Nancy E. Dayhoff

Developing Clinical Nurse Specialist Practice Competencies

Background: In 1998, the National Association of Clinical Nurse Specialist (NACNS) developed the first ever core competencies for clinical nurse specialist (CNS) practice. Purpose: This article describes the method used to develop, validate, and revise CNS core practice competencies. Methods: The stepwise method of identifying core CNS competencies included content analysis of CNS position/job descriptions, extensive literature review, development by role experts, first-tier corroboration, second-tier corroboration encompassing stakeholder review, final review/editing, approval by the board of directors, and dissemination. Discussion: The process used by professional organizations to develop competencies and standards varies; however, it should be transparent and consist of adequate review and validation for accuracy and applicability by members of the representative group for whom the standards and competencies apply. Conclusions: The stepwise method used by the National Association of Clinical Nurse Specialist generated valid CNS core competencies and may be instructive to professional organizations interested in developing competencies and standards.

A description of clinical nurse specialist programs in the United States.

Changes have occurred in clinical nurse specialist educational requirements in recent years, and it is not known how programs have responded. The purpose of this descriptive survey was to identify the number of clinical nurse specialist programs in the United States, describe curricula, and examine enrollment and employment trends. This report contains data from 157 separate clinical nurse specialist programs/majors representing 139 different schools. The mean number of credit hours for semester- and quarter-based programs was 41.4 and 52.2, respectively. The mean number of clinical/practica clock hours was 416.2. Approximately half of the respondents (56%) used the National Association of Clinical Nurse Specialists Statement on Clinical Nurse Specialist Practice and Education to guide curricula. Nearly 66% of the programs had from 1 to 10 applicants during the previous year. The majority (68%) indicated that their graduates do not have difficulty finding employment after graduating. These findings indicate that efforts to revise curricula and clarify the CNS role must continue.

You don't have to leave your hospital system to be an entrepreneur.

CLIN ICAL NURSE SPEC IALI STTM A misconception among clinical nurse specialists (CNSs) is that entrepreneurial activities can only be accomplished in the private sector and not within hospital systems. However, there are two kinds of CNS entrepreneurs: an entrepreneur, who works outside of an organization and an intrapreneur, who takes hands-on responsibility for creating innovation as an employee of an organization.1 Pinochet developed the concept of intracorporate entrepreneurs in 1976, and the concept has continued to grow since that time primarily by companies and not hospital systems. CNSs with an entrepreneurial spirit may not wish to leave hospitals to become entrepreneurs. In fact, hospital systems that embrace entrepreneurship will find themselves on the cutting edge of patient care with system growth and economic advantage. However, few CNSs consider framing their work as an intrapreneurial endeavor. As a part of expected CNS work, patient care problems may be solved through the introduction of new products, redesign of processes, or addition of new services.2,3 For CNSs to be intrapreneurial, in addition to being traditional clinical problem solvers, the CNSs will use intrapreneurial thinking rather than corporate thinking to solve patient care problems. Using traditional or corporate thinking means that CNSs look for how others have solved similar problems, recommending purchase of existing products, or introducing new services similar to what other hospital systems have previously developed. In other words, traditional CNSs will look to strengthen and improve hospital systems using existing solutions. What makes the CNSs’ work intrapreneurial rather than part of expected performance? Innovation is a hallmark of CNS intrapreneurs. CNS intrapreneurs are actionoriented dreamers. They may spend considerable time building and testing their mental images about new care processes or products. Others may believe they are daydreaming. However, it is the creation and testing of mental images that is the prelude to actualizing their dreams to improve practice and contribute to the economic advantages of their hospital systems. One difference between CNSs as inventors and CNSs as intrapreneurs is that inventors create new products and processes in their minds or even on paper, but intrapreneurs bring their ideas into systems to solve patient care problems. CNS intrapreneurs focus not only on the patient care benefits of change but also on the economic value of the innovations. When CNSs think about ways to deliver better patient care, they not only want to improve care for the patient but also want hospital systems to benefit. All CNSs are concerned about cost-avoidance and costreduction, but CNS intrapreneurs are also looking for revenue generation from their innovations. CNS intrapreneurs are concerned about enabling their hospital to grow and profit—how to turn their ideas into profitable reality. Because of these attributes, CNS intrapreneurs are not only willing to assume some of the risks of innovation but also to seek to participate in the benefits realized by hospital systems. These attributes are what differentiate traditional CNS work from CNS intrapreneurship.

A Cost-effectiveness Worksheet for Patient-education Programs

This article describes the development, implementation, and evaluation of a worksheet used by nursing faculty in a graduate clinical nurse specialist course to assist students in learning to estimate the cost-effectiveness of patient-education programs. 1 The worksheet was found to be a satisfactory method of facilitating student learning and could also be used in the service arena to evaluate the cost aspects of patient-education programs.

The diabetes educator as an entrepreneur: Starting your business

If you determine that you have many of the attributes of an entrepreneur (including being a risk taker), if you have a passion for your products and services, and if you are willing to risk an uncertain income, then you are ready to be an entrepreneur. The steps outlined in this article provide a basic overview of how to set up a business. If you decide to become an entrepreneur, there are numerous books and Web sites to guide you through the steps of establishing and managing a business. Although the challenges of becoming an entrepreneur may seem intimidating, becoming an entrepreneur can be very rewarding.