Category: Blog

“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 >

As CNS week begins, NACNS wants to give members and readers a look into where their board went to school to become a CNS, and what lessons they took away from their programs.

The CNS board encourages members and other readers looking for more information on CNS programs to check out the program guide on the NACNS website. If you know of any CNS programs that are new, or not listed here, please reach out to questions@nacns.org to get the program on our website!

Phyllis Whitehead PhD, APRN/CNS, ACHPN, PMGT-BC, FNAP, FAAN, President of NACNS

What CNS program did you attend? 

Radford University, Radford, VA (No longer offers a CNS track; offers a post-graduate DNP)

What is the biggest lesson you learned through becoming a CNS? 

I went into nursing to make a difference in my patients’ lives. Being a clinical nurse specialist has taught me the importance of collaboration and hard work in positively impacting my patients and their families, as well as my nursing and medical colleagues and institution. The role of the CNS offers me the versatility to do what I need in whatever the situation warrants. There is simply no other role that I prefer to have in healthcare.

Jan Powers, PhD, RN, CCNS, CCRN, NE-BC, FCCM, FAAN, Past President of NACNS

What CNS program did you attend? 

Indiana University School of Nursing

What is the biggest lesson you learned through becoming a CNS? 

The complexities surrounding healthcare, and how important nursing practice positively impacts patient outcomes and prevents complications. The CNS as an APRN is the guardian of nursing practice and continues to advance nursing to provide optimal patient outcomes. Advanced nursing practice is so much more than procedures and prescriptions, it is looking at the patient holistically, identifying evidence-based or innovative interventions to facilitate care so patients can reach their optimal state of wellness.

Mitzi Saunders, PhD, APRN, CNS-C,NACNS President-Elect

What CNS program did you attend? 

Oakland University, Rochester, MI – Adult Health CNS

What is the biggest lesson you learned through becoming a CNS? 

Besides it being the best APRN role, the ability to flex our skills in a variety of health care directions is my favorite part. I also think being a prescriber in my role as a CNS gave me a whole new appreciation for the art of CNS prescribing – I do believe every CNS should have some capacity in their role to be a prescriber, even if the formulary is tiny. 

Linda Thurby-Hay DNP, RN, ACNS-BC, BC-ADM, CDCES, Secretary/Treasurer of NACNS

What CNS program did you attend? 

I graduated from Virginia Commonwealth University’s Clinical Nurse Specialist program years before the release of the Consensus Model for APRN regulation.  My educational preparation was quite different from current requirements, and the conversation around full practice authority for APRNs was not underway.

What is the biggest lesson you learned through becoming a CNS? 

One lesson learned relates to the need for active engagement in the national conversation about the nursing profession. There are many stakeholders whose livelihoods are grounded in maintaining the status quo in healthcare delivery, while there is ample evidence that our model of care is ripe for innovation to better equip our people with the knowledge and tools to stay healthy, recover from illness, or die with dignity. Nursing must speak deliberately about changes in care delivery that will produce better patient outcomes, and articulate more clearly how professional nurses contribute to those outcomes. 

What Has The Pandemic Taught You?

Mark your calendars and get your tickets now, because the NACNS annual conference is fast approaching on March 14^th-17^th in Baltimore, Maryland. 

This year, the theme of the conference is the Rise of the CNS. Back in person for the first time in two years, the annual conference will feature workshops, networking opportunities, an awards presentation, and three keynote speakers. 

To get to know the keynote speakers a little better, we asked them all a question about what they’ve learned through the past two years, and how that will affect nursing in the future.  See what they had to say below. For more information on the annual conference and to register, click here!

As we enter the third year of the pandemic, what is the most important thing this situation has taught you and how will what you’ve learned inform your future decisions? 

Andrew Miller, MA Denver Health’s LGBTQ Center of Excellence

 One thing I’ve learned throughout the pandemic is the importance of flexibility and teamwork. This pandemic has been a challenge on so many different fronts for all healthcare workers and finding ways to accommodate and work together has been our saving grace, especially on some of the harder days. I am in constant awe of the incredible and brave frontline workers who I get to work with daily and their dedication to providing affirming and respectful care, even when times are scary.

Andrew Miller (he/him/his) provides training, consultation, and capacity-building assistance through the Denver Health’s LGBTQ Center of Excellence. Specializing in Transgender and Gender Expansive affirming care, Andrew provides trainings spanning across medical systems, public health departments, academic settings, and community-based non-profit programming. After graduating with a Master’s in Multicultural Clinical Counseling in 2019, Andrew combined his over ten years of national training experience with his passion for creating accessible, affirming clinical settings, and has focused his work towards medical and public health settings.

Mary Zellinger, RN, MN, ANP-BC, CCRN-CSC, CCNS, FAAN, FCCM

 Teamwork, communication, and mentoring have always been cornerstones of successful interprofessional practice. During the pandemic, the need for effective and timely communication was especially essential. The importance of sharing information at least daily with colleagues internally in our healthcare system, and externally through list-serves, personal contacts, and organized webinars allowed all of us to learn from other’s experiences and quickly incorporate advances into our own practice.   Ensuring frequent communication with staff to provide support and share new information in a rapidly changing environment, frequent communication with patients who were unable to have family members with them, and frequent, scheduled communication with other team members and peers demonstrated to me that the impact of clear, informative, and ongoing communication prevents isolation and supports our mission of optimizing patient, staff, and community health.

Mary Zellinger RN, MN, ANP-BC, CCRN-CSC, CCNS, FAAN, FCCM was the CNS for Cardiovascular Critical Care at Emory University Hospital for over 42 years and was a collaborative faculty member of the Emory University School of Nursing in Atlanta, Georgia before retiring in November 2021.  She received her BSN from Duke University, her MN in Adult Health/Critical Care, and her Post Masters Nurse Practitioner degrees from Emory University.  

Deborah Klein, MSN, APRN, ACNS-BC, CCRN-K, FAHA, FAA

 One important thing the pandemic has taught me is that moral injury is real; nurses are tired, frustrated, and angry.  Many are retiring, traveling, or are leaving nursing resulting in dire staffing shortages. We must develop strategies that address moral distress and staffing shortages including ensuring a healthy work environment, effective communication, and meaningful recognition that creates well-being at work. My future actions will focus on developing and supporting these strategies. 

Deborah Klein, MSN, APRN, ACNS-BC, CCRN-K, FAHA, FAA recently retired as the Clinical Nurse Specialist for the Cardiac ICU, Heart Failure ICU, and Cardiac Short Stay/PACU/CARU at Cleveland Clinic in Cleveland, Ohio where she also served as Vice-Chair for the Ethics Committee. She has 45 years’ experience as a nurse and 39 years as a Clinical Nurse Specialist.

Watch the keynote speakers live at the annual conference.  For more information on the annual conference and to register, click here!

Ted Walker, A-CNS, CNOR, NPD-BC, CPPS, remembers when he knew being a nurse was what he was meant to do as a career. 

 Two years into his career, a Yupik elder approached him on the floor of the Bethel, Alaska hospital where he worked for the U.S. Public Health Service. He had wondered how long Walker would be working there. 

“He said, ‘I think that you are a good nurse. This will be the last time I’ll speak to you in English,’” Walker remembers. “For a non-native person, it was quite a thing to have someone say that.” 

“If you were going to be there and live, and do everything you could do to help them, you’d do everything you could to learn the language,” says Walker.  

And so, he learned medical/conversational Yupik. But he also learned so much more. The 20-something nurse learned about sub-arctic life and the delivery of health care in a 50-village service area the size of Oregon.  

“It was wonderful,” says Walker, “There was a real sense of community. Everything is around subsistence. It’s about hunting, fishing and gathering – and surviving the seasons.” 

He and his wife also welcomed their oldest daughter there.  

“I learned the operating room in Bethel,” says Walker. He remembers being on call and supporting the one operating room at the hospital. He remembers the cold 100-yard walk from his home to the hospital. 

From Bethel, Walker transferred as an OR nurse into the Air Force, where he would ultimately achieve the rank of colonel, earn his advanced practice nursing credential as Clinical Nurse Specialist and spend two years as chief of safety for the Air Force Medical Service. 

He retired from the Air Force in 2017 after 26 years and moved back to the state where he started his career. 

“I wanted to work somewhere that supported my core values,” Walker says. “I spent my whole career working with ‘integrity, service before self and excellence in all you do. It was serendipity in a way. All the stars aligned.” 

The best part of his job at Providence Alaska Medical Center (PAMC) is coming in as a consultant to help staff nurses, clinical managers and nurse educators work through challenges, helping them realize “that they really do know the answers.” 

“It’s just helping them get to that point,” Walker says. “Many times, it’s just talking about it and going through the solutions.” 

“The staff in this organization really do look at our core values from the Sisters,” says Walker. “They want to take care of the poor and vulnerable and the people who need our help. It’s just about figuring out how we are going to do it – safely and the best way we can.” 

Through a partnership between University of Alaska Anchorage, the state’s hospital association and Providence, Walker now helps introduce all new surgical nurses to the operating room in Alaska. Whether part of Providence or another health system, nurses spend four weeks of classroom training in Anchorage before going to their home hospital where they work with a preceptor for an additional 11 weeks. 

“The best thing about being a Clinical Nurse Specialist is working with your population or your system,” says Walker. “For me, being an OR nurse as long as I have been, this was an extension to show that I’m an expert.” 

“It’s just an honor to work in this capacity,” says Walker.  

Walker is one of more than 1,200 nurses working at Providence Alaska Medical Center and one of more than 1,600 nurses who work in service of the Providence Alaska Region. The World Health Organization extended its 2020 “Year of the Nurse and Midwife” celebration into 2021. Providence couldn’t agree more.

Jan Powers and Phyllis Whitehead discuss 2022 trends and the CNS

As 2021 — the second year of the pandemic — ends there are some very positive trends taking shape for the CNS community. CNSs numbers, responsibilities and influence continue to grow as 2022 is certainly trending in the right direction for NACNS and CNSs.

Recently, President of NACNS Jan Powers, and President-Elect Phyllis Whitehead sat down to discuss some of the future trends they see for the CNS. 

Overall, 2022 appears to be about growth.  Growth in the CNS population. Growth in student enrollment in CNS programs, And growth in mental health services for CNSs to help deal with job stress. Keep reading to see what Jan and Phyllis had to say;

Q. The healthcare system is losing nursing professionals. Do you see this being a trend for CNSs as well in 2022?

We have close to 90,000 clinical nurse specialists in the United States and our membership is growing. So, the short answer is no. I think that the CNS is stronger now than ever and will continue to grow in numbers. 

The pandemic has been horrible but one positive to come out of the chaos was the way CNSs contributed in leadership positions during the crisis.  We have CNSs that act as providers and then we have CNSs in the hospital really focusing on evidence-based practice and improving patient outcomes. I think the beauty of the role is we can go back and forth, and pivot based on what the needs are. I see a lot of CNSs that act in a provider capacity and then are also looking at organizational or system improvements.  We are confident that an important trend is that the role of the CNS will continue to expand in 2022 along with the number of nurses choosing the CNS career path.

Q. Is there one CNS trend for 2022 that you find surprising?

Yes.  Innovation.  We think the pandemic has created the opportunity for innovation. Innovation is where the CNS lives.  This has resulted in great gains in responsibility and influence for CNSs as they are looked to for leadership and new ideas during the pandemic. We are seeing signs that CNSs are using this evolving status to advocate for other CNSs, other APRNs and, of course, patients.

Q. Has the pandemic effected the number of clinical nurse specialists coming into the field?

 We had started to see a resurgence of the CNS role prior to the pandemic. What we’ve seen during the pandemic is really the rise of the CNS. We’ve really pivoted “on a dime” and increased innovation as to what do we need to do and how do we do it.  

The big question is how do we continue to meet the needs of all our patients, wherever they are, whatever the setting? In 2022, this expansion of the scope of a CNSs’ work will continue to ramp-up and with it, more innovation in healthcare settings will result.  Also, the trends toward CNS as credentialed service providers and prescriptive authority continues to remain strong.

Q. What are some goals for NACNS and for CNSs in 2022?

We had anticipated that there would be a decrease in applicants for nursing school, but we’ve seen an increase — which is super exciting. The thing that concerns us though is how do we keep them at the bedside? How do we maintain their mental health? We want to continue to work on that and advocate for clinical nurse specialists and all APRNs.  We do see those advocacy activities expanding quite a bit in 2022.  

To join or renew your NACNS membership:  https://nacns.org/connect/become-a-member/

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.