A Close Look at the Clinical Nurse Specialist Role

Podcast Transcript

Carol Pehotsky (00:04):

As nurses, we have no shortage of options these days when it comes to advanced degrees. But sometimes it's hard to figure out which direction to go. And some of those advanced degrees really lead down a very specific path. If you're a nurse who's intrigued by patient care, supporting nurses, evidence-based practice, and influencing organizations, we may have the role just for you. I'm joined today by Kayla Little and Mindy Rivera to learn more about the clinical nurse specialist role.

(00:35):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of surgical services nursing.

(00:55):

Like a lot of nurses, I got to a point in my life where I wanted to further my education, and it was time to get my master's degree. And I knew I wanted to be an advanced practice nurse, but like a lot of us, sort of sifting through what that would be, what it would look like. And initially I, I began my master's degree journey on a nurse practitioner track. And while nurse practitioners are amazing people and some of them are my providers, I got about a semester and realized that was not the right fit for me and became really intrigued by the role of being a clinical nurse specialist.

(01:25):

And throughout the next several years, I had some really amazing experiences with clinical nurse specialists as my preceptors, along my education journey. I go to graduate, and then suddenly I find myself (laughs) in leadership instead. So, I'm the CNS that never was, but I'm thrilled to be joined today by two amazing clinical nurse specialists from Cleveland Clinic. It's my pleasure to introduce our guests for today. We have Kayla Little and Mindy Rivera here. Welcome.

Kayla Little (01:50):

Thank you so much for having us.

Mindy Rivera (01:51):

Yes, thank you.

Carol Pehotsky (01:52):

So, I'd love to hear a little bit more about each of your career journeys and how you ended up finding your way to the clinical nurse specialist advanced practice role. Kayla, would you mind getting us started?

Kayla Little (02:02):

Yeah, I'd love to. So, I started at Cleveland Clinic as a clinical nurse on J62, which is cardiac step-down.

Carol Pehotsky (02:10):

Mm-hmm.

Kayla Little (02:10):

And things just took off rapidly.

Carol Pehotsky (02:13):

(laughs)

Kayla Little (02:13):

So, Terry Marie, she was actually a great mentor of mine when I started.

Carol Pehotsky (02:16):

Mm.

Kayla Little (02:17):

And I was always that nurse that was questioning things.

Carol Pehotsky (02:20):

Okay.

Kayla Little (02:21):

And then I quickly got involved with shared governance-

Carol Pehotsky (02:23):

Mm. Mm-hmm.

Kayla Little (02:24):

... being a preceptor for new nurses. And I really enjoyed that. And as I got more involved doing the shared governance bootcamp and coaching, being charged nurse, I realized that I wanted to do more than just being at the bedside.

Carol Pehotsky (02:39):

Sure.

Kayla Little (02:39):

And at the time, I actually thought I wanted to be a nurse practitioner because that's just what, that's what everyone does.

Carol Pehotsky (02:44):

(laughs) A lot of us were there. Yeah.

Kayla Little (02:44):

That's the next step.

Mindy Rivera (02:44):

That's the next step.

Kayla Little (02:45):

Yeah, exactly. And so, I enrolled in a program to become for [inaudible 00:02:46] a, a women's health nurse practitioner of, of all things.

Carol Pehotsky (02:45):

Okay. (laughs)

Kayla Little (02:55):

And no experience at all. But it sounded right. So, as I was starting the program, started the basics, you know, pharmacology pathology

Carol Pehotsky (02:56):

Mm-hmm.

Kayla Little (03:04):

... I realized this isn't what I wanted to do. Like, I don't want to just do direct care. I wanted to continue to impact the nurses, mentor them-

Carol Pehotsky (03:05):

Mm-hmm.

Kayla Little (03:13):

... do patient education, do more projects. And I actually looked online at Kent State's website.

Carol Pehotsky (03:20):

Okay.

Kayla Little (03:20):

And I read their program description for CNS.

Carol Pehotsky (03:21):

Okay.

Kayla Little (03:24):

And it was exactly what I had wanted to be.

Carol Pehotsky (03:26):

(laughs) What you wanted to be when you grow up. Yeah.

Kayla Little (03:28):

Yeah. So, I was like, "All right, I'm sold." And I talked with one of our clinical nurse specialists that was on the unit at the time, Jennifer Caldwell.

Carol Pehotsky (03:34):

Mm-hmm. Yeah (laughs)

Kayla Little (03:35):

And spent some time with her. And then I became a CNS, and I am so happy that that's the choice that I made.

Carol Pehotsky (03:42):

Excellent. And Mindy, your journey is a little different.

Mindy Rivera (03:45):

It's... So, it's actually funny that the Kent State Nursing website is also to blame for me being a CNS as well.

Carol Pehotsky (03:45):

Oh, okay. (laughs)

Mindy Rivera (03:50):

(laughs) You know, I worked on, you know, several different types of units and several different hospital systems, but, you know, throughout that journey, I never had the opportunity to-

Carol Pehotsky (03:51):

Mm-hmm.

Mindy Rivera (04:01):

... be exposed to a CNS, unfortunately. And so that being said, I had gotten to kind of a point in my career where I felt kind of that I had mastered what I was doing at the bedside and was really kind of proud of the quality of care that I gave to patients in the context of a 12-hour shift-

Carol Pehotsky (04:18):

Mm-hmm.

Mindy Rivera (04:18):

... but kind of thought, "Okay, I like what I do. How do I take this, and I extrapolate it out bigger than myself? You know, how-"

Carol Pehotsky (04:18):

Oh, it's a great way to describe it. Yeah.

Mindy Rivera (04:27):

... "how do, how do I take this and replicate it and kind of leave a footprint on nursing practice that's just bigger than-"

Carol Pehotsky (04:33):

Mm.

Mindy Rivera (04:33):

... "what my two hands can do in a 12-hour shift?"

Carol Pehotsky (04:36):

Yeah.

Mindy Rivera (04:36):

And so, of course, I consulted Google and-

Carol Pehotsky (04:36):

(laughs)

Mindy Rivera (04:40):

... said, "Okay, what else can I do as a nurse? What is the next step? What's the trajectory?"

Carol Pehotsky (04:45):

Mm-hmm.

Mindy Rivera (04:45):

And I knew a lot of people that were, of course, going to school to be nurse practitioners and the same as Kayla, I thought, "Okay, that's not quite right."

Carol Pehotsky (04:46):

Mm-hmm.

Mindy Rivera (04:54):

"That, that could be very fulfilling-"

Carol Pehotsky (04:55):

Absolutely.

Mindy Rivera (04:56):

... "but that's not exactly what I'm looking for."

Carol Pehotsky (04:56):

Yeah.

Mindy Rivera (04:57):

And so, doing some research, stumbled upon the Kent State graduate website, which actually I had already gotten an associate degree and a bachelor’s degree from Kent State.

Carol Pehotsky (05:08):

So, it just made sense. (laughs)

Mindy Rivera (05:09):

And one of my instructors in my BSN program actually was a clinical nurse specialist and I just, you know-

Carol Pehotsky (05:10):

Oh, dear. Yeah.

Mindy Rivera (05:16):

... it wasn't kind of aware of it at that time as a student but-

Carol Pehotsky (05:19):

Sure.

Mindy Rivera (05:20):

... between reading this and thinking back, I'll give her a little shout-out Tina Saunders is one of my mentors-

Carol Pehotsky (05:24):

(laughs)

Mindy Rivera (05:25):

... and kind of put that together and how she related to me and, you know, her skills in teaching me and I thought, "Okay, this feels more like home."

Carol Pehotsky (05:33):

Mm-hmm.

Mindy Rivera (05:33):

"This feels like where I'm supposed to be going, so."

Carol Pehotsky (05:37):

Mm-hmm. Mm-hmm. Excellent, and tell us a little bit more about your specialty, Mindy. (laughs)

Mindy Rivera (05:40):

So, I like to say that I am not a jack-of-all-trades. I'm a master of one.

Carol Pehotsky (05:41):

(laughs)

Mindy Rivera (05:46):

I am a clinical nurse specialist in pulmonary hypertension.

Carol Pehotsky (05:47):

(laughs)

Mindy Rivera (05:50):

So that is my subspecialty from inpatient care, outpatient care, direct care of patients, research education, the whole gamut.

Carol Pehotsky (05:58):

Wow!

Mindy Rivera (05:59):

So that is what I do.

Carol Pehotsky (06:01):

And Kayla, what is your day-to-day look like for your role?

Kayla Little (06:04):

So, my day-to-day is very different every day and that's what I love most about it.

Carol Pehotsky (06:08):

(laughing) Sure.

Kayla Little (06:08):

Every minute is different of every day, it keeps me busy. But my assignment is on the main campus-

Carol Pehotsky (06:14):

Mm-hmm.

Kayla Little (06:15):

... and I support the cardiovascular medicine, vascular surgery-

Carol Pehotsky (06:18):

Mm.

Kayla Little (06:18):

... and heart and lung transplant, stepped down nursing units within HVTI.

Carol Pehotsky (06:23):

Oh, wow! (laughs) Yeah.

Kayla Little (06:24):

So, it's six clinical nursing units. So, I have local responsibilities-

Carol Pehotsky (06:24):

Mm-hmm.

Kayla Little (06:28):

... and then also enterprise responsibilities. And then outside of, you know, the day-to-day stuff, I do volunteer for our national organization.

Carol Pehotsky (06:36):

Oh, wow!

Kayla Little (06:37):

And our local organization as well, Northeast Ohio Clinical Nurse Specialist.

Carol Pehotsky (06:42):

Wow. Thank you for giving back to the organization. My goodness. So, I'm sure a lot of our listeners are saying, "Well, that's nice, but what is a clinical nurse specialist?" (laughs) So could you share with our audience; how would you define being a clinical nurse specialist and what are some of the core tenets of the role?

Kayla Little (06:56):

So, a clinical nurse specialist is an advanced practice nurse.

Carol Pehotsky (06:56):

Mm-hmm.

Kayla Little (07:00):

And we practice it within three spheres of influence.

Carol Pehotsky (07:01):

Mm-hmm.

Kayla Little (07:06):

And so, it's patient care, nursing, and then the enterprise-

Carol Pehotsky (07:11):

Mm. Mm.

Kayla Little (07:11):

... or the systems is, is how they define it. And everyone practices a little bit differently.

Carol Pehotsky (07:17):

Sure.

Kayla Little (07:17):

Even here at Cleveland Clinic, you know, you have Mindy and I, who practice very differently.

Carol Pehotsky (07:20):

Mm-hmm.

Kayla Little (07:21):

Some cover an entire hospital system, some cover one unit, and others are just very disease focused.

Carol Pehotsky (07:27):

Mm. Mm-hmm.

Kayla Little (07:27):

And really, I think your assignment, where you're working, that's what drives your practice.

Carol Pehotsky (07:28):

Sure.

Kayla Little (07:34):

And, and every day can be something different. But we are researchers-

Carol Pehotsky (07:38):

Mm-hmm.

Kayla Little (07:38):

... we do patient education, nurse education, we teach classes, we do quality improvement initiatives, and we're also leaders.

Carol Pehotsky (07:47):

Mm-hmm.

Kayla Little (07:48):

And so, we're really a little bit of everything. We're all the nursing specialties combined.

Carol Pehotsky (07:52):

Yeah.

Mindy Rivera (07:53):

If you want to talk about like the ultimate chameleon in nursing practice-

Carol Pehotsky (07:53):

(laughs) Yeah.

Mindy Rivera (07:57):

... the CNS role is 100% that.

Carol Pehotsky (07:59):

Excellent.

Mindy Rivera (07:59):

So, you know, your career looks very varied and just your day can look varied-

Carol Pehotsky (08:04):

Mm-hmm.

Mindy Rivera (08:04):

... where you're doing 10 different roles in the same day to support the patients and the organization.

Carol Pehotsky (08:09):

And just reflecting back on my educational journey, while I may not ever officially practice with CNS, the idea around the spheres of influence and the, the practice of being a clinical nurse specialist has really, really helped me in systems thinking and, and working in an organization, and one of my preceptors during my education said, "Well, basically we're the nurse's nurse," which I liked, right?

Kayla Little (08:10):

Mm-hmm.

Carol Pehotsky (08:31):

Like, I'm, I'm out there, I'm advocating for nurses-

Kayla Little (08:32):

Mm-hmm.

Carol Pehotsky (08:34):

... and like you, like, you said, Mindy, really, how can we extend beyond our own fingerprints to influence nursing practice?

Mindy Rivera (08:40):

Yeah, absolutely. That is our expertise in taking, you know, evidence-based practice and emerging trends, our own experience and knowledge, and really distilling that, you know, into best practice and then taking that and supporting the nurses around us to deliver that level of care-

Carol Pehotsky (08:56):

Mm-hmm.

Mindy Rivera (08:56):

... you know, and also trying to influence nationally and, you know, just our own enterprise to really kind of replicate that best practice care so that all patients can experience that.

Carol Pehotsky (09:06):

Sometimes you see out there in the world some confusion about, you know, a master's prepared nurse educator versus a clinical nurse specialist. And yes, both can absolutely deliver educational content to nurses. CNS will wear a lot of hats, but how would you help define that for people listening?

Kayla Little (09:23):

I would say that my role is very unique in the sense that I provide the education and expertise because I live this role also as a pulmonary hypertension provider.

Carol Pehotsky (09:33):

Mm, sure. Yeah.

Kayla Little (09:34):

So, I am diagnosing these patients, making treatment decisions with these patients and really just walking the whole journey with them.

Carol Pehotsky (09:40):

Mm. Mm-hmm.

Mindy Rivera (09:40):

So, the education and expertise that I give to support nurses and the organization stems from my experience-

Carol Pehotsky (09:47):

Ah! Yeah.

Kayla Little (09:48):

... through providing that care.

Carol Pehotsky (09:49):

So, we have listeners of all generations. Some are still nursing students. Some are more advanced in their career. Their hospital just hired a CNS, let's say. So how can I... Whether I'm a brand-new nurse or more seasoned nurse, what should I be tapping into my local CNS? How can they help my practice as I'm at the bedside?

Kayla Little (10:09):

The CNS can really help at any point in time-

Carol Pehotsky (10:12):

Mm-hmm.

Kayla Little (10:12):

... whether you are trying to discover what your next step is or what to do next with your patient, it's a very complex patient scenario-

Carol Pehotsky (10:19):

Mm-hmm.

Kayla Little (10:20):

... or how to do a procedure at the bedside, or you want to get a certification-

Carol Pehotsky (10:25):

Hmm! Mm-hmm.

Kayla Little (10:25):

... or you notice that you read an article and, "This seems like a good practice that we should implement at our institution-"

Carol Pehotsky (10:32):

Mm. What's the next step. Yeah.

Kayla Little (10:32):

... call your CNS and they can help with that. So really, we are good to call at any point in time.

Carol Pehotsky (10:32):

(laughs)

Kayla Little (10:39):

And I think that's something that as our role gets out there more and people are seeing us-

Carol Pehotsky (10:39):

Mm. Mm-hmm.

Kayla Little (10:45):

... out on the units and at the hospital level, they are recognizing that we are very easily accessible-

Carol Pehotsky (10:52):

(laughs)

Kayla Little (10:52):

... and always willing to help because if we don't have that good relationship with the nurse-

Carol Pehotsky (10:52):

Yeah.

Kayla Little (10:58):

... then we don't know what needs to be changed. I-

Carol Pehotsky (11:00):

Yeah, I don't... I can't be the nurse's nurse if I don't know what's going on.

Kayla Little (11:03):

Ex- exactly, yes.

Carol Pehotsky (11:03):

Okay.

Mindy Rivera (11:05):

Yeah, it's very much we're working for you, so-

Carol Pehotsky (11:07):

Hmm!

Mindy Rivera (11:07):

Mm-hmm.

Mindy Rivera (11:07):

... reach out to us at any juncture.

Carol Pehotsky (11:09):

Mm-hmm. Well, when you think about, you know, wound care, advanced therapies, you know, oftentimes, are there CNSs that specialize in something like that?

Kayla Little (11:18):

Yes, yeah, diabetes care, wound care-

Carol Pehotsky (11:19):

Mm-hmm.

Kayla Little (11:22):

... you know, really any disease process, a clinical nurse specialist could be the guru for that.

Carol Pehotsky (11:23):

(laughs)

Kayla Little (11:28):

And that is something that in, in my area where I'm supporting so many different cardiac-

Carol Pehotsky (11:34):

Yeah (laughs)

Kayla Little (11:34):

... diagnoses, it's hard to be, like, the expert.

Carol Pehotsky (11:36):

Mm-hmm.

Kayla Little (11:37):

But if I don't know something, I have another CNS on speed dial-

Carol Pehotsky (11:40):

Sure.

Kayla Little (11:40):

... that could easily speak to, you know-

Carol Pehotsky (11:40):

Mm-hmm.

Kayla Little (11:42):

... what question I have, and they would know the, the answer to that.

Mindy Rivera (11:46):

And my life is being a, a living, walking, talking, breathing Wikipedia for pulmonary hypertension care for physicians-

Carol Pehotsky (11:46):

(laughing)

Mindy Rivera (11:53):

... for patients, for, you know-

Carol Pehotsky (11:54):

Sure.

Mindy Rivera (11:55):

... organizations, et cetera, so.

Kayla Little (11:57):

And I think one thing too, as far as the professional development for nurses. You know, and when-

Carol Pehotsky (12:02):

Mm. Okay.

Kayla Little (12:02):

... when to call a clinical nurse specialist is, you know, we are involved at the hospital level, but then at the national level we do stay up to date with what's going on, the certifications, and I don't know that a lot of the clinical nurses or aspiring nurses know of those advanced steps to take to get certified-

Carol Pehotsky (12:20):

Sure. Mm-hmm.

Kayla Little (12:21):

... or other advanced practice opportunities-

Carol Pehotsky (12:24):

Mm-hmm.

Kayla Little (12:24):

... or even just to be the expert at the bedside without going back to school. And, and we maintain that working knowledge. So, I think mentorship is something that I really enjoy doing.

Carol Pehotsky (12:34):

Yeah.

Kayla Little (12:35):

And it's always a joy to see someone come in and ask for your guidance-

Carol Pehotsky (12:38):

(laughs)

Kayla Little (12:38):

... and then to see them take that journey.

Carol Pehotsky (12:40):

Absolutely. So, we've spent some time talking about the patient sphere and the nursing sphere. Talk to me a little bit more about how clinical nurse specialists in our organization or in others have really influenced that organizational sphere.

Kayla Little (12:54):

It's happening all day, every day.

Carol Pehotsky (12:54):

(laughs)

Kayla Little (12:56):

It really is.

Carol Pehotsky (12:56):

Sure.

Kayla Little (12:57):

And, you know, things like our nursing sensitive indicators-

Carol Pehotsky (13:01):

Okay. Mm-hmm.

Kayla Little (13:03):

... so CAUDI, CLABSI, falls, pressure injuries, I promise you that there is a CNS involved in every single one of those projects.

Carol Pehotsky (13:03):

(laughs) Sure.

Kayla Little (13:09):

And we help by ensuring that the process is followed for quality improvement-

Carol Pehotsky (13:16):

Mm. Mm-hmm.

Kayla Little (13:16):

... implementation or research or any sort of process improvement we ensure that that's being done and then just making sure that we're advocating for nursing practice-

Carol Pehotsky (13:17):

Mm.

Kayla Little (13:28):

... and working with the nurses to make sure, "Hey is this what you're doing, does this seem feasible?" And being that almost like the liaison between the bedside and then executive leadership.

Carol Pehotsky (13:40):

Sure.

Kayla Little (13:41):

And we have that working relationship and just to know what the evidence is showing-

Carol Pehotsky (13:47):

Mm.

Kayla Little (13:47):

... we do a really good job of doing those literature reviews and, um, bringing that evidence into practice.

Carol Pehotsky (13:53):

So, I imagine that can come with some conflict, right? Sometimes it's the "Why can't you just," and then you fill in the blank of something that that might be simple to do but might not be effective or easy for the bedside nurse to do, or maybe not found in evidence.

Kayla Little (14:10):

Mm-hmm.

Carol Pehotsky (14:10):

So, what kind of skills does a clinical nurse specialist need to have to manage those murky waters of organizational conversations and perhaps some conflict?

Mindy Rivera (14:19):

I laugh because we literally just got out of a meeting together.

Carol Pehotsky (14:19):

(laughs) Well, there you go.

Mindy Rivera (14:23):

Um, (laughs) basically describing that exact situation. And you know, especially when you work here at Cleveland Clinic and you're treating very rare subsets of patients-

Carol Pehotsky (14:35):

Mm. Sure.

Mindy Rivera (14:35):

... and you're really on the cusp of how to care for those patients.

Carol Pehotsky (14:35):

Yeah.

Mindy Rivera (14:38):

Sometimes there's a lot of murky water. And you know, just like anything else, people have different backgrounds and knowledge and different perceptions of things. And, you know, there's always competing priorities in healthcare organizations-

Carol Pehotsky (14:39):

Mm-hmm.

Mindy Rivera (14:50):

.. and sometimes it's difficult to navigate.

Carol Pehotsky (14:52):

Yeah.

Mindy Rivera (14:52):

But I think we were really champions of evidence, and we're great patient advocates, and I think those two things, uh, always kind of lead us through the-

Carol Pehotsky (15:01):

Yes (laughs)

Mindy Rivera (15:01):

... the sticky, you know, difficult-

Carol Pehotsky (15:03):

Sure.

Mindy Rivera (15:03):

... conversations about how to navigate these things.

Kayla Little (15:06):

And then always reframing the focus to this is all for the patient safety factor, right? Like we're all working-

Mindy Rivera (15:11):

Patients first.

Carol Pehotsky (15:12):

(laughs)

Kayla Little (15:13):

... towards the same thing as patients first-

Carol Pehotsky (15:13):

Yeah. Yeah. Yeah.

Kayla Little (15:15):

... and so just reframing the conversation to make sure we're always doing what's best for the patient and not necessarily treating a metric per se. And just bringing that into perspective and then I think something else that the clinical nurse specialist is really good at is speaking to the why.

Carol Pehotsky (15:15):

Mm.

Kayla Little (15:32):

We always want to know why we're doing things, and I think that's just something that is-

Mindy Rivera (15:35):

We never stop asking why.

Kayla Little (15:36):

Right. We're always asking. (laughs)

Mindy Rivera (15:37):

There, there is no bottom to that well. (laughing)

Kayla Little (15:39):

There isn't. No. And so, we can work to get to a good answer as to why we're doing this practice change-

Carol Pehotsky (15:48):

Sure.

Kayla Little (15:48):

... and relay that back to the nursing teams.

Carol Pehotsky (15:50):

And then sustainable change because the nursing teams can go, "Oh, I get it. I can do it, and I can share it with my patient or my colleagues." This is the why.

Kayla Little (15:58):

Exactly.

Carol Pehotsky (15:59):

[inaudible 00:15:59]

Kayla Little (15:59):

And that's usually the point of frustration is someone's-

Carol Pehotsky (16:01):

Sure.

Kayla Little (16:01):

... doing something and they don't know why they're doing it.

Carol Pehotsky (16:01):

Yes. Yeah.

Kayla Little (16:04):

So, you have to have that, that good reason why.

Carol Pehotsky (16:06):

So, I imagine, well I know, but to share with our audience that clinical specialists probably spend a lot of time in ensuring our policy is aligned and evidence based.

Kayla Little (16:15):

We do, yes. Always reviewing, uh, we review our policies every three years-

Carol Pehotsky (16:21):

Mm-hmm.

Kayla Little (16:21):

... and it's always doing that literature review and then always going to the experts too to make sure is-

Carol Pehotsky (16:22):

Mm.

Kayla Little (16:27):

... this is still the practice. And it's really a good way to work across the system too-

Carol Pehotsky (16:32):

Mm.

Kayla Little (16:32):

... because what you're doing in one area, we want to standardize it across the health system.

Carol Pehotsky (16:37):

Sure.

Kayla Little (16:37):

And so, it's a good way to collaborate with your peers, whether they're other CNSs-

Carol Pehotsky (16:37):

Mm-hmm.

Kayla Little (16:41):

... other nurse leaders, and just to make sure that we're aligning practices and then getting that onto paper-

Carol Pehotsky (16:46):

Mm-hmm.

Kayla Little (16:46):

... and to a spot that a nurse can access at 2:00 AM.

Carol Pehotsky (16:49):

That's right. (laughs) Hopefully, they're not calling our local experts.

Kayla Little (16:53):

(laughs) [inaudible 00:16:54]

Mindy Rivera (16:53):

(laughs)

Carol Pehotsky (16:55):

I suppose it's possible too. So, we're so very fortunate to have a very robust department full of clinical nurse specialists here at Cleveland Clinic, but I imagine there are listeners who are not as fortunate, who are in organizations that either don't have a clinical nurse specialist or have very few.

(17:09):

So, in that scenario, let's linger with the nurse leader who says, "You know, I think I really need this resource." What advice would you give a nurse leader to be able to, especially this day and age, right, health care isn't getting any cheaper or easier to deliver, what is the unique value that a CNS brings that a nurse leader could take to their leadership?

Kayla Little (17:30):

Well, we actually just published an article.

Carol Pehotsky (17:31):

Hey, all right! (laughs)

Kayla Little (17:34):

(laughs) It's in the Journal of Nursing Administration and it talks about the value that a clinical nurse specialist adds to a highly reliable organization.

Carol Pehotsky (17:41):

Ah! Perfect.

Kayla Little (17:42):

And a lot of that is speaking to those patient outcomes-

Carol Pehotsky (17:47):

Mm.

Kayla Little (17:48):

... [inaudible 00:17:48] reduction and looking at the financial impact too.

Carol Pehotsky (17:51):

Yeah.

Kayla Little (17:51):

Money is the universal language.

Carol Pehotsky (17:52):

There is an ROI for sure. Yeah.

Kayla Little (17:54):

Yes, yes. And clinical nurse specialists are uniquely trained and very skilled in looking at that cost avoidance-

Carol Pehotsky (17:54):

Mm-hmm.

Kayla Little (18:04):

... and cost savings.

Carol Pehotsky (18:05):

Sure.

Kayla Little (18:05):

And everything we do; we can essentially assign a cost to that.

Carol Pehotsky (18:06):

Mm.

Kayla Little (18:09):

And if you give that to a nurse leader to say, "Hey, we can save you this much money or avoid spending by implementing this intervention-"

Carol Pehotsky (18:16):

Sure.

Kayla Little (18:16):

... I think that goes a long way.

Carol Pehotsky (18:17):

Avoid these penalties, all of that, sure.

Kayla Little (18:18):

Mm-hmm. Exactly.

Carol Pehotsky (18:20):

And, and Mindy, from your perspective, right, you've got a very specialized role.

Mindy Rivera (18:24):

Yes.

Carol Pehotsky (18:24):

But you bring a ton of value, too. How would you inform a nurse leader to go after that type of resource?

Mindy Rivera (18:30):

Absolutely. You know, and the clinical nurse specialist role is very different than a lot of the other advanced practice nursing roles-

Carol Pehotsky (18:34):

Mm-hmm.

Mindy Rivera (18:34):

... especially as we live in an era of billing and our view generation.

Carol Pehotsky (18:38):

Mm. Sure.

Mindy Rivera (18:39):

The CNS is very unique from that that to what Kayla was saying. It's more about cost avoidance and improving outcomes.

Carol Pehotsky (18:45):

Mm. Mm-hmm.

Mindy Rivera (18:45):

And, you know, our pulmonary hypertension program here at Cleveland Clinic has been CNS led for over 25 years.

Carol Pehotsky (18:46):

Really. Wow!

Mindy Rivera (18:54):

And which is, is incredibly unique. It's one of the only programs in the country.

Carol Pehotsky (18:57):

Yeah.

Mindy Rivera (18:58):

And, you know, the proof is in the pudding, so to speak, in our outcomes, our patient outcomes.

Carol Pehotsky (18:58):

Mm.

Mindy Rivera (19:02):

Our patients live longer receiving their pulmonary hypertension care here at the Cleveland Clinic versus the national average and internationally.

Carol Pehotsky (19:10):

Really? Wow.

Mindy Rivera (19:10):

So, you know, advocating for them, preventing harm. Some of these are, you know, really rare diseases, the hospital system, the, the hospital organizations are not set up necessarily to care for them or to protect them from harm.

Carol Pehotsky (19:23):

Sure.

Mindy Rivera (19:24):

And so, you know, having the CNS to give that expertise and navigate them through that is... it's worth the money.

Carol Pehotsky (19:30):

(laughs) And hopefully, have some clinical specialists listening. They might be an army of one in their hospitals, so how can the hospital help support them in successful practice and what advice would you give them if they're like, "Yeah, I'm really struggling because I'm pulled in so many directions"?

Kayla Little (19:45):

So, we continue to see a need for clinical nurse specialists.

Carol Pehotsky (19:45):

Mm-hmm.

Kayla Little (19:49):

That's something that I think is definitely across the nation.

Carol Pehotsky (19:52):

Mm-hmm. Mm-hmm.

Kayla Little (19:53):

There's a need for it. And the programs are... They're popping up and they're going away.

Carol Pehotsky (19:58):

(laughs) Yeah.

Kayla Little (19:58):

And so that- that's always a challenge of how we train the clinical nurse specialist.

Carol Pehotsky (19:58):

Mm-hmm.

Kayla Little (20:02):

And so, I think utilizing our NACNS, the National Association of Clinical Nurse Specialists, to network-

Carol Pehotsky (20:09):

Mm-hmm.

Kayla Little (20:09):

... with CNS across the country-

Carol Pehotsky (20:11):

Ah! Yeah.

Kayla Little (20:11):

... and find out what they're doing. And also locally, you know, we have the CNS intern program-

Carol Pehotsky (20:19):

Yeah.

Kayla Little (20:19):

... where we can find nurses who we think meet the build for ACNS-

Carol Pehotsky (20:26):

(laughs) Okay. We're recruiting.

Kayla Little (20:27):

(laughs) And, and we can mentor them and then we do have a formal process of where they would actually-

Carol Pehotsky (20:34):

Mm.

Kayla Little (20:35):

... apply and actually go through the CNS internship and learn the role as they're going through school.

Carol Pehotsky (20:41):

That's fantastic.

Kayla Little (20:41):

And I know there's some other Healthcare institutions in Ohio that-

Carol Pehotsky (20:42):

Mm-hmm.

Kayla Little (20:46):

... have a really great program to of just essentially growing their own CNS.

Carol Pehotsky (20:46):

Wonderful.

Kayla Little (20:50):

And I think that's that we just need to rely on each other to, to find those people-

Carol Pehotsky (20:51):

Mm-hmm.

Kayla Little (20:55):

... and then when we find jobs for them, let them know where they're at because a CNS is just so valuable.

Carol Pehotsky (21:00):

Yes. So hopefully we've inspired some folks here on this episode, and they're thinking, "This might be the direction I want to go." What should some of the first steps be?

Kayla Little (21:09):

Definitely talk with another CNS first.

Carol Pehotsky (21:12):

Okay. (laughs)

Kayla Little (21:12):

It- it's good to understand the challenges.

Carol Pehotsky (21:15):

Yeah. Yeah.

Kayla Little (21:15):

Because it can be scary if you're going into a hospital where you are the only clinical nurse specialist.

Carol Pehotsky (21:21):

Yeah. [inaudible 00:21:22]

Kayla Little (21:21):

There's imposter syndrome.

Carol Pehotsky (21:23):

Oh! (laughs)

Kayla Little (21:24):

That's pretty well known amongst the CNS group.

Carol Pehotsky (21:26):

Mm.

Kayla Little (21:27):

And it's just scary to not know your resources.

Carol Pehotsky (21:30):

Yeah.

Kayla Little (21:30):

And you want to develop those collaborative relationships and really partner with the nurse leaders-

Carol Pehotsky (21:36):

Mm-hmm.

Kayla Little (21:36):

... because I always say that they're my customer.

Carol Pehotsky (21:39):

Okay.

Kayla Little (21:39):

So, I work with them to find out what they need-

Carol Pehotsky (21:41):

Mm-hmm.

Kayla Little (21:41):

... and meet their needs, and then the patients will have good outcomes too.

Mindy Rivera (21:45):

To bring those kind of last two questions together, I think that they're-

Carol Pehotsky (21:45):

Mm-hmm.

Mindy Rivera (21:48):

... whether you are interested in becoming a CNS potentially or you're an existing CNS and you may not be blessed to work in such a CNS-led forward organization as we do-

Carol Pehotsky (21:48):

Yeah. Yeah.

Mindy Rivera (21:58):

I think seeking support from other CNSs whether that's through any CNS, your local chapter, you know, even just putting your feelers out in your nursing Facebook groups even-

Carol Pehotsky (22:09):

Sure.

Kayla Little (22:09):

Yeah.

Mindy Rivera (22:09):

... um, you know to kind of discover and connect to people that are nearest to you to understand the role. But I think that's critical and especially as we talk about, uh, the NACNS census that came out in recent years that talked about kind of an aging CNS population and talking about retiring.

Carol Pehotsky (22:26):

Oh, sure. Yeah.

Mindy Rivera (22:26):

So, I was not joking when I said we... the CNS- CNS's, uh-

Carol Pehotsky (22:26):

(laughs)

Mindy Rivera (22:29):

... uh, organization is recruiting because, you know-

Carol Pehotsky (22:30):

Yeah.

Mindy Rivera (22:31):

... we're actively trying to engage nurses who have an interest in generating knowledge, who are the ones who ask why, you know, to really attract those people to this profession.

Carol Pehotsky (22:41):

Yeah. Well, you've both been very informative. I'm so glad you were able to join us today. Before we call it a day, we're going to flip to our speed round. I'm going to ask each of you a question so our audience can get to know you a little bit more as amazing people in addition to being amazing CNSs. So, I'm going to pick on Kayla first. Who was one of your nursing influences?

Kayla Little (23:01):

Debbie Klein. She is just-

Carol Pehotsky (23:03):

(laughs) Debbie Klein. Yeah.

Kayla Little (23:04):

Yeah, she's just so well accomplished and she retired a few years ago, and I will forever remember that day. I just cried, I cried so hard.

Carol Pehotsky (23:13):

Oh, (laughs)

Kayla Little (23:13):

So, I didn't, I didn't want her to leave me, but she's so well accomplished, and she continues to make great progress and impact on the nursing practice even after retirement.

Carol Pehotsky (23:22):

Yeah.

Kayla Little (23:22):

And she's really inspired me to be active, you know, at the national level-

Carol Pehotsky (23:22):

Mm-hmm.

Kayla Little (23:27):

... and the local level and really just think in a different perspective. So, she's the one that got in my head that-

Carol Pehotsky (23:27):

(laughs)

Kayla Little (23:33):

... "You know, what's the nurse going to do at 2:00 AM?"

Carol Pehotsky (23:35):

Sure. Yeah

Kayla Little (23:35):

So, you want to make sure that your documents are in good order so that way they know what to do.

Carol Pehotsky (23:39):

Absolutely. Those of us in the Cleveland Clinic absolutely know Debbie by name, but you can Google her on Google Scholar. She has plenty of published research that all of us can benefit from.

Kayla Little (23:49):

Yes, she does.

Carol Pehotsky (23:50):

Yes. All right, and I'm going to pick on Mindy. What's something about you that surprises people?

Mindy Rivera (23:56):

I think something that surprises folks is that somehow this crazy CNS job in being this, you know, this master of one subspecialty-

Carol Pehotsky (24:04):

(laughs)

Mindy Rivera (24:06):

... in between all that I balance actually being a full-time caregiver for my spouse-

Carol Pehotsky (24:11):

Mm. Okay.

Mindy Rivera (24:11):

... who actually is also a nurse and had kind of an interesting journey with Cleveland Clinic. We call ourselves the Cleveland Clinic couple because our life has pretty much been-

Carol Pehotsky (24:11):

(laughs).

Mindy Rivera (24:19):

... around nursing and Cleveland Clinic. But he actually came here to Cleveland at age 11 with childhood cancer-

Carol Pehotsky (24:26):

Hmm.

Mindy Rivera (24:26):

... and was very, very-

Carol Pehotsky (24:27):

Oh, wow!

Mindy Rivera (24:28):

... sick and actually had to make a wish granted, and thankfully he has survived-

Carol Pehotsky (24:34):

Oh, oh yeah.

Mindy Rivera (24:34):

... (laughs) uh, being well, well beyond that. But he was so inspired by the nursing care that he received here, you know, spending years, uh-

Carol Pehotsky (24:41):

Yeah.

Mindy Rivera (24:42):

... months and months on our pediatric oncology units that inspired him to become a Cleveland Clinic nurse. And although unfortunately his health needs have precluded him from continuing to practice, he is still very much a champion of Cleveland Clinic Nursing.

Carol Pehotsky (24:42):

(laughs)

Mindy Rivera (24:56):

And I'm always happy to kind of represent us both.

Carol Pehotsky (24:59):

Oh, it's fantastic. Thank you for sharing that. Thank you so much. You've been so helpful today. Thank you for coming on the show.

Kayla Little (24:59):

Thank you so much for having us.

Mindy Rivera (25:06):

Thank you.

Carol Pehotsky (25:11):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(25:45):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.