elevate the scope of practice of the CNS to allow for prescriptive authority.

“There was a real need for credentialing CNSs,” said Elgin. “The fluidity of the CNS role is important, but it could lead to role confusion for colleagues. After centralizing the CNS team, I performed a systematic gap analysis, comparing our practice to the National Association of Clinical Nurse Specialists (NACNS) core competencies. Being able to validate our CNSs were ‘aligning with and meeting national standards’ is actionable language that is meaningful and powerful to an organization.”

NACNS core competencies can be found here. They include competencies in Direct Care, Consultation, Systems Leadership, Collaboration, Coaching, Research and Ethical Decision-Making, Moral Agency, and Advocacy.

The Benefits of Credentialing the CNS

As a credentialed provider, CNSs’ validation as an APRN by the UVA Health nursing body and interdisciplinary colleagues is helping to build the structures and processes that are necessary to facilitate reimbursement practices. Another significant improvement will be CNSs’ ability to formally consult other interdisciplinary clinicians without a physician co-signature. This efficient approach to patient care leverages the CNSs’ ability to generate revenue for the organization for the work they perform. Finally, and most importantly, validating a CNS as a credentialed provider creates an opportunity to rethink processes and structures around interprofessional practice and develop different and more efficient methods to work together in a healthcare setting.

A CNS-Credentialed Provider “How To”

The entire formal credentialing process at UVA Health took four months and involved the entire organization.

The process included working with stakeholders to obtain subcommittee approvals, a full vote by all of the organization’s clinical staff, and final approval by the UVA Health Board. Critical to the success of this effort was securing support from the chief nursing officer, director for advanced practice, as well as buy-in from the CNS team.

“Our CNSs had a vision for it, but we still put a lot of energy and effort into securing their buy-in,” said Elgin. “The change will create different workflows for our CNSs, so I needed them to be engaged in the credentialing process from the beginning if we were to be successful.”

The approval process started with the proposal being presented to the Advanced Practice Provider Subcommittee of the Organizational Credentialing Committee. Once approved, a recommendation was made to the Credentialing Committee to add CNSs as a provider type. Next, it was voted on and approved at the Credentialing Committee and the Credentialing Committee made their recommendation to the Clinical Staff Executive Committee. This executive committee also approved the proposal and sent it to the entire clinical staff for a vote. Finally, the last step was the UVA Health Board’s approval validating the CNS position as a credentialed provider.

Elgin credits her relatively smooth approval process to never underestimating the importance of engaging stakeholders both in formal and informal settings and really taking time to listen to them and hear their concerns.

About the author

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN is a Director at Large for NACNS, the only national organization representing the 89,000 CNSs in the US. CNSs are the most versatile advanced practice registered nurses and work in a variety of health care specialties to ensure the delivery of high-quality, evidence-based, patient-centered care. As leaders in the acute, post-acute, and ambulatory health care settings, CNSs impact direct patient care, nurses and nursing practice, and organizations and systems to optimize care and drive outstanding clinical outcomes.

Succession Planning To Advance The CNS Profession

Jan Powers, in her recent National Association of Clinical Nurse Specialists President’s Letter titled “We Rise By Lifting Others,” stated:

“As CNSs, we must look to the future and work to improve the pipeline of qualified CNSs to fill positions of vital need. We must have an intentional focus on succession planning and simultaneously encourage younger nurses to explore and step up to the role of CNS.”

Five generations of nurses are now working together with the oldest generation reaching retirement. As a matter of fact, nearly 20% of CNSs will reach retirement age over the next five years. Succession planning is an important way to fill this potential retirement gap in the ranks of the about 89,000 CNSs in North America.

Succession planning is defined as the systematic process of recognizing and creating future leaders who ready and able to accept the roles and responsibilities of those leaving the workforce via retirement, resignation, or promotion. Succession planning is a future-oriented process.

In short, it’s about giving younger nurses a “hand up” by introducing them to the role of the CNS and encouraging them to pursue the career. It is primarily through this effort that we advance the CNS role and ensure it thrives well into the future.

The Big Question

Ask yourself this question:

Who will replace you when you retire or leave the organization?

To truly RISE UP as a profession we must lead others forward. This is where succession planning is so critical because our current CNS positions must pave the way for the next CNS to take our place. Below are some tips and ideas to think about as you begin a succession plan.

CNS Succession Planning Tips

1. Establish accountability

• Agree who has the responsibility to make the succession decision. Establishing clear responsibility of organizational succession early on is key to avoiding confusion later and is important to ensure a CNS has input into the process.

2. Focus on learning, not just performance

• Provide potential successors opportunities to experience the future role and be educated on responsibilities before the succession itself is decided and implemented. This is where mentoring is important.

3. Turn succession short-term by breaking down tasks

• Succession planning is a journey with many steps. People tend to think better in the short-term so breaking down the succession process into smaller projects rather than trying to make a switch all at once has a better chance of success.

4. Build transparency with the scientific method

• Be upfront about succession planning and use CNS data skills to measure a potential successor’s performance and leadership ability. Establish standards to measure the success of a transition and share this information. This not only makes the succession process cleaner, but it builds trust among coworkers and the organization generally.

Is 90,000 Enough?

There are about 89,000 CNSs in North America and it is not nearly enough. The pandemic is swallowing resources while the online job boards scream for more CNSs. Our goal should be to retain and add more CNS to the workforce every year. We can do this with mentoring, succession planning, advising younger nurses, speaking at nursing programs among may other things. In sum, by giving a hand up to younger nurses to become CNSs we ensure the continuity of our profession and truly “RISE By Lifting Others.”

Lt. Colonel David Bradley Interview – Q&A

Q. What prompted the reinvigoration of the military affiliate within NACNS?

A few colleagues and I have been attending the National Association of Clinical Nurse Specialist (NACNS) Annual Conference for years and always found it exciting and informative. We decided there was a real
need for a military affiliate, and — in true military fashion — we just went ahead and completed all the paperwork and executed the mission. We plan to launch NACNS’s military affiliate in October with representation across three branches of the military — Navy, Air Force and Army. We’ve had a lot of interest already.

Q. What do you hope to accomplish with the creation of the Armed Services affiliate?

People are just unaware of the Clinical Nurse Specialist’s (CNS) role. They ask: “What are your skill sets and how can we better utilize you?” There is a great need for education and awareness around the CNS in the military. We want to make sure that the role of the CNS is understood and valued. The best ambassadors for this effort are the CNSs themselves, so we want to put our heads together and have an organization to build awareness and appreciation of our role.

Being an affiliate linked to a national organization can support and help with visibility and grow awareness. Our second goal is to share and collaborate on evidence-based practice and research. NACNS gives us the best forum for accomplishing these goals.

Q. Can you tell us more about the benefits of a NACNS military affiliate?

The primary benefit of the NACNS military affiliate is that it establishes a platform to better market the role of the CNS. An active affiliate will highlight the great things CNSs are doing across the nation as well as showing how CNSs are making an impact in military healthcare. We also plan to use the military affiliate to network and establish a robust mentoring program for newer CNSs. That’s an area of opportunity for the military affiliate, providing experienced mentors for recently graduated CNSs.

Q. Do you have anything else you would like to share about the role of the CNS?

I’m always looking for better ways to describe the role of a CNS. When the message gets through, people really do understand the unique value we bring to the table. I’ve found that analogies go a long way in this regard; they’re a simple way to explain what otherwise can sound like a complicated role. Here’s one of the best analogies about CNSs that I’ve heard:

A CNS is like a pitching coach in baseball. Now, can you play baseball without a pitching coach? Absolutely. So, why do they have pitching coaches and pay them so much money?

Teams invest in pitching coaches because pitching is the most important position on the field. For a team to be great, it has to have great pitching. So, even small improvements to a pitcher’s mechanics, to his pitch selection, or to something as simple as how he grips the ball can have significant impact on the team. The pitching coach can look at the spin of the ball, the velocity, or the way the ball leaves a pitcher’s hand and be able to offer insight that no one else on the field can see. The pitching coach will see things others miss. “You’re dropping your shoulder,” he’ll tell the pitcher who can’t find the strike zone. This advice and corrective action can and regularly does change the outcome for a pitcher and for the game.

A CNS plays a similar role to the pitching coach, providing expertise and guidance at key moments, relying on their deep expertise, to improve the quality of care and outcomes in hospitals and health systems across the country.