In this month's issue of Advanced Emergency Nursing Journal, we are reprinting an article from Spirit, the Southwest Airlines in-flight magazine. Reprinting articles between professional journals is common. It is a good way to reach a broader audience of those most likely to be interested in the information. Reprinting an article from the lay press in a professional nursing journal is probably unheard of, but this is an unusual article. In “Rebrand Nurses,” Spirit Editor Jay Heinrichs considers the image problem of advanced practice nurses (APNs) from a business perspective. His insight about the issue is spot on, and we commend him for highlighting the situation in a publication that will reach a broad audience outside of healthcare. Advanced practice nurses provide essential care and services throughout the United States. Increased utilization of APNs may not only help mitigate some of the access problems currently faced by many patients but also the utilization of APNs can lead to more comprehensive, cost-effective, and safe patient care. In fact, healthcare bills currently moving through Congress contain provisions that would increase funding for nurse training programs, including one aimed specifically at increasing the number of APNs (Andrews, 2009). There are four APN roles recognized in the United States: nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife (CNM), and certified registered nurse anesthetist (CRNA). The roles of midwives and anesthetists are fairly easy to explain and the public is often aware of their presence as healthcare providers. Unfortunately, as Heinrichs noted, patients may not fully understand the qualifications and scope of practice of NPs or CNSs.
The role of an NP is more likely to be understood by the public than that of a CNS because many patients have received care from an NP at one time or another. We know that research demonstrates that patients are satisfied with the care they receive from NPs (Hart & Mirabella, 2009) and that patient outcomes are very similar when NPs and MDs deliver the same type of care (American Academy of Nurse Practitioners, 2007). In areas such as communication and teaching, patients often feel that NPs outperform MDs. However, there is a tendency for patients and family members to call NPs “doctor.” Technically, doctor is correct for NPs who have doctoral degrees; it is not correct for NPs without a doctoral degree. Unfortunately, when most patients call an NP “doctor,” they are probably confused and think that the NP is really a medical doctor (MD) in disguise. Clearly, as “Rebrand Nurses” states, we need to get the word out to the public about this advanced practice role.
Clinical nurse specialists are not present in every hospital or healthcare environment, so the role is poorly understood even within nursing, let alone the lay public. One of the most common responses I (J.A.P.) receive when I tell laypeople that I am an emergency clinical nurse specialist. “So, are you a nurse?” I tell them that CNSs have at least a master's degree in a clinical specialty of nursing and are experts who support clinical nurses so that they have the resources necessary to take care of patients. Resources include knowledge, psychomotor and cognitive skills, processes, and equipment. The usual answer is “So, you're an educator.” I reply that that is partially correct, but the role encompasses a lot more than teaching. Providing the necessary resources may include assisting with the hands-on care of complex patients, reviewing charts, coaching nurses in skill development, bedside consultation and troubleshooting, research, creating systems that support specific patient care activities, evaluating potential supplies and equipment, developing multidisciplinary protocols and policies, implementing new practices, disseminating information, and yes, teaching. At this point, I often see their eyes glaze over and I know they are holding on to the one thing they really understand—educator. Sometimes I see a spark of understanding and hope that I have planted a seed. Our chief nursing officer at Dartmouth-Hitchcock Medical Center, Linda Von Reyn, PhD, RN, herself a former CNS, may have put it best. She says, “The clinical nurse specialist is the nurse's nurse.” That sums it up in a nutshell; we take care of the nurses so they can take care of the patients.
As stated in “Rebrand Nurses,” the challenge is to educate the public and reinforce our “brand” as APNs. Any new ideas for getting the word out?
Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP
Emergency Clinical Nurse Specialist, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Proehl)
Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA (Hoyt)
American Academy of Nurse Practitioners. (2007). Quality of nurse practitioner practice.
Retrieved November 19, 2009, from
Andrews, M. (2009, November 6). With doctors in short supply, responsibilities for nurses may expand. New York Times
. Retrieved November 18, 2009, from
Hart, L., & Mirabella, J. (2009). A patient survey on emergency department use of nurse practitioners. Advanced Emergency Nursing Journal, 31