Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.
Nursing News
Year in Review: Reflections on Nursing in 2021 With an Eye to the Future
To commemorate the 200th anniversary of the birth of Florence Nightingale, the World Health Organization (WHO) designated 2020 the International Year of the Nurse and the Midwife. The year turned out quite differently than expected, due to the onset of the COVID-19 pandemic.
But in recognition of the contributions made by the healthcare force, the WHO extended the celebratory year by designating 2021 the International Year of Health and Care Workers “in appreciation and gratitude for their unwavering dedication in the fight against the COVID-19 pandemic.”
In a speech in late 2020, the WHO regional director for Europe, Hans Kluge, MD, promised nurses: “We will push back COVID-19 and I promise: we will celebrate you.” Unfortunately, Kluge was unable to keep his promise about pushing back COVID-19, as the pandemic spilled over into 2021 and raged throughout the year, even with the availability of a vaccine. Rather than being a year celebrating nurses, it continued as a year fraught with turmoil as the pandemic challenged the capacity of hospitals and intensive care units (ICUs) worldwide.
The pandemic seemingly far from being over, 2021 is ending with severe staffing shortages and hospitals in many regions — both in the US and abroad — bursting at the seams with COVID-19 patients, to say nothing of those needing care for other conditions.
The work and sacrifice of nurses and other healthcare professionals during the pandemic did not go unnoticed, as headlines often focused on the challenges workers were contending with. However, at the same time, the pandemic also put a glaring and unforgiving spotlight on the deficiencies and shortfalls of the healthcare system — both in preparedness for an emergency and in basic support of its nursing staff.
Native American and Indigenous Nurses You Should Know About
Native Americans face disparities in healthcare, but these five trailblazing nurses confronted the medical system to improve healthcare access and outcomes for Indigeneous people. Read about their legacies.
The accomplishments of Native American nurses often remain overlooked. However, Native Americans and Indigenous people have a history in medicine that dates back thousands of years.
Healers in 1,000 B.C. used native plants, such as peyote, for anesthesia. Native Americans sang healing songs passed down from generations and made poultices for medicine. Indigenous nurses who recognized the benefits of traditional medicine have incorporated it into Western medicine, while often facing backlash.
Despite the important contributions made in healthcare, Native Americans and Indigenous people have a life expectancy of 5.5 years less than other communities in the United States, according to the Indian Health Service. More than 5 million Native Americans and Indigenous people face drastic health disparities. These communities encounter some of the highest rates for heart disease, diabetes, and chronic liver disease.
The five trailblazing Native American nurses featured here overcame discrimination to pursue their education and made it their mission to improve healthcare for their communities.
Clinical Nurse Specialists: Leaders in Improving Patient Outcomes
Each year, the first week of September is recognized as Clinical Nurse Specialist (CNS) Week, and what better time to recognize the CNS’s unique contributions to healthcare.
As one of the four advanced practice registered nurse (APRN) roles — the others are certified registered nurse anesthetist, certified nurse midwife and certified nurse practitioner — the CNS leads and collaborates with other members of the interprofessional team to enhance care delivery and improve outcomes for patients and families. A recent article in Critical Care Medicine describes how CNSs contribute to the interprofessional team:
- Provide clinical expertise and education
- Coordinate the development and implementation of a plan of care
- Implement evidence-based practices
- Lead quality initiatives
- Conduct research
- Promote effective communication
To better understand and appreciate this vital APRN role — especially if you are considering a CNS career path — let’s take a look at CNS role requirements, scope of practice, core competencies and overall impact.
Happy Birthday and Thank You Hildegard!
Annually, the National Association of Clinical Nurse Specialists (NACNS) celebrates CNS Week during the first week of September. We do this in honor of Dr. Hildegard Peplau, Ed.D., RN (1909 – 1999), who established the CNS role. September 1st is her birthday. If she were alive today, she would be 112-years-old. The CNS role has been in existence for 65 years with nearly 90,000 CNSs currently practicing in the United States.
Click here to wish Dr. Peplau a Happy Birthday and maybe leave a few words on what the CNS role means to you.
On the Road Again (Sort of) with Virtual Nursing Meetings
Virtual meetings are likely here to stay, at least in part.
For the past 18 months, I’ve spent a lot of time attending virtual meetings. You name the app—Zoom, Facetime, Microsoft Teams—I’ve been on it. While I appreciate the advances that enable us to have visual as well as audio connections with colleagues, family, and friends, I do miss meeting the old-fashioned way: in person. The good news is that many people who might not have been able to attend meetings because of the travel costs are now able to “zoom-in” on meetings.
I’ve “attended” several virtual meetings this spring but messages from two of them stay with me:
The resurgence of the clinical nurse specialist (CNS).
The National Association of Clinical Nurse Specialists (NACNS) had its virtual meeting with 900 attendees from 46 states. The theme was “The Resurgence of the CNS,” focusing on how the CNS has become the “go to” professional to lead quality initiatives. I recall the 1980s, when hospitals were in a cost-cutting mode and many cut the CNS role.
A decade later, reports from the National Academies of Medicine on medical errors (To Err is Human) and later, on safety and quality (Crossing the Quality Chasm) called for change, but there was no one to take this on. The CNS role was reborn in many institutions and charged with improving care. The incoming president, Jan Powers, noted her theme for the 2022 conference, “CNS Rise,” and challenged each member “to rise and demonstrate the CNS role through vision, visibility, voice, and value.” As a former CNS, I couldn’t agree more—we must make our work and contributions visible. You can listen to my interview with Jan here:
Keeping the focus on nurse voices after the pandemic.
The New Jersey Association of Nurse Leaders (NJAONL) sponsored a webinar with two noted nursing leaders—Joanne Disch and Diana Mason, both former presidents of the American Academy of Nursing. Dr. Disch gave some wise advice, noting that sometimes, “Advocacy is not enough some—we need to move to activism, actively supporting change.” She emphasized that we can’t allow nurses’ voices to be dismissed after the pandemic. Our value became more apparent than ever, and nurses must continue to stress that organizations will do better if nurses play a key role.
Diana Mason reminded attendees that her replication of the Woodhull study of nurses’ voices in the media show that not much has changed—nurses are still largely invisible. She offered practical techniques (my favorite: “Grab the mic”: in other words, don’t wait to be invited to speak—make your own opportunity). She and co-researchers also surveyed journalists to find out why they didn’t include nurses more often as sources and what nurses can do to reach out to journalists.
What resonated with me from both of these meetings is that nurses MUST speak up about their contributions and the value they bring to health care. If we don’t, we will continue to remain in the shadows; when it comes time for budget cuts, we’ll be back on the chopping block. Use Nurses Month to showcase what you and your colleagues bring to the table.
Success Story: The CNS As Credentialed Provider
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.
NACNS took the time to interview Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN, the lead clinical nurse specialist of UVA Health who 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 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.
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 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.
NACNS is dedicated to advancing CNS practice and education and removing unnecessary and limiting regulatory barriers, while assuring public access to quality CNS services. For more information or to join NACNS click here.
Question and Answer with the Conference Co-Chairs
The NACNS annual event will be virtual this year taking place on March 9th-11th of 2021. The agenda for the first virtual conference is packed with over 100 on-demand sessions and poster presentations to watch at your own pace. With keynote presentations from Vince Holly and Katherine Brown-Saltzman. NACNS is also offering a total of 63.75 contact hours, plus 4.50 Nurse Pharmacology credits.
We spoke with the co-chairs of the event to find out what they were most excited for this year and we wanted to share what they had to say with you.
Registration is now open for the event and you can register here.
Ludmila Santiago-Rotchford, Conference Chair
Q. 1 What is the best reason for people to attend the 2021 Annual Conference?
It is the only National conference organized by CNSs, for CNSs, to get reinvigorated and inspired to continue to do great things in your role! There is no need to worry about not being safe during the pandemic in the virtual platform. The ability to have access to more than 63 CEs in one conference!
Q.2 What is your advice for early-career attendees attending this conference to maximize their experience?
Plan your days so that you can ask questions live to speakers who are experts in your areas of interest. Participate in the moderated discussions to share your experiences as well as challenges in your role as a CNS. You will have the ear of the BOD firsthand and they are excited to know what you need, and what is important to you as you progress in your career.
Q. 3 What are your memories from your first conference?
I felt like a groupie. It was fascinating to meet so many CNSs who had published the articles I read in my CNS program. It was great to be able to ask them questions about best practices. It was amazing to be surrounded by people who knew exactly what a CNS does!
Q.4 What are you most looking forward to at the 2021 Annual Conference?
I am looking forward to hearing all the live sessions from the keynote speakers and the incoming and outgoing Presidents of NACNS. I look forward to hearing about all the amazing work that CNSs are doing around the world. I am especially excited to network with other CNSs at various levels of expertise.
M. Jane Swartz, Conference Co-Chair
Q. 1 What is the best reason for people to attend the 2021 Annual Conference?
Being in a room with 400 people and not having to explain what a CNS is and understand the role.
Q.2 What is your advice for early-career attendees attending this conference to maximize their experience?
Be an extrovert–talk to someone you do not know, engage the speaker after the sessions, listen to ways you can support NACNS, talk to the officers and Board member. There are many opportunities to engage if you open the door.
Q.3 What are your memories from your first conference?
Going back home with more confidence and strategies to promote the role.
Q.4 What are you most looking forward to at the 2021 Annual Conference?
Being a part of the first virtual NACNS conference, connecting with friends throughout the USA, and meeting new friends. I also look forward to listening to how our organization will connect with the Canada organization.
To register for the conference or for more information, please click here.
10 Reasons to Attend the First Ever NACNS Annual Virtual Conference!
Things that happen once a year: 1. Your birthday. 2. Car inspection sticker 3. Getting a raise (hopefully) 4. Taking a bath (just kidding) and 5. Attending the National Association of Clinical Nurse Specialists Annual Conference.
It’s time for #5 again! Here’s 10 reasons you can’t miss this year’s conference.
1. 63? Whew that’s a lot!
We have over 63 credit hours available for you to earn throughout the conference. Each hour is filled with training and insight especially for the Clinical Nurse Specialist and has been planned and implemented by Amedco, LLC and the National Association of Clinical Nurse Specialists. Amedco, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
2. Keynotes that Inspire
We are featuring keynote presentations from Vince Holly, MSN, RN, CCNS, ACNS-BC, CCRN, about the resurgence of the CNS and from Katherine Brown- Saltzman, MA, RN, about self-care in difficult times. To learn more about our keynote presenters, click here!
3. Knowledge is Power: Pharmacology Workshops
Pharmacology workshops have been approved for 4.50 Nurse Pharmacology credits. Eleven learning goals focus on key objectives and pharmacotherapy options for patients.
4. Over 100 On-Demand Sessions and Poster Presentations
This year we have 116 presentations to watched 24/7. With over a hundred presentations, attendees are sure to find something useful and can earn CEs at their own pace.
5. Virtual Expo Hall
Not only will the virtual Expo Hall give you the chance to meet with our valued sponsors and exhibitors, you’ll also be able to meet with all of the NACNS Committees. Each Committee will have their own virtual booth where you can drop in during exhibit hours, ask them questions and hopefully sign up to join! And you can also compete in the Leaderboard Game, sponsored by Nurses Service Organization (NSO) —earn points for visiting booths, downloading materials, and asking questions. The points you earn can transfer towards great prizes!
6. Chit-Chat: Interactive Networking Meetups and Activities.
Organized midday meet-ups for attendees to chat about pressing topics and connect with one another, a trivia tournament and end-of-day networking parties are just some of the ways we will help you foster meaningful connections at the conference.
7. Hob-Nob with the Stars
You can connect with your colleagues at any time during the conference, and you can do the same with the speakers too! Scroll through the attendee or speaker list and send a request for a one-on-one chat. Or invite others and make it a party! You can also send a private message to any of the speakers and attendees.
8. Watch the Virtual Award and Induction Ceremonies
We will be honoring the new class of CNSI Fellows with a virtual Induction Ceremony on Wednesday evening and NACNS Award Winners on Thursday morning. Join us to raise a glass and toast the best and brightest in our field. Please join the fun!
9. Save Money
Did we mention there are no travel costs to attend the event? And if you’re missing New Orleans, we found some great ways to bring the city to you! You will have the opportunity to take virtual tours of New Orleans, hear the music of the city, watch virtual mixology lessons and even join a LIVE virtual Cajun cooking class hosted by the New Orleans Culinary & Hospitality Institute—plus a few more surprises!
10. Easy Registration
Registration is simple. We have three options to register—member, non-member and student—and we accept credit cards. To learn more about our registration and get yourself a seat at the conference, follow this link.
Register for the first ever NACNS annual virtual conference HERE—we can’t wait to see you there!
Meet the NACNS Nominating Committee Candidates
Voting for the NACNS 2021 Board of Directors election is open now through Nov. 30. With the positions of President-Elect, Secretary/Treasurer, Board of Directors, and Nominating Committee up for election, you don’t want to miss out on your chance to cast your vote.
To learn more about the Nominating Committee candidates, read this Q&A about who they are and why they want your vote. You can learn more about the duties of this position here.
Click the link at the bottom of the page to cast your vote.