Bill Klaproth (host): This is today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth, and joining me is Leah Hot, Miranda Goggins and Carla Brown. As we talk about nurturing future leaders, the value of a CNS internship program. Leah, Miranda and Carla, welcome.

Karla Brown: Hi Bill. Thanks for having us. Thank you for letting us be here today.

Bill Klaproth (host): Yeah.

Miranda Scoggins: Thank you for making this one of my bucket

Bill Klaproth (host): list checkoffs. See, there it is. I knew we would get one of those today.

I'm happy to fulfill that bucket list checkoff list for you, Miranda. I love it.

Miranda Scoggins: Absolutely had to drag my friends with me

Bill Klaproth (host): that well, and you did a great job as we welcome Carla and Leah and you here to our podcast booth. So thank you all for your time. I really, really appreciate it. Leah, let me start with you first question to you, for listeners who may be less familiar, can you briefly explain the role of a clinical nurse specialist or CNS.

And how it differs from other advanced practice roles.

Leah Haught: Absolutely. the National Association for Clinical Nurse Specialists, which is our national organization, actually updated our official definition of what the CNS is. so basically it's an advanced practice registered nurse, A PRN, prepared by a master's or higher level, education in a CNS program.

CNS is diagnosed, prescribe and treat patients and specialty populations across the continuum of care. we improve outcomes by providing direct patient care, leading evidence-based practice, optimizing organizational systems, and advancing nursing practice.

Bill Klaproth (host): All right. Well thank you for explaining that.

It's a good place to start in Miranda then. the CN s's ability to identify gaps in practice and things like that. Can you share a specific example of how this has led to, uh, measurable improvements in patient outcomes or operational efficiency?

Miranda Scoggins: Absolutely. this is actually how I came to be part of the CNS internship program.

with nursing, we have our nurse sensitive indicators. I worked on the Covid Hot Unit. And our collapsing numbers were significantly high. especially even after the pandemic started to decrease. We were still hitting those double digits very early on in the year with that direct care sphere, me working at the bedside, I was able to identify different barriers, that were taking place in practice and able to see what areas of improvement we could do.

There was no set, audit tool. Teammates were still, kind of operating on cowboy techniques. I would say we had started, we had, missed our labels and those practices that were firsthand nature to us prior to the pandemic. Just reiterating those and bringing back, but then also updating with the best, evidence-based that we have found within those five to seven years.

Of literature and we were able to develop a protocol, which was an audit tool. We had a reward system that went out with it, and when you were removing lines, really pushing for ultrasound guided IV placement and training, we also included provider education and nurse education for that interprofessional collaboration.

Spec. And from that work, we were able to take our clap seeds down in 2022 to 16, 20 23, we went down to nine, and then in 2024 we had four. So a lot of improvement.

Bill Klaproth (host): Yeah, so measurable benefits there for sure. Absolutely. Yeah. That you've seen. So, Carla, let me ask you this. What strategies did your team use to recruit then high performing RNs into CNS roles in a budget neutral, friendly way?

Karla Brown: so actually all of us here, we're part of that program, or currently part of the program, as Miranda just mentioned. the best part of this was being able to recruit from within. So taking what already was a full-time employee and putting them in what was at the time called a clinical outcomes leader role.

and it's since morphed into more of a CNS internship just to align with, N-A-C-N-S, as Lee had mentioned the organization before, but just looking for those high performers who in the unit. were looking to advance their careers and just had kind of that mindset of a CNS of, they were very outcomes driven.

You saw, the passion they had to make things better. within the CNS role, it's, we work within the three spheres of impact, so that is system nurse and patient. And so just seeing that nurse that had that mindset of being able to look at it. All around. So, they were working hard. They agreed with that evidence-based practice mentality.

so finding those nurses and bringing them in. and then from there, if you got accepted into that role, you then would be expected to go to, an accredited CNS program. and then from there you were assigned a mentor and so. You are able to really help to grow, from within. And we all kind of had different roles.

I was a bedside nurse, so mine just remained as a bedside nurse within the unit. Leah actually was a service line educator, so she just kept that position, but really morphed into more of the outcomes leader. So it kind of varied based upon where we all started. but we just kind of kept what we already were, but just our roles and responsibilities changed as we became the CNS intern.

Bill Klaproth (host): there a certain type of person you were looking for when you were recruiting? Is that were, what do you look for?

Karla Brown: So, I know personally, I actually came at the right time for myself. my mentor, Lacey Banger, who's one of our other, CNSs in our ICUs, she was trying to find someone that could help.

and I actually came to her because I knew I wanted to do something else, but I couldn't figure out what it was that I wanted to do. And I think that's what we all do. We're out there. We are helping with the professional development of our nursing staff. And you find where people's niches are, you find what their passions are.

And when I came to her, I described like what it was that I wanted to do. And I was like, I don't quite wanna be a nurse practitioner. I don't quite wanna be an educator. I can't figure out where exactly I fit. But I was like, I love just the idea of like putting a puzzle together, figuring out where pieces are missing, how can we do better?

And she was like. Like, girl, you need to be a CNS. And I was like, okay. And so I shadowed her and sure enough, like once I figured out like more about what A CNS did, I was like, this is exactly what I was looking for. And so I think just paying attention to. The nurses on your units or wherever you are and learning more about them.

I feel like they come to you. Mm-hmm. like, you just have to pay attention. You have to be looking out and, ' cause like I said, I just happened to come to her at the right time 'cause they were actually looking to see who could help. Mm-hmm. And not really become a CNS, just like, help fill in the gaps.

And once she heard what I said she was, she was like, change of plans. We're putting her in an outcomes leader role, I slowly transitioned away from the bedside. And so just really being open-minded as to your staff and where they just shine.

Bill Klaproth (host): Yeah, that makes a lot of sense. what's that saying? When the pupil is ready, the, the teacher will appear.

Mm-hmm. So those people will present themselves to you that are looking for potentially a role that fits them like a CNS. Role. Yeah, for sure. So Miranda, I know this is really important. We talked about recruiting RNs into CNS rules. How do you go about showcasing the ROI to upper leadership so they understand that this is important?

Miranda Scoggins: So this is actually really funny. I got into this program after I completed months after I completed, my master's degree in nursing administration. So a lot of that degree was talking about stakeholders and how do you make it. Stick because at the end of the day, they want to know how much money is it?

How much money is it gonna save me, or how much is it gonna put in my pocket? and I think that with, the CNS role, because we do operate within those three spheres, we get to be that face for the patient, for the nurses, for the system. A lot of our leaders are unable to be at the bedside so that we can actually break down, this is where your area of infection is and it's related to X, Y, and Z.

This is what we need to do for that. And you need to be able to do it in a very quick and concise manner. So no long emails. So we are very efficient with SBAR and hitting out, here's your situation, here's what the evidence says, this is what we're recommending and this is how we're gonna follow up with you.

And then in six months they come back and they're like, where are you at on this? Mm-hmm. Oh, we finished that two months ago, but here you are. and also, a huge component of being a CNS is disseminating that work. I can talk to my coworkers about a project, but how am I speaking about that with people at the bedside?

Because once again, we have our own language that we have, we need to figure out how to make it easier so that the bedside staff knows so that they continue to champion and support our efforts. Because if they can continue to champion our efforts and we are advocating for them, that change is gonna be sustainable, and then that is what the leadership is gonna see.

We are effectively making that change. In practice, in culture, and just overall benefiting the whole organization. Yep. And just to, if

Karla Brown: it's okay, to, add to Miranda, sometimes it's not always a return on investment, but a lot of what we are able to demonstrate is a cost avoidance. so as she mentioned, we work on clabsi, we work on happy, we work on these, big nurse indicators and just looking at how.

Wow. The impact that we've made has been able to decrease those numbers of infections or able to then go back and say, because of what we implemented, because of this initiative, we have been able to decrease by X percentage, and based upon the average cost of a collapse of a happy, we have been able to avoid X amount of dollars.

so even though we may not be able to show. That this, gained money, we are able to show that we were able to avoid those extra costs for our facilities as well.

Bill Klaproth (host): Cost avoidance. That's a really important point. Another way to put it, so, mm-hmm. Yeah. Thank you for saying that. And then Leah, looking ahead, if you could look into your crystal ball right there, how do you see the CNS role evolving, and what advice would you give to organizations considering expanding or introducing this role?

Leah Haught: So you're right, it is absolutely evolving. which is why the N-A-C-N-S, along with the CNS Institute had to actually update the definition of the CNS, just to bring more clarity. there's a lot of misunderstanding sometimes around what A CNS is and what a CNS does. CNSs are, really starting to expand their practice areas and taking on more responsibilities.

they're also becoming more credentialed and can prescribe, In some states, and more and more states are, expanding privileges and full practice authority. CNSs are increasingly taking on more leadership positions, influencing policy, and driving changes within healthcare systems. and sometimes these roles can be underutilized or, depending on the workforce, that may not be there.

Sometimes CNS roles have actually been, Restructured or replaced by other roles. so, my biggest advice to CNOs or, nursing leaders out there is, to really look at, what CNS programs are around your area. because the CNS role can be a really effective way to, improve system outcomes.

and obviously our patient outcomes as well, and nurses, So really, looking at having agreements with those programs and there's a lot of flexibility now with, even though we have, some of our numbers have dwindled as, as far as the n number of nursing CNS programs available, they're a lot more accessible with having online or, hybrid, options available to practicing nurses.

Because having those agreements and like really building that talent pipeline would be important to help improve outcomes overall.

Bill Klaproth (host): Yeah. Better outcomes, for the patient, better outcomes for the nurse leader or the CNS 'cause they're really doing something that really fits them and in an area where they want to be.

So it's kind of twofold, kind of a thing. Well, I want to thank you all for being here today. This has really been great. If we could just go around the table and get final thoughts from each of you. Miranda, let me start with you. Any final thoughts?

Miranda Scoggins: Yeah, I think the most important thing, if you're trying to look in the value of what this investment brings, our program has taken your highly motivated individuals and you have basically made them the clinical expert for your patient population.

They know your patients, they know your staff, they know the processes. and it's essentially like you have your very own. Cheerleader for the unit that's able to be like, I will help you build the base so that you can stand on the top. Because we want our teams to excel and I think as a CNS we're what the team needs so that they have that professional fulfillment that everybody's looking for.

Bill Klaproth (host): Yeah. Very well said. Carla, how about you? Final thoughts?

Karla Brown: you know, if you're truly interested in. Outcomes and just progressing, you know, nursing care, patient outcomes, and just the system as a whole. The CNS role is definitely for you. And then just showing the value because as Leah said, we're just so underutilized and clearly we are all very passionate about this role.

And we would shout it from the rooftops of how important it is to embed clinical nurse specialists within our facilities. So any leaders that are out there. looking to see how a clinical nurse specialist can be woven into your facility and where they would fit even if you're just starting out small.

we thankfully have been able to grow, what are we at, at least 14 CNSs within our facility, which when you talk to other facilities that is. A huge amount. So we are very lucky that we get to have this team of clinical nurse specialist brains working together on so many things. But I would just extremely push for any leaders to look at the value of this role and how it can really just drive patient outcomes even further.

Bill Klaproth (host): So it sounds like start small experiment, get out there, right? Mm-hmm. If you wanna try this, just get out there and do it. Yeah, yeah, for sure. Leah, final thoughts?

Leah Haught: Yes. Um. Having the mentorship there, is really important in growing, us as leaders and clinical nurse specialists, even if you're in an organization where you have no clinical nurse specialists, CNSs are a really tightly knit group through our national organization.

and CNS programs are very supportive. So there's, even if you don't have a mentor in place, a CNS to grow more CNSs within your, organization. like I said, we have Our home base of the N-A-C-N-S and our CNS programs and s sc NS is, we know how to make things work. So, definitely reach out to those programs and, these academic partnerships.

Yeah, there resources out there.

Bill Klaproth (host): We know how to make things work. I like it. That sounds great. Well, thank you all, all three of you for being here. I appreciate it. Thank you so much for your time.

Karla Brown: Thanks. Thank you. Thank you. Yeah.

Bill Klaproth (host): Once again, that is Leah h Miranda Goggins and Carla Brown. And for more information.

Please visit a l.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is today in Nursing Leadership. Thanks for listening.