Year: 2023

There have been so many great things happening that it’s hard to believe that the year is half over. Thanks to the hard work of the membership, we’ve scored a lot of wins we can all feel proud of so far. As people wind down for summer vacations, it’s important to take a moment to reflect on all that we’ve accomplished in the first half of the year.

In this article, we’ll talk about new committees, a new scholarship, a great conference, education updates, and the regulatory and legislative work we’ve done.

Two New Committees to Encourage Younger Members

In 2023, we started the Next Gen committee to build public awareness of the CNS role using Instagram and TikTok. Their second meeting took place on July 21, and they’re already excited about helping to promote the role on these wildly popular social platforms — stay tuned for the links.

The Novice to Exceptional Transformational (N.E.X.T.) CNSs also started this year, with their first meeting coming soon – and we’ll be sure to announce it. N.E.X.T. CNSs includes our 300 CNS student members and over 80 transition-to-practice members — our highest numbers ever for these groups. 

The committee is about helping new CNSs transition into their careers. Experienced CNSs nurture and mentor them, teach leadership skills, and provide all kinds of tips to help them launch their careers. Samantha Knight, a CNS student, is their first facilitator.

Annual Conference was a Huge Success

In March, our annual conference saw one of our highest attendance numbers yet. We had over 120 podium presentations including 12 pharmacology presentations. The increase in pharmacology presentations will only continue with the shifting paradigm of CNS practice to prescribing roles. We hope to have 25 pharmacology presentations at the next conference in New Orleans (March 10-13 2024).

Encouraging Diversity

In June, NACNS President Mitzi Saunders was a guest on a webinar for the National Association of Hispanic Nurses — an organization with thousands of members in 40 local chapters. You can watch the video on YouTube, moderated by Mayra Garcia, who is a CNS.

We had an extra 20 minutes of excellent questions at the end. A few of the people who attended are interested in the CNS role and have reached out to us to get more information or to get started. We need more diversity in the CNS role, and with this video, we are trying to do our part!

A New Partnership for Stronger Practice

The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare promotes improved evidence-based practice (EBP) implementation science. NACNS has signed a contract with them for a partnership to assess the strengths and weaknesses of our members in terms of implementation science. A timeline is being worked on for a January 2024 rollout (keep an eye out at that time for a webinar signup).

To support this initiative, ex-officio board member and CNS Journal Editor Jan Fulton and a small strategic planning group have led the creation of a new Center of Excellence for Implementation Science. This Center will lead the execution of improvement initiatives once we’ve worked with the Helene Fuld team to understand our needs. This is a big opportunity to grow our strengths in this regard.

Finding New Ways to Share Our Census Data

Very soon we’ll be sharing two highly visual infographics that will introduce a storytelling element to the results of our 2022 census. Once you have them, we encourage you to share them, print them, and post them where you work as a conversation starter.

One of the most significant takeaways about the Census is the wonderful level of engagement. COVID hurt nursing badly, and some nurses even left the profession. Not everyone embraces a situation like this and tries to help, but our CNSs stepped forward.

Similarly, for the last three years, CNSs have ranked higher in career satisfaction than any other group (RN, LPN, NP, NM, NA, and CNS) in the Medscape survey; they saw the need for more nursing support. CNSs come to this career because they want to make a change happen, and there was no better time to do that than during COVID.

Partnership with Consultant on NACNS Messaging

Dr. Winifred Quinn of AARP is a non-nurse consultant with expertise in communications who assists nurses in practicing to the limit of their education. We’re working with her on primary target audiences and messaging.

She recommended that we highlight patient and family outcomes. She also recommended that we target the roles who are the ultimate decision-makers about using CNSs in healthcare systems: CFOs and CEOs. They are responsible for the financial health of their businesses, so we need to showcase the financial wins that CNSs are able to achieve. 

New Scholarship

The Katie Brush Critical Care CNS Scholarship was created in honor of Katie Brush, who suddenly passed in 2007. She was a strong CNS advocate, an NACNS board member, and critical care clinical nurse specialist for over ten years at Massachusetts General. We will announce this year’s awardees very soon.

Regulatory Action and Wins

New Position Statements

We created two new position statements: Entry for CNS Practice Position Statement and Clinical Nurse Specialist Full Practice Authority, with a third paper submitted for comments from our members. Two more are coming soon, one on title and role protection and the other on our position on compact states. In a nutshell, we’re for the concept of being able to practice in multi-state groups, but against the red tape that means we have to do more work to do what we do. 

ANA Hill Day

On June 15, NACNS members supported the American Nurses Association for ANA Hill Day. Linda Thurby-Hay, our secretary-treasurer, was on-site to formally represent NACNS, along with an enthusiastic group that included Pamela Moss, board members, CNS at Johns Hopkins Hospital as well as many other NACNS members.

This was our first year organizing a group to attend, but everyone who was there have said that they would definitely go again. We’re speaking with the CNS Institute to get funding so that more participants can attend next year. 

We are also looking at organizing also our own “mini” Hill Day. The Legislation and Regulatory Committee is working on this, led by chair and co-chair Elizabeth Duxbury and Elizabeth Hoxie, along with board liaison Rick Bassett.

A Win in Maryland

On May 3, the Governor of Maryland signed a bill giving clinical nurse specialists in the state to have prescriptive authority. While this was not an NACNS-led initiative, it is a huge milestone for CNSs in Maryland and all over the country.

NPI Campaign Continues

The campaign to encourage more CNSs to get NPI numbers continues. This is important because we want to change the Bureau of Labor statistics classification of CNSs from RNs to APRNs. Only when enough CNSs have NPI numbers can we work towards getting the classification corrected.

More Important Ongoing Work

We have many more important goals that we are working on.

Our EDGE learning platform is now in year two, and we have overwhelming engagement on the platform! We have four bundles of courses we’re developing this year, including more pharmacology. We’ll continue to develop courses and webinars and other materials to ensure our members have a convenient way to earn CE credits. It’s all about CNSs teaching CNSs, and we have a lot of talent in the group.

The work towards CNS recruitment and enrollment also continues. We have too few CNSs out there, too few programs, and too few students in those programs. One of the best marketing tools for something like this is word of mouth, so we’re trying to ensure that all of our students feel supported and well-mentored so they spread the word to their friends and colleagues. 

We’re also trying to appear on more podcasts to bring greater visibility to the CNS role.

Stay Connected for All the Latest Updates

There’s still so much to do, and always more to accomplish — but as they say, time flies when you’re having fun. To find out all of our new updates as they happen, follow us on LinkedIn, Facebook, and Twitter.

“Dr. Mitzi,” as her students call her, has been a CNS since 1994 and an NACNS Board member since 2019. She has worked directly with thousands of patients, has authored or co-authored over forty research studies, and is now a tenured professor at the University of Detroit Mercy. You can read more about her credentials and career in her bio and connect with her on LinkedIn.

She started her NACNS presidency in March 2023, and declared that her main goals are to increase the number of CNSs, while ensuring the role has title protection and full prescription privileges.

We asked Mitzi about her work as a CNS, making the shift to academia, and why the work of NACNS is so important.

Q: Why did you decide to become a CNS?

Mitzi:  I started out as a travel nurse, but I was looking for more from my career. Like many nurses, I stumbled into the clinical nurse specialist role because there aren’t as many programs as possible for us. I knew that I didn’t want to be a nurse practitioner, because the role did not meet my needs for complex patient care and acute care. 

I had to do a little bit more searching around, but I found a program here in Detroit. I checked into their CNS program and it had exactly what I wanted, including being a practitioner, researcher, consultant — it had all these roles that I thought were just fascinating and so exciting.

I just felt like I could make a bigger difference at the patient-family level and beyond, with nurses, with the system, using all those business skills that you learn in a CNS program. I think that’s what draws most nurses to the CNS role. 

Q: Talk to us about your work with vulnerable patients at the level-one trauma center in Detroit. How did you try to make a difference as a CNS?

Mitzi: These were mostly very poor individuals, so they typically did not have insurance. When they came in, many already had very progressive diagnoses of heart failure or cancer, or something else that hadn’t been treated.

Many of them were at the point of end-of-life care because they didn’t have the resources to see a doctor, they hadn’t gotten an early diagnosis, and sometimes they weren’t following up with care.

Every patient that we saw required a lot of education, and it required a skillful way of finding low-cost medications, because if they weren’t affordable they probably wouldn’t be able to afford or take them. We also had to be so careful about any strong side effects, because it would also mean they wouldn’t take their meds.

I worked with a wonderful group of six physicians and six clinical nurse specialists. We would do four days in acute care in the hospital setting and one day in the clinic. On that one day in the clinic, we would see all the patients from the hospital who did not have a doctor. 

The physicians gave us full authority to diagnose and prescribe. They would see the patients in the emergency room, make the initial diagnosis and establish the plan. Then I would see their patients from that point on.

I know that many people in healthcare would say, “Oh, that sounds like nurse practitioner work.” But I really wore the hat of a CNS, because I was always thinking about outcomes and efficiency, and how I could progress patients through the system at a lower cost, and change the trajectory of care for a population.

One example of this efficiency was in my work with newly diagnosed heart failure patients. They typically needed treatment over five days, but I was able to get it down to four days through new ways of being really efficient and doing teaching from day one.

The other CNSs and I put together a report to show the value of our work, we were able to show that we saved four times over our salaries every quarter. We were just so good about making sure that none of the services were duplicated and ordering the right tests. We also knew the cost of everything, like MRIs and CAT scans. We were so careful about everything that we did, so that we were able to treat these people and the hospital did not lose money. What that meant was that we could treat more patients who couldn’t otherwise afford care.

We also had so many things going on besides just seeing patients, including presenting at conferences and running research studies. But it was the full breadth of what you think of as a CNS.

When you have the CNS training and full privileges to diagnose and prescribe, that’s the kind of difference that you can make.

I also worked with dementia patients. Like heart failure, dementia is fairly common: typically 50% of older persons over the age of 85 have dementia. My most recent National Institute of Health-funded study was on women caregivers whose husbands with dementia had passed away, and I’ve presented it at several venues.

Because of all my research, Springer Publishing came to me last year and asked me to write a book on family caregiving of adults with a gerontology focus. It’s called “Nursing Interventions for Family Caregivers”, and it will be out in 2024. It will feature at least 20 chapters from CNS authors to highlight the role of the CNS in family caregiver care. 

Q: You were fully credentialed and privileged in most of your roles. Can you explain a little bit about what that means for patients and health care systems? 

Mitzi: To be fully credentialed means that you’ve been through an academic program that has prepared you for the role of a CNS, and it’s prepared you to take the national certification exam. As long as you maintain those credentials, those would be the minimum standard for gaining privileges. In order to gain privileges, most states require that you’ve had training in the three Ps: advanced physical assessment, advanced pathophysiology and advanced pharmacology. 

This can be an issue because in some areas, nurses are given the title of clinical nurse specialist, but they haven’t had the full training. If we’re going to be able to prove the value of this role, everyone has to have the same level of training.

Being privileged means that you are qualified to assess the patient and prescribe medication or specialty equipment. To become privileged, you need to have had those foundational courses I mentioned, which now include lots of clinical hours associated with the practice of diagnosing and prescribing. So all of our students now are fully prepared to go into those privileged roles if the health care system offers them. 

Q: What made you decide to make the switch over to academia?

Mitzi: I happened to see a need for an instructor for medical surgical nursing at the University of Detroit Mercy, which I was qualified to do. It would allow me to use all my years in the trenches, and my experience doing research. Plus, I’ve always loved to educate, so it was a perfect fit for me. To make a long story short, I got hired.

I’ve always loved research, and any academic work requires that you to do research. During that time, I also went back and got my Ph.D. in nursing, so I really understood research well.

Q: Can you tell me about your work getting title protection and prescriptive authority for CNSs is in Michigan?

Mitzi:  It took us about four years to get title protection and prescriptive authority. 

At the time I was the secretary of the Michigan Clinical Nurse Specialist organization. I was working with a small team and we were on call constantly, ready to meet with legislatures whenever they wanted us to come forward to give testimony. We were on pins and needles for years to get that through legislation.

Part of what worked was finding the right legislative partners who wanted this for us, including the nurse practitioner organization here in Michigan. It’s a more powerful group, with more members and more money. 

Five years later, however, CNSs in Michigan are still struggling to get prescriptive authority. It became official, but I still only hear of handfuls of CNSs who are actively prescribing.

We need to be prescribers to fill in the gaps and get care for patients, and get it faster. Sometimes, we realize we need something else ordered and done for the patients so they can be discharged, but the physician is nowhere to be found. A CNS could quickly write for things like wheelchairs or diabetes supplies.

Q: What made you decide to run for the NACNS presidency? 

Mitzi:  When I started on the board a few years ago, right away it just felt so right to be at this level, helping to make decisions for the role, which is what the board does. 

I admired Sean Reed’s passion for the role and his style of leadership. It was very empowering and I felt like I could do it too. And that’s what you want to see: a great president that continues to move the organization forward, and makes everyone else want to move things forward too.

Like most other CNSs, I like being in charge of things. That’s why I’ve directed an academic program for years. I’m very comfortable in a leadership role and I have no problem delegating, but also not overdoing it and making sure that the work is equally distributed. I also think I have a good mind for strategic planning.

So three years later, here I am — and so far, I love it. 

What I’ve also learned is you can’t do this alone. What I love about the NACNS is that I always feel like if I can’t do it, I can ask Jennifer Manning, Phyllis Whitehead, Rick Bassett or the board. There will be someone who will be able to help me. 

It’s the strength of the people, the leaders in this organization, that I lean on. And I know if I don’t have an answer, they will.

Q:  Why is the NACNS so important? 

Mitzi:  Well, I think the nursing industry loves the idea that APRNs are filling the physician gap and providing access to care for patients. But, additionally, our nurses and healthcare systems are in desperate need of leadership and support. The CNS often fills those needs but unfortunately, they tend to not get as noticed as the nurse practitioners because of their direct focus on patients. CNSs often provide indirect care and focus on patient outcomes.  

So, unless someone like NACNS is promoting the role, it can be kind of invisible. NACNS knows what we do, and can help us speak to how important it is, and help us to be able to do that more strongly.

The CNS role is vital. We have a crisis in nursing right now, we really do. There’s a nursing shortage, and we could use CNSs everywhere, and we don’t have them. We have oodles of nurse practitioners, and that’s great, but that’s not doing anything about the nursing crisis. We need CNSs more than ever right now. .

What’s great about NACNS is that it is the only association that represents all CNSs. Each day, NACNS works to increase the visibility and influence of CNSs. 

We’re dedicated to advancing CNS practice and education, removing certification and regulatory barriers. Not only do we offer professional development and enhanced leadership possibilities and opportunities to network with other CNSs from around the country, we promote ground-breaking research done by CNSs. This further illustrates how CNSs are instrumental in raising the quality of health care, improving patient safety and reducing the costs of health care delivery.

Q: Looking back on your career so far, what are some of your proudest moments? 

Mitzi:  I think I am most proud of the students I’ve taught. I feel like their successes are my successes too, because I’ve nurtured them through the program. I’ve maintained contact with just about every student that I’ve had, and they let me know when great things happen. They’re like friends now, even though they still call me “Dr. Mitzi”. And I’ll say, “No, you can call me Mitzi now.” But they still keep saying Dr. Mitzi! 

In 2020 I applied for the Best Online Masters Program with the US News and World Report. I knew that in the first two years nothing would happen. But by the third year, I had three years of outcomes and data, and my program went up from the #130 position to #37. 

I am so proud of that, because there are probably a thousand online programs out there in nursing. Plus, I’ve been able to keep my numbers, and I always I keep enough students in this program, which is a lot of work — I do my own marketing and recruiting constantly.

I also think it’s wonderful that I’ve been asked to write a book; that I’ve done enough research and caregiving work to be noticed. Springer Publishing is a very well-known publisher in nursing and medical literature, so I’m very proud of being able to write that book right now. 

Q: Is there anything else that you’d like to share? 

Mitzi:  I came from a family of people who were not educated past high school. But my mother always said, “Be a nurse, help people.” That turned out to be great advice.

I would also say what’s been critical for me is to have a husband who has encouraged me and supported me 100% in everything. I’ve always been a working mom and my sons have seen that, and they respect that. I think they have more respect for women because they’ve watched a mom who worked and went to school, but was still a soccer mom and still supported all their activities. So I think having the support of your family has been critical for me.

Also, I encourage anyone looking for an educational program to become a CNS to visit our NACNS CNS program directory. We invite CNSs to join NACNS and become part of 2,000+ community of members working in hospitals and health systems, clinics and ambulatory settings, colleges, universities, and even non-traditional healthcare settings as entrepreneurs today. The benefits of joining the NACNS far outweigh the costs. The total value of a NACNS annual membership is more than $1,900. Actual membership dues are less than a fraction of that, making NACNS membership and a great way to advance your career and community engagement.

Finally, the best gift is the friendships and work colleagues with some of the best nurses in the profession that you will make. I encourage you to not only join but volunteer and make a difference in your life and the life of all CNSs. I love being a CNS and NACNS!

Connect with Mitzi Saunders on LinkedIn >