Nurses Honored for Extraordinary Efforts

They braved floodwaters to rescue dozens of nursing home residents; crawled under and into mangled vehicles to save those inside; ignored blood, mud, and freezing cold temperatures to administer CPR; even rushed in to rescue survivors of terrorist attacks or hurricanes.

These nurses are among the 10 recognized as Nurse Heroes this year by Nursing Spectrum, NurseWeek, and Gannett Healthcare Group, as well as our cosponsors, The Johnson & Johnson Campaign for Nursing's Future and Sigma Theta Tau International Honor Society of Nursing.

"These nurses showed initiative, leadership, and clinical competence in extraordinarily difficult circumstances," says Steve Hauber, CEO and publisher of Gannett Healthcare Group, parent company of Nursing Spectrum and NurseWeek. "By honoring their accomplishments, we bring attention to the scope and skills of professional nursing as it's practiced every day."

The winners were selected from a pool of many worthy nurses nominated by peers and patients for their efforts to save lives outside the workplace and under adverse circumstances between May 2004 and May 2007. In November, each recipient was honored at Sigma Theta Tau's 39th biennial convention in Baltimore, Md.

"Nurses respond to these types of disasters, and many others, every day of every year," says Cynthia Vlasich, RN, BSN, vice president of Gannett Healthcare Group. "We need to take pride in what we do every day, and we need the heroes from our profession to lead the way."

Here are their stories.

Janet S. Rami, RN, PhD

Janet S. Rami, RN, PhD, made it her goal to not only provide health care to those who needed it after Hurricane Katrina hit but also to ensure ongoing quality care.

The dean at the school of nursing at Southern University, Baton Rouge, La., worked tirelessly from Aug. 31, 2005, to May 31, 2007, to provide primary healthcare services to Hurricane Katrina evacuees. Rami led the mobilization of advanced practice nurses, nursing faculty, and student and physician volunteers. As shelters around the city began to close in September 2005, Rami made plans to adopt Renaissance Village, the largest FEMA transitional trailer community in the city. She arranged for the school of nursing to coordinate care, so everyone caring for people in the village would be credentialed and care would be efficient.

She says the experience made clear the power of nursing. "The idea that a nursing school could actually go into a FEMA village of 1,500 people ... and they would allow us to independently control all their health care in their village — that's the most amazing thing when I look at it. But we did it," Rami says.

Lynne Burns, RN

When the passenger van ahead of her went off the road, smashed into a tree, and overturned, Lynne Burns, RN, pulled over to help. Unable to open the van's doors, Burns ignored the smoke and a stream of fluid she suspected was fuel and crawled through the broken windshield, searching for the most severely injured of the 15 terrified, bloody victims.

"I don't think I could have turned back, but I did wish I had gloves," she says. Burns extricated and cared for two men in critical condition, who had suffered closed head injuries and collapsed lungs, and remained on the scene until everyone inside the van had been transported to hospitals. "Even with all the ambulances there, we could have used 20 more hands," she says.

Burns called her supervisor at the North Shore-Long Island Jewish Health System hospital in Syosset, N.Y., to say she'd been delayed, and went to work after showering and changing her uniform.

Three days later, Burns received a letter from a first responder. "In the midst of all the chaos, I saw you, a nurse, giving care to a patient," wrote Steven Bernstein, EMT CC. "You didn't have to stop, but you did. Just seeing you there was a 'home run' for all of us ... [I] had a touch more confidence in my job just knowing that you were there."

Ursula Goodine, RN

Birdwatcher Ursula Goodine, RN, was in the country when she saw Kerri Hatch lying facedown on the road, moments after falling from a horse. "It was very ominous," says Goodine, who was an OR nurse at Brigham and Women's Hospital in Boston until retiring recently. "She was bleeding profusely from her ear, nose, and mouth. I was afraid she had a brain injury and, because of her head position, a possible c-spine fracture. Then she arrested."

Bystanders helped Goodine turn Kerri. She started chest compressions, and Kerri's mother, Audrey Hatch, began ventilation. "We continued CPR for 20 minutes," recalls Audrey. "At one point, I remember saying, 'It is no use; she is gone.' [Goodine] said, most firmly, 'Continue! You never give up.' "

Audrey marvels at how "Ursula gave of herself, totally, without reservation, to save a life," touching Kerri's blood regardless of risk. Goodine marvels, too, especially at Kerri's "amazing progress" today.

"By chance, we happened to be at that place at that moment with someone whose life was essentially gone," she says.

Paul David Meek, RN, BSN, BEd, CEN, CLNC

Floodwaters rose to dangerous levels Oct. 2, 2005, putting search-and-rescue volunteer Paul David Meek, RN, BSN, BEd, CEN, CLNC, in a precarious position. The trauma specialist and ED nurse at Stormont-Vail Regional Medical Center, Topeka, Kan., had never done a water rescue.

Still, Meek and his search-and-rescue team colleagues rescued 75 people — including 56 from a local nursing home. Miraculously, no lives were lost or serious injuries sustained.

Meek and his team worked a harrowing 17 hours to rescue adults and children from the raging waters. He says his scariest moment was holding an infant above the water as the baby's family climbed into the rescue boat.

"[The nurse in me thought], there's no way I'm going to let go of that baby until it is back in the mother's arms," Meek says. "Sometimes when things happen, nurses are people who keep calm, look at the situation, and take care of the people — no matter how insurmountable it may seem."

Ruth Rucker, RN

Just eight months after implementing nursing services at Hands of Hope Clinic, the only provider of free medical and dental care in Henry County, Georgia, volunteer clinical director Ruth Rucker, RN, was asked to extend services to Hurricane Katrina evacuees — 18,000 of them.

In fewer than 24 hours, Rucker assembled teams of volunteer nurses and physicians, medical equipment, supplies, and funds for medications. Rucker supervised her staff onsite (in Stockbridge, Ga.) more than 12 hours daily for seven days. The volunteers ultimately served 1,600 patients with pregnancy-related, cardiac, diabetic, and other acute and chronic problems, as well as those with disaster-related psychological trauma, infection, and injuries.

"Nurses are great assessors and planners," she says. "When something so big happens, you want to be part of it ... you jump in and do what needs to be done."

LaVonne L. Lewis, RN, PhD

A massive snowstorm and treacherous, icy roads in Pine Mountain, Calif., didn't stop LaVonne L. Lewis, RN, PhD, from helping a man who had been thrown from his car after an accident. Neither did the tremendous pain she experienced as a result of Reynaud's disease, a condition of the hands and feet that worsens in cold temperatures.

Lewis provided emergency first aid and kept him stabilized as they waited 45 minutes for an ambulance to arrive.

A trained psychologist and experienced nurse, Lewis had volunteered for a decade with the local fire department in Pine Mountain, an area filled with steep canyon roads. But all she could do that day, she says, was to tell the driver jokes to keep up his blood pressure and help him stay conscious.

"I function well in emergencies, and I know it's because of my belief in God," she says. "I've always had the philosophy that you cure sometimes, you heal often, and comfort always."

Shonna Robison, RN

Moments after a car sped by, Shonna Robison, RN, a licensed paramedic, watched as it crashed head-on into another car and both vehicles caught fire. After ensuring the driver of the other car was safe, Robison searched the wreckage.

"There was nothing to climb into," says Robison, who was then the ER director at Hopkins County Memorial Hospital in Sulphur Springs, Texas. "I shimmied under what was crushed into the ground."

Both the driver and front-seat passenger were dead, and neither she nor arriving rescuers saw a baby, but Robinson thought she had seen an infant seat through the rear window as the car sped by. Ignoring their pleas to clear the scene, Robison felt her way through the debris until she reached a tiny body and pulled it out.

Moments later, the wreckage collapsed. By then, Robison was starting IVs and splinting the baby’s fractured limbs. “I was so blessed to do it,” she says. “Life and death are totally different when you’re not in uniform.”

Barbara Chamberlain, RN, DNSc

Barbara Chamberlain, RN, DNSc, was volunteering to build rail fences at Gettysburg (Pa.) National Battlefield Park when a fellow volunteer, 76-year-old Bruce Pince, became faint, lost consciousness and suffered a heart attack.

Chamberlain, corporate director of clinical education and research for Kennedy Health System, Cherry Hill, N.J., immediately went into nurse mode. In cold, hard rain and standing in ankle-deep mud, she began CPR while recruiting others, including park rangers, to help. Because of poor weather conditions, park rangers decided not to use their equipment to restart Pince’s heart, and the local EMS crew was delayed. So Chamberlain and her team continued CPR for about 14 minutes until help arrived.

They saved Pince’s life. “I learned that I have a strong head, a good heart and can hold my own in an emergency situation,” Chamberlain says.

Capt. Betty Clavijo Bennett, RN, PhD(c), CCRN, CEN

Betty Clavijo Bennett, RN, PhD(c), CCRN, CEN, was the house supervisor at Baptist Hospital in New Orleans, preparing, watching and waiting for Hurricane Katrina to hit New Orleans. That was Sunday, Aug. 28, 2005. By the following Tuesday night, flooding from downed levees forced the evacuation of more than 2,000 people in the hospital, including some 200 patients, staff and families.

Bennett took charge of the air evacuation efforts on the hospital’s 11th story. An Air Force critical care nurse and hospital ICU nurse, Bennett drew on her military and nursing know-how. She managed — without modern communication systems — to coordinate patient evacuations with helicopter pilots, throughout the brutal heat of the days and lightless, dangerous nights. With gunfire from local gangs right outside the hospital walls, Bennett and her team worked round the clock for more than four days.

“It wasn’t just my ICU nursing or my 33 years of all different specialties of nursing or just my Air Force nursing that bailed me out,” Bennett says. “It was the combination of all the mentors through the years,” Bennett says. “We just flat out wouldn’t give up.”

Lisa Levine, RN

Lisa Levine, RN, was on the London subway on July 7, 2005, when terrorists attacked. The train car next to the one she was in was bombed. Her car derailed and filled instantly with smoke.

Levine, who was uninjured, didn’t think twice before trying to help those screaming in nearby cars. She jumped through a broken window to begin triage and assessments. She instructed those who were feeling faint to lie down and moved those with broken bones out of harm’s way.

Hailed as an “American hero” by local and international media, Levine, a Fort Lauderdale, Fla.-based senior implementation consultant for Quadramed Corporation, which provides IT solutions for health care organizations, says she wishes she could have done more that fateful day.

Breastfed Babies With Excess Gas

If your breastfed baby seems to have excess gas, it can be disconcerting because you're wondering if s/he is in pain. Surprisingly, some babies seem to have no problems and don't mind being "gassy". But if the baby seems to be in some discomfort, try these tips to help with excess gas.

1) Let Gravity Assist When Feeding

Basically, any position that causes the milk to go against gravity will help baby handle the flow of milk more easily, and cause him to swallow less air - resulting in less gas. Try nursing baby in the "football" hold with him looking at your breast and partially sitting up, facing you. Nursing lying down will allow baby to let extra milk flow out the side of his mouth. After a feeding, try holding him upright in a baby sling. Many Moms have found that their babies who frequently spit up are helped when they're frequently held close to Mom's body in a soft carrier.

2) Finish The First Breast First

At the beginning of a feeding, your baby is getting the lower fat "foremilk" and later on, the higher fat "hindmilk". If you remove baby from the first breast before he pulls away and give him the other side, he may fill up with foremilk, causing some gassiness, fussiness, and spitting up.

Let him decide when he's done with the first breast, either by pulling away or falling asleep. If you have a very strong "letdown", or milk ejection reflex, then this is especially important. You may have an overabundant milk supply. Try keeping baby on one side for an entire feeding.

3) Pay Attention To Your Latch

Be sure baby is latched on properly. His mouth should be open wide and he should have a lot of areola (not just the nipple but surrounding tissue) in his mouth. If he is latched on well you will have no pain, and baby will swallow less air - again, the result being less gassiness. It's also a good idea to burp your baby before offering him the second breast. Oftentimes a thorough burping will prevent spit up later.

4) Relax!

Frequent spitting up is often caused by an underdeveloped esophageal sphincter (fancy term for the muscles that keep food down). The problem will likely resolve as baby gets older.

Spitting up and excess gas is rarely caused by something a nursing Mom ate. There is no one food that causes trouble in most or all breastfed infants. Nursing Moms worldwide eat a variety of foods (including spicy foods, garlic, dairy products and "gassy" foods like onions, cabbage and beans) and nurse healthy babies. Food allergies are rare in breastfed infants. If you have a strong family history of allergies, then your baby may be allergic to something that appears in your milk. Ask your health care provider for recommendations about changing your diet if this is the case.

Fussiness and gassiness can be caused by many different factors, including temperament. If you suspect that your baby's frequent spitting up is caused by Reflux, he may have some of the following symptoms: trouble gaining weight, difficulty breathing, gagging and extreme irritability. Ask your baby's Doctor about your baby's symptoms if you're unsure.

by: Carrie Lauth

Breastfeeding Problems - Mastits

Mastitis

Women deciding to breastfeed anticipate that it will be a wonderful bonding experience for her and her baby. Nursing mothers all know that breast is best but what does she do about a case of mastitis?

Recognizing the problem

There are many warning signs and indicate that you may be coming down with mastitis.

1) An area on the breast becomes sore and red. The site of the clogged duct develops a very pronounced red spot which is extremely painful to the touch and holding or carrying your baby on this side may become unbearable. You may also see or feel a lump.

2) You may experience pain during nursing sessions. This may begin as a tingling sensation in the nipple. If there is no pain while the baby is nursing on that side, it does not mean that you don't in fact have mastitis.

3) Development of flu-like symptoms. You may experience a fever along with chills and body aches. Exhaustion is another common side effect. Many women report not even being able to get out of bed.

What to do if you suspect mastitis

At the first signs of developing mastitis:

1) Get into bed and rest! Even if you can just sit quietly for a few hours without doing anything such as housework or taking care of other children or family members, you'll benefit.

2) Apply warm compresses to the site of the clogged duct. Take a hot shower or even lower your breast into a bowl or pot filled with warm water and soak for a few minutes, several times an hour.

3) Nurse, nurse, nurse! Try to nurse the baby on the side of the clogged duct as often and as long as possible to work out the clog. Massaging the breast while the baby suckles may also help.

4) Remedies such as echinachea and vitamin C can be taken. Antibiotics may be prescribed by a physician or midwife as well.

How to avoid mastitis

Mastitis starts out as a plugged duct and develops into an infection. In order to avoid your ducts becoming clogged in the first place, it is a good idea not to constrict your milk ducts with underwire bras or tight fitting clothing. Try not to sleep on your stomach as this may also lead to a plugged duct. Avoid supplementing with bottles because this may lead to an overproduction of breast milk. When a feeding is missed, breasts may become engorged and ducts can get plugged up. Breast compression or breast massage before latching is also a helpful tool to avoiding clogged ducts all together.

by: Liz Picket

Nurse, Heal Thyself

Healing the self is the beginning of the healing journey.

How best to do this?

How have you been healed in the past, and how did it feel?

What spiritual practices have you previously practiced that brought you strength that you continue to use to raise your energy, to gather courage to meet the challenges of the job? and every other challenge of life!

If you no longer are practicing meditation or yoga or any other practice you once did regularly, what would it take to get back to the practice--without excuses!!

Just do it!! Ask your angels for assistance! They will be ecstatic that you remembered them.

You will be rewarded.

-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

Nothing is as it should be. And everything is exactly as it is.

The first statement implies resistence to the dance of life-- the second recognizes a situation for what it is, and acceptance oversees all.

I remember this as I walk into the confines of my hospital walls. We see scenerios all the time that we all proclaim, "NOT FAIR!!"

Who are we to say? But we certainly can say it is exactly as it is--no more, no less.

I have to ask myself: What is in the realm of my ability to help, to change the situation for the better, to help a grieving person, to give comfort and grace?

As I think of ways to help other people, I must be constantly on the lookout for all the ways I must heal.

Because I can't help anyone nor can I help myself as long as I judge, lack acceptance and resist everything that presents --disguised as problems --but truly are opportunities for growth and enlightenment.

And continue to take good care of myself, every moment along the way.

-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

"And what is as important as thinking," asked the Mind. "Caring," answered the Heart.

- Favio

As I age wisely, I've come to realize that Not Thinking is the heart of my own spiritual practice.

Everyday, I meditate, take long slow walks by the river that runs by my house, and do my entrainment brain exercises--giving my brain the same aerobic workout that the rest of my body enjoys with exercise.

And consequently, my mind slows down, and I feel at peace. I am taking care of myself, and can take better care of everyone else.

"Caring" is what a nurse does--in the framework of Being. We listen, give what is needed, take care of machines and do a lot of charting--not necessarily in that order.

Because of our ability to care in this state of Being, and ability as healers, others in the healthcare arena may see nurses as weak and as easy prey--to verbally abuse, to sexually harass, to make her think she is an idiot.

This is what needs to be healed within our profession. We need to take back our strength and our courage. We need to stand together, a nd protect the new nurses coming in. We need to create a forum to make sure our voices are heard.

And continue to take good care of ourselves, every moment, with every breath.

by: Kate Loving Shenk

Do You Need A Maternity Nurse

If you've determined there's enough money in your budget for a baby nurse (they don't come cheap), you'll need to consider several other factors before deciding whether or not to hire one. Here are some reasons why you might opt for the help:

• To get some hands-on training in baby care. If you haven't had experience or taken a parenting class and feel you'd rather not learn from the mistakes you make on the job and on your baby, a good baby nurse will be able to instruct in such basics as bathing, burping, changing nappies and even breastfeeding. If this is your reason for hiring a nurse, however, be sure that the person you hire is as interested in teaching as you are in learning. Some won't tolerate novice parents peeping over their shoulders; one with such a dictatorial take-charge attitude can leave you as inexperienced and unsure when she departs as you were when she arrived.

• To avoid getting up in the middle of the night for feedings. If you're formula feeding and would rather sleep through the night, at least in the early weeks of postpartum fatigue, a baby nurse, on duty twenty-four hours a day or hired just for nights, can take over or share this feeding responsibility with you and your spouse.

• To spend more time with an older child. Some parents hire a baby nurse so that they can be more available to their older children, and hopefully spare them the pangs of jealousy that are often provoked by new arrivals. Such a nurse might be hired to work just a few hours a day during the time you want to spend with your older child. If this is your major reason for hiring a nurse, however, keep in mind that her presence will probably serve only to postpone feelings of sibling jealousy.

• To give yourself a chance to recuperate after a Caesarean or difficult vaginal birth. Since you probably won't know if you're going to have a difficult time before hand, it's not a bad idea to do some scouting around for nurses in advance, just in case. If you have the name of a potential nurse or two, or at least have spoken to an agency, you can call shortly after you deliver and have a helper hired before you get home.

On the other hand, a baby nurse may not be the best solution to your postpartum needs if:

• You're breastfeeding. Since a nurse can't feed a nursing newborn, and feeding is one of the most time-consuming tasks in the care of a young baby, she may not prove to be all that helpful. For the nursing mother, household help - someone to cook,clean and do laundry — is probably a wiser investment, unless you can find a nurse who will do these chores and also offer breastfeeding tips.

• You're not comfortable with a stranger living in your home. If the idea of having a non-family member sharing your bathroom, your kitchen and your table twenty-four hours a day makes you uneasy, hire a part-time nurse rather than a live-in, or opt for one of the other sources of help.

• You'd rather do it yourself. If you want to be the one to give the first bath, catch sight of the first smile (even if they say it's only gas), soothe your baby through the first bout of crying (even if it's at 2 am), don't hire a nurse, hire household help to free you up for fun with baby.

• Dad would rather do it, too. If you and your spouse are planning to share baby care, a nurse may get in the way. There may also not be much left for her to do - except to collect her paycheque - especially if dad's around full-time while he's enjoying paternity leave. In that case, the money could probably be more sensibly spent on cleaning help.

If you decide that a baby nurse is right for you, the best way to go about finding one is to ask for recommendations from friends who've used one. Be sure to find out if the nurse in question has the qualifications and qualities you're looking for. Some cook, some don't. Some will do light housework and laundry, others won't. Some are gentle, motherly women who will nurture your innate mothering ability and leave you feeling more confident; others are bossy cold and patronizing and will leave you feeling totally inadequate. Many are qualified nurses: some have also been trained specifically in caring for mother as well as baby, in mother-child relations, and in teaching breastfeeding and child-care basics. A personal interview is extremely important, since it's the only way to know whether you are going to feel comfortable with a particular candidate. But excellent references ( do check them out) are a must. A nurse hired through an agency should be registered. It's also very important that a nurse - or anyone else you hire who may come in contact with the baby - has been screened for TB. She should also be trained in CPR and child safety, as well as be up-to-date on baby-care practices (putting baby to sleep face up; keeping toys, pillows and blankets out of the cot. and so on)

by: Carolyn Joana

The clinical nurse specialist role

AORN Journal, April, 2007 by Stephen Patten, Dennis E. Glover, Laura E. Newkirk, Lisa M. Cole, Theodore J. Walker, Kelly C. Nader

I was disappointed with the article Perioperative clinical nurse specialist role delineation: a systematic review" (December 2006, vol 84). I am presently a clinical nurse specialist (CNS) in the perioperative setting and know this role from a very personal perspective. I would agree that the role has not been delineated as clearly as I would like and that many people both inside and outside of the perioperative setting do not understand the CNS role. There are some misconceptions that have been portrayed in the article, however, that provide substantiation and validation to incorrect information in the national forum provided by this publication.

There are several areas of inaccurate information to which I take exception. My first and greatest concern is the statement made in the article that CNSs and nurse practitioners (NPs) have similar roles. I am not an NP, but I understand that most NPs define their role as medical diagnosing, prescribing medication, and providing direct patient care. The NP role is clearly needed in order to increase access to the health care system for patients in need, and at times, I feel the role is performed better by an NP than by a physician.

A CNS, however, is very different than an NP. My role as a master's-degree prepared CNS is to be the clinical expert who practices nursing in a specialty area identified in terms of a population, setting, disease, type of care, or type of problem. (1) I find the suggestion of merging the NP and CNS roles to be an affront to both roles. They are different, both are much needed, and both provide strength to the provision of patient care. The authors state that the major benefit of merging the two roles would be an increased validation of the CNS role, but in the same paragraph, they state that the NP works in the medical realm and the CNS works in the nursing realm. How can you merge two practices that work in different realms?

In the results and findings, the authors stated that

   the perioperative CNS
 was shown to affect the
 surgical environment
 through activities such as
 advocating for patients,
 collaborating with surgeons,
 consulting for
 nursing staff members,
 precepting, assessing
 patients both physically
 and culturally, and offering

 clinical insight. (2(p1022))

They then go on to state that this versatility leads to ambiguity. It is my opinion that this versatility leads to good patient outcomes through the provision of advanced practice nursing care.

The authors also state that regulatory inconsistency from state to state leads to confusion and varying roles for CNSs. Of note is the fact that state boards of nursing also have inconsistent regulations for NPs. It is my opinion that this problem would not be solved by combining the two roles, it would just be exacerbated. In that same paragraph, the authors say that several states fail to recognize a CNS as an advanced practice nurse (APN). Oregon is listed as a state that fails to recognize the CNS. I practice in Oregon, and I am recognized and title-protected because I have a separate certificate as a CNS. The Oregon State Board of Nursing, Nurse Practice Act, Division 54, defines a CNS as an advanced practice nurse. (3)

Not all of my comments about the article are negative. I agree with the authors that the current health care climate is ready for growth and that the perioperative CNS provides a needed dimension of advanced practice nursing. I also agree that CNSs need to work with the National Association of Clinical Nurse Specialists and AORN to develop clear expectations of the role of the perioperative CNS. AORN has APN competency statements that, unfortunately, blend the two roles. (4) I would be a strong advocate of supporting the American Nurses Credentialing Center in the creation of a certification examination for all CNSs.

In closing, I want to say that although there are problems with the role delineation of the perioperative CNS, the best way to solve the problem is not to combine the CNS role with the NP role but to define the two roles and clearly delineate the differences. A CNS provides expert nursing care as defined by and through nursing terms and not as defined by medical terms. Yes, there will be some crossover in the roles, but the differences are what define the two roles not the similarities.

(4.) Perioperative advanced practice nurse competency statements. In: Standards, Recommended Practices, and Guidelines. Denver, Colo: AORN, Inc; 2007: 97-124.

Authors' response. We would like to say a few words that may help to clarify this issue. Let us begin by stating that this article was, as it is titled, a systematic review of the literature comprised of 859 articles. The information presented is the published fact and opinion of many other authors over the years and in various regions without the current authors' personal perspective. We forced ourselves to step back and present not what we may have personally thought but what the literature holds for nursing on this topic. This article should serve as a basis for research to go forward and either support or contest the statements about the relationship between the CNS and NP roles. Evidence-based research is needed to clear the air.

Role confusion was clearly evident in the articles about the CNS and NP. We found the sides of the debate were clearly defined even though the roles were not. Although you see a clear distinction between the roles and competencies, the literature revealed that many people do not. In the literature, the similar educational preparation as well as the extreme versatility of the CNS and NP have led organizations to blend the roles or let the individual person define the role in his or her position. Organizations may have an NP seeing patients three days a week and working on system-oriented problems on other days. They also may have the same NP act as the office manager and fulfill CNS functions. In the name of patient safety and patient advocacy, these nurses fulfill the position that the organization has defined, a blended role of an NP and CNS utilizing both realms of practice. We do not deny that the versatility of the CNS and NP has offered improved patient outcomes, but it also has led to ambiguity by organizations about these roles. We as authors are not condoning this action, only stating that it is happening.

We are grateful that the state of Oregon has recognized the CNS as an APN. Our search revealed the American Nurses Association (ANA) documentation of APNs and the states that recognize them. Unfortunately, the three references in our article showed that Oregon did not recognize the CNS as an APN. The search criteria described in the article did not provide the Oregon State Board of Nursing web site in our results. Thank you for this information update, and we hope the ANA has or will publish an updated roster as well.

We hope that we have clarified how our article was presented. It is the opinion of the authors that the CNS and NP roles should not be blended, and additional research needs to be performed to facilitate evidence-based decisions and role definition. This reader has demonstrated that he has clearly defined his role and separated it from the perceived NP role. This supports our statement that "CNSs must define their roles in an organization or risk having their roles defined for them."

LCDR DENNIS E. GLOVER

RN, MSN, MBA/HCM,

CNOR, NC, USN

DEPARTMENT HEAD OF PERIOPERATIVE SERVICES

NAVAL HOSPITAL OAK HARBOR

OAK HARBOR, WASH

LTC LAURA E. NEWKIRK

RN, MSN, CNOR, AN, USA

CHIEF OF PERIOPERATIVE NURSING SERVICES

WINN ARMY COMMUNITY HOSPITAL

FT STEWART, GA

MAJ LISA M. COLE

RN, MSN, CNOR, USAF, NC

PERIOPERATIVE CNS

96TH MEDICAL GROUP

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MAJ THEODORE 3. WALKER

RN, MSN, CNOR, USAF, NC

PERIOPERATIVE CNS

MIKE O'CALLAGHAN FEDERAL HOSPITAL

NELLIS AIR FORCE BASE, NEV

MAJ KELLY C. NADER

RN, MSN, CNOR, USAF, NC

PERIOPERATIVE CNS AND ELEMENT LEADER

CENTRAL STERILE SUPPLY

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COPYRIGHT 2007 Association of Operating Room Nurses, Inc.
COPYRIGHT 2007 Gale Group

Bibliography for "The clinical nurse specialist role"

Stephen Patten "The clinical nurse specialist role". AORN Journal. April 2007. FindArticles.com. 28 Dec. 2007. http://findarticles.com/p/articles/mi_m0FSL/is_4_85/ai_n19021025