Robin Strongin
Good morning, everybody. Robin Strongin here with Health Dame. And today I am delighted to welcome Dr. Jackie Iseler with us, who is an adult health clinical nurse specialist. And we're going to learn about advanced nursing and clinical nurse specialists. You are also president of the National Association of Clinical Nurse Specialists. And on HealthDame.com, we'll have lots of information about. what these nurses are, their credentials, what the organization is doing. But for folks who are listening right now, what I'd like to do by way of introduction is you have so many amazing responsibilities under one hat. So I don't know how you probably don't sleep a whole lot. But in addition to being president of the National Association, you're also very involved on the ground and teaching. So say a little bit about your background for us because it's insanely impressive, Jackie.
Dr. Jackie Iseler
Well thank you. first of all, thank you for having me here. I'm I'm very happy and I love talking about clinical nurse specialists and and obviously the National Association of Clinical Nurse Specialists. So my journey to even being here today started back in 2001. I graduated with my bachelor's from Bradley University and my first job was over at Mayo Clinic in Rochester, Minnesota. And while I was there, I it's first of all, like the The bar was set high for this is the type of environment I want to work at. It was amazing, truly where patients are, where patients do come first. and so just wanted to give a shout out to Mother Mayo there. and another impressive thing about Mayo is that they have clinical nurse specialist. And and I was as I was working on the unit there, I I was one of the nurses that asked. Why questions? Why do we do it this way? Why can't we do it this way? And so she was there and she's like, That's a great question. Let's investigate this further. And so that really kind of
Robin Strongin
That's what I
Dr. Jackie Iseler
been around well, I started there in two thousand one and so before I went back for my masters was in two thousand four. So it was between there when I was peppering her and colleagues with questions.
Robin Strongin
Okay, that's good. That reference. Okay, great.
Dr. Jackie Iseler
Great. Yeah. And then I went back to school for my master's. I went to Winona State University, which was right there in Minnesota. I initially went back to become a nurse practitioner because a lot of people know what nurse practitioners do. but my first year there, I was just like, you know, this doesn't feel right. And so I went back to the CNS and just talked to her a little bit more about what she does because all I saw was a little snippet of what she actually did was answer my questions and kind of you know, provide the rationale or put me on a team to work on improving something. And so then I changed to go with the clinical nurse specialist route, adult health, and graduated in 2008 and I moved to Grand Rapids, Michigan. And my first job was as a cardiovascular clinical nurse specialist at Spectrum Health, which is now known as Corval Health. And I was the first certified CNS there and I had multiple units across two hospitals. And because of my background, I went in and helped build the heart and lung transplant and ventricular assist device program, which is now like one of the best ones that we have in the country. Wow. And went back, got my ma or my doctorate. And I wanted to keep a foot in clinical and a foot in the academic world. Right. 'Cause I saw that there there really is a gap once you leave school and things are moving fast and now we're teaching, you know, and so I worked at Michigan State University where I became the program director for the clinical nurse specialist program and I was able to continue to practice as a clinical nurse specialist in in different hospitals one day a week. So I was really, very grateful for that opportunity. Sure. And so then I was able to really expose hospitals that didn't have CNSs as to what a CNS can do for you. And continued on, built the program, and now I'm at Grand Valley State University, where I am essentially doing the same thing. I'm an associate professor and program director. and I've just started this year an adult JERO. and a pediatric clinical nurse specialist program here. So yeah. So it it's great to to spread and and and get it out. And I'm over at today is Tuesdays, which is my practice day. So I'm actually at Trinity Health in Grand Rapids. And my main focus here is really coaching and mentoring nurses to lead an evidence-based practice, quality improvement and research. wow. Because they do so much work and and they really could use, you know, like I, you know, I was grateful that I I had you know, the CNS back at Mayo, but having somebody who can actually lead and coach and mentor you along the way to doing these projects and getting it published. Cause that's the other challenging part is getting those things published.
Robin Strongin
Hundred percent. And you know, I the one question that immediately comes to mind, can you say a little bit about the difference between CNS and a nurse practitioner? Different yeah.
Dr. Jackie Iseler
Yes, absolutely. Yeah. So with our nurse practitioner colleagues, they they do amazing work first. They see patients just like we would think of our physicians or n and our physician associate groups. So they see our that one patient one on one. They are able to prescribe, provide interventions, you know, do that point of care. CNSs could also do that if they want to, and there are cases across the US where Clinical under specialists are doing that such thing where they are seen more in that advanced practice provider role. and the thing that makes the CNS as unique is that we really focus or we really practice within the three spheres of impact. So everything we do kind of falls within those three buckets. So one is that direct patient care. So things that we think about like an as an advanced practice provider, seeing patients one-on-one, writing prescriptions, deprescribing. prescribing interventions, diagnosing, that kind of thing. And then what makes it unique is that we can also look at it from a group of patients. So for example, my patient population was heart lung transplant and ventricular cyst devices. And so the nurses and the community actually across the state of Michigan actually knew to to call me and email me when I worked over at at Spectrum Health, if they needed additional education, that kind of thing for that patient population. And then it spreads into the nursing sphere, which is that coaching mentoring of nurses to either implement evidence-based practice or the jackies in the world that ask a lot of why questions and and really looking at it like you're right, this is a problem. Let's investigate it further. so really working at the bedside with the nurses to ensure that they have what they need to do the best care possible, eliminate any barriers or bring the right equipment to them. And equipment and supplies could be, you know, policies, procedures, actual equipment, or you know, figuring out what the process is. And then at the organizational level, that's where, you know, building new programs, for example, the heart lung transplant ventricular assist device and really being part of the team and looking at where are these patients going to go and who do I need to make sure are at the table. So we can bring people at the table that are experts in those specific areas. and then also look at What are the requirements for joint commission accreditation certification, you know, CMS, and then looking at, you know, any additional certifications or accreditations that are required for a hospital to have a certain type of service or become a comprehensive stroke center? You need a CNS and hospitals that are looking for magnet. status, which means like this is the place where nurses want to come and work. You need a CNS and we're able to look at all of those things and really think about like, and this is what we need. We can look at the gaps that are involved and really bring in the best evidence into it to make sure that not only is it the best, it'll be sustained and there's continuous quality improvement because it's not a one and done.
Robin Strongin
Right, sure, sure. So are CNS folks primarily hospital based, would you say? Do
Dr. Jackie Iseler
I would say that I think the majority are hospital-based. There are a few of CNSs that are working in primary care. And I've actually published with a couple of them where it was such a unique and not a unique to them, but unique to where the majority of CNSs are working, which is hospital-based, where they are seeing a group of pati for example, a diabetic CNS, they will see their group of patients that and they're able to do either you know, group counseling, group teaching, they see patients one on one. we have wound ostomy, clinical nurse specialists. So we can specialize and be specific to that patient population and work outside or have that bridge where we're hospital based, but we're also bridging that gap or bridging that transitions of care where care continues on whether they leave a particular unit or that hospital. It continues on when they go home.
Robin Strongin
It and before I ask my next question, I got so excited when I was looking at your bio with the LVAD, the left ventricular assist device, because early on in the very early 1980s to mid-80s, when it was when that's when they really came into practice. They were being innovated along the way. And I just started working at the Prospective Payment Commission, which was brand new, looks at Medicare. coverage reimbursement and gives recommendations and I was assigned to the LVAD. That was I was on the di I was on the technology and innovation side of things. There was a whole economics team that I wasn't, you know that wasn't that wasn't what floated my boat. I loved all the innovation and that seemed like one of the coolest one my choice was I think is it called elect elect wait ES what was that? Extracorporeal shock weight. That was the other big one. haven't thought of that in about 40 years, but okay. But the LVAB, so you were really involved. That's really exciting. Because I got to like study it from that point from a coverage and reimbursement point of view, but you were actually like using them to keep people alive. Because that was the bridge while they were waiting for the transplant, if I'm remembering correctly.
Dr. Jackie Iseler
Correct.
Robin Strongin
Okay. And I'm sure they've iterated over the decades, but they're still like going strong, right?
Dr. Jackie Iseler
They are, yes. It's definitely become smaller. It used to be a small ATM on wheels when it first rolled out. So it was huge. And yeah, now it's portable and you wouldn't know unless you've taken care of patients before that they even have an LVAD on the person. 'Cause
Robin Strongin
Amazing.
Dr. Jackie Iseler
it's so subtle, like everything is like smaller now. the clothing, the how you carry the equipment, it it just looks like a regular sling bag. It doesn't look like this is your life saving device that you have on you.
Robin Strongin
So how much interaction do you guys have with the the patient's family and caregiving team? Is that part of it or it depends on what what you're working on, obviously?
Dr. Jackie Iseler
Right. It well, for me, I I had contact with all parties, right? Patients, families, the nurses, firefighters, sheriff's department. So I I did do that. I was actually very much involved. But it's very dependent on the state in the US that you live in and what, you know, title protections, what practice authority you have, prescription privil privileging that you have. So it kind of depends. and some hospitals have been thriving on having CNSs working really at that system sphere, working at, you know, making sure we have all the policies in place and order sets. And then there's some that really thrive on like the Mayo Clinic model, where there was one per ICU step-down med surge area. So they were able to see the transition from acute care to, you know, step-down or progressive care. so it it really depends. I, you know, I am biased towards the Mayo clinic model because I do feel then we we as CNS can truly practice within those three spheres of impact.
Robin Strongin
Sure.
Dr. Jackie Iseler
a particular story that I have is so as we were building this program, one of the requirements is that we notify the community that they will be receiving this patient. And so I would get phone calls from, like I kind of mentioned, you know, the sheriff's department or EMS or the flight crew. And I've driven anywhere five hours away, stayed overnight to train the flight crew. And that was really cool because then I can really use not overburden them with knowledge that they don't need, but what do they need to know to that
Robin Strongin
Yeah.
Dr. Jackie Iseler
next place? Right. And so I'm able to take everything that I know, everything that the patient knows, and really condense into, and this is what you need to know to transfer them. And not kill them on the way. You know, so make sure you take this bag with them. Don't cut this line. And if you have a family member who understands what's going on and there's room in the ambulance, let them come in because they can manage the equipment while you manage, you know, the broken leg or whatever you need a shark bite. There's no sharks in Michigan. But you know, as an example, like you handle the actual emergency, they can handle the equipment. So that you can really focus on what's what's really important is making sure that patient survives to the next
Robin Strongin
Have to carry some type of liability insurance different than RN, say? Yeah.
Dr. Jackie Iseler
Yes, you you definitely should. so I know the hospitals do have that part of that, but for your own protection, yes, I do recommend that you have that. I would
Robin Strongin
think so just given the level of training and involvement that you would provide. One would think in this day and age it would be
Dr. Jackie Iseler
Why documentation.
Robin Strongin
So so then that brings me to the the association that you're president of. What would you say is the main mission and say the top two or three priorities right now? Because the whole nursing profession in general has been through the ringer, let's say, in the last
Dr. Jackie Iseler
A little right.
Robin Strongin
so
Dr. Jackie Iseler
Yeah. So NACNS, and in my own words, is really the home for clinical nurse specialists. We're here to continue to advocate, highlight, and really support the work that CNSs do. And when I was elected president elect, you know, every president gets to pick their theme. And so I had a long time thinking. I I took a while to think about what is the theme. because it had You know, it was very meaningful. And so again, it came down to people don't know, but it's my responsibility to share two people and go out there and tell them this is what a CNS is and does, and I'm a CNS. And so amplify was the theme. You know, how do we make the invisible indispensable? So that has been my my and NACNS's goal for all CNSs. Introduce yourself as a CNS, let them know what you're doing. Yes, it's teamwork, but you led this, you started this, you asked the why question, you looked at the literature, you saw a problem, you got the team together. So really letting them know, letting the public, our coworkers, our you know, C suite people that this was done by a CNS.
Robin Strongin
Wow, that's that so do you go up to the hill or are you involved in state because I know a lot of your issues are probably state level with different licensing and all of that. So it's both obviously big federal policies, but then it's also more local at the the state level. So you're probably having to really educate a lot of folks because so I used to have a firm that did a lot of advocacy and communications and it was called amplify actually so same concept and whenever we would do programs with the word nursing in it we would get so many people because n but there was a lot of confusion often because there are many, many, many types of nurses with a lot of different concerns and issues. So it What you're suggesting and doing is so critical, especially as the complexity continues. Right.
Dr. Jackie Iseler
Right. and really, yes, there is, you know, the the federal level, and then there's the state and local. And and I think thinking of it, you know, e even as a as a nursing student or or as a brand new nurse, I always thought, man, you know, that seems kind of scary to advocate for yourself and go up to legislators. And you just have to remember, and what I tell my students, these are people. These are, you know, business owners, they could be farmers, they could be, you know, lawyers, but they're not nurses. They're not CNSs. So you are the keeper of that story and you need to share that story. And and as much as we think, you know, at the federal level, everything's controlled there, but you have control at your state and local level. So when they have those coffee talks or they have those town halls, you should definitely go, especially if you want them to know about your what you're passionate about and educate them. And also, you know. really having an understanding and asking them what do they know about fill in the blank, right? but it is a long it's a marathon. It's not a one and done and then it gets, you know, your bills get changed. You know, if you remember the bill from PBS back in the day, it takes a long time and some of it just gets, you know, declined, vetoed. but it is a it's a progress, it's a process. You need to have that persistence and a team. And you can't do it alone. It definitely helps if you have an organization. It definitely helps when that organization is also colleagues with other nursing organizations. So you can have really a unified void voice versus, well, this nursing group is fighting for this. It's similar to this one, but they're a little bit different. But really, let's get let's get together and have a unified voice.
Robin Strongin
Important. So the message gets heard even more strongly. And that is really a key point. And that's where the coalitions and partnerships definitely strengthen. What would you say is the most challenging issue that your organization is grappling with today? That maybe we can help spread the word or get some information.
Dr. Jackie Iseler
One yeah, I think one of it is, you know, that there's not all fifty states have title protection or full practice authority for clinical nurse specialists, let alone eight advanced practice nurses, advanced practice registered nurses. And so until we have that, it it makes it challenging, but we are very flexible and adaptable as nurses because we have to be and we can always reach out to our neighboring states and go, How did you guys do this? So I've being able to talk to California recently about how did Michigan get title protection and full practice authority, how is that working? So over the summer, a handful of us past presidents talked about our journey and you know to hang in there and be persistent and look at what they're asking and if there's any modification in the language and but it's it's always on that person. You know, it's it's on us. to make sure it moves forward. Sure. and you know, and just building relationships. That's that's a huge part of it. It's yeah. Yeah. So, you know, one of one of the the challenges is that is the role recognition and people not really understanding what CNSs do. Because like you mentioned earlier, there's a nurse, there's an RN. And an RN in GI is different than an RN in cardiovascular, which is slightly different than the RN at the clinic. So a CNS is also different than a CNS, how Jackie functioned as a CNS, versus how my friends across the street are functioning as CNSs, because we all the way I see it, we adjust to the needs of that unit or service line that we serve. So if their nursing practice is solid, you have experienced nurses, they're doing the right thing, then you're going to focus on, okay, so we have these other issues going on. You're going to focus on that versus we have practice issues. That CNS is going to work with the nurses at the elbow to make sure we standardize practice, we're reducing errors, we're getting the right equipment there. And you know, making sure that this is also transferable into the other spheres of practice. So again, it's That's what makes it challenging because we're not cookie cutter. We have all of these skills, but we know when to use it and how.
Robin Strongin
That's really exciting. And some some of the CNS specialists will go into full-time policy work, is that right? in some places, or would you say the large majority are still very involved at the clinical frontline level?
Dr. Jackie Iseler
Say that the large majority are definitely in the hospitals. Okay. and what I'm finding out as I am in the academic world. So I've been, you know, an assistant associate professor since twenty seventeen. And as I'm looking at the l published literature and textbooks and looking at their credentials, I'm like, that's a CNS. Okay. that's a CNS.
Robin Strongin
Interesting.
Dr. Jackie Iseler
dang. That's a CNS. And so I'm finding that yes, we work in hospitals, but yet we're also in the other world. So really looking at that system sphere where we're going beyond the hospital sphere, like really
Robin Strongin
Because so many of the issues today, one of the big issues I've been watching and doing some work in is the private equity and the overcorporatization of healthcare. And I can't imagine that doesn't have an impact on everybody at the bedside for all the reasons we've been reading about. Has that been an issue that you've seen in the work that you're doing or your members? The equity
Dr. Jackie Iseler
Yeah, I can't.
Robin Strongin
taking over, you know. Gobbling up hospital system.
Dr. Jackie Iseler
I mean, we're definitely seeing that, right? I mean, it and that's not a new concept either. I mean, it's been going on for a while. so yes, especially with like hospital mergers and you know, and during that chaos, there are some positive things that come out of it and hopefully we have the right actual leaders, not people in leadership positions, but actual leaders that can really guide and make sure that patients are really going to be taken care of, that the nurses and our healthcare team are really being taken care of. And it's yes, healthcare is a business, but it should not be a cold, hard business. It needs to be we're here to care for patients and make sure that they get the right care. So but yes, it it it does make it challenging because in some some of these organizations and hospitals where if they don't see the value in CNSs, they're usually the first ones to go. Well that's they don't really want to
Robin Strongin
was getting at is on a on a ledger it's hard to justify when you just look at a budget line but when you then put the quality and safety and the improvements and the system enhancements obviously it's a very different calculation but if all you're looking at is a net profit right bad decisions as far as patients go happen and that that's my conclusion
Dr. Jackie Iseler
Yes. It's something those decisions.
Robin Strongin
Yeah.
Dr. Jackie Iseler
Yeah, no, I agree with you a hundred percent. And that's something that, you know, I've shared at I think it was the Michigan CNS group. Mm-hmm. We need to be able to pivot and not only see things. This is how we've always done it, because we don't like that phrase. But look at it. So how can we be revenue building? And we need to Step out from behind the curtain of everything we've done. We need to, you know, publish more. We need to tell people in the C suite people again, this is what we do and this is how much it's saving. And these savings are also part of the reputation, which you you know, you ruin your reputation. It doesn't matter how much money you have, it's gonna be hard to rebuild that. So it's really thinking differently and making sure that we speak the same language. Because how we speak to one another in the in the words we use makes sense. But if we're gonna talk to somebody who doesn't understand what a CNS is or what why you need a nurse and not a fill in the blank, we need to be able to articulate that in ways that whoever's making the decisions really understand the value of what you're bringing to the table.
Robin Strongin
And I would think that the magnet hospitals recognize this, which is why they are the top quality tier when it comes to this sort of thing. And one would think other hospitals and health institution systems, what have you, would want to replicate that and other organizations, employers who are paying God knows how much for healthcare for their employees would want to make sure That the care that they're paying for is of such a high quality that they're gonna get it right the first time and minimize absenteeism. And so there's lots of really solid arguments one could really make if you took the time to understand what a CNS is and so on.
Dr. Jackie Iseler
Right.
Robin Strongin
So that's really cool. And the other thing I would, and I'm sure you guys have looked at this, but because I tend to focus mostly at the federal level, being in DC. There are so many wonderful fellowship programs that a lot of where you can spend time on a staff of a member or a committee. I mean often they're physicians or RNs, but it would be really cool to get some CNS in there in some of those fellowships who are really every day working with, you know, across the aisle and so on and so forth would be great. I'm sure there are, you know, many, but There's always room for more and they they really do make a difference.
Dr. Jackie Iseler
I agree with you. I agree with you. there's I think close to if not five million nurses and maybe nine hundred thousand physicians and yet the physicians have a louder voice or a bigger to stay more
Robin Strongin
Or weight they do. I think it's going to be very interesting in the next, I would say, ten years. I think some of that's gonna really switch because younger people are very open to not necessarily needing paper and a man and a white code in an office. They're very happy to put things online. I mean, there's lots of caveats and all of that, but it's just a very different way of who and where and how younger people are and and some in my age cohort, but you know, I'm already way past Medicare. And so, you know, your mind is in a different place at that point, not to mention everything else. But younger people are just used to a very different model now. And you know, it's interesting because when the quality organizations will interview consumers for what they define high quality care, often it's really convenience. It's not necessarily better health outcomes, although at the end of the day, of course it is, but pe and and and they're not as beholden anymore to the old construct of it has to be a you know MD after that. And so it I think it's going to change because of so many factors. So many factors. And there are so many more really highly qualified nurses. And they're just more need help desperately. So really
Dr. Jackie Iseler
So this is
Robin Strongin
exciting. I I just love that you guys are at every level, right? On the ground. all the way through to everything we've been talking about and really out there getting things published and if there's any way we can be helpful to helping to spread the word and educate people. because it it is hard. There's so many different people and experts in healthcare. And at the end of the day, patients just want to feel better and you know
Dr. Jackie Iseler
Yeah.
Robin Strongin
Family members just want their loved one back home. But people with your expertise and your colleagues and members' expertise are really gonna help us get to goal in a way that I think is very very exciting because it wasn't like that when I started out, that's for sure. And in 40 years, I've seen a very big difference. And this is just great. This is really great. I guess I'm gonna I'm gonna let you go. But before I do my last question is one that I always ask. And I don't know if you know why I asked this question, but my husband passed away about a year and a half ago. Hang on one second. I've been talking way too much today. he had Louis body dementia, and we both loved, loved, loved music. And he was very young to have it, relatively speaking. And but music was something we could do a lot of together, even when he couldn't speak. And I've done a lot of work. I got to meet Dr. Oliver Sachs with music in the brain and all of this. And so isn't that very cool? Yeah. Yeah, yeah, yeah. In fact, the first person I interviewed for Health Team. Is Dr. Connie Tamano and he dedicated musicophilia to Connie? They worked together in the Bronx when he first did his original research. So I was on their board and it was thrilling to get to meet him. And yeah, yeah, it was really something. And then, of course, using everything I learned from that experience when my husband was so ill. And so we have a health game playlist because I just want to keep the music going and I d on so many levels. So we have a really cool playlist. And I ask everyone to contribute either your favorite song or a song that reflects the work that you're doing. And if you don't have it off the top of your head, you can always email it to me. But if you know it, I'll take it now and I'll add it to the playlist.
Dr. Jackie Iseler
Yeah, I'm kind of going between two. One, Fiona Apple extraordinary machine.
Robin Strongin
I love the hat.
Dr. Jackie Iseler
Really about, you know, resilience and you know giving yourself grace. And the other one is pink, raise your glass.
Robin Strongin
Love her. Okay. Love these. Okay. Well, we may have to add both. We don't have to choose. You know, the playlist you can have a lot of very many. This is wonderful. And it was really terrific to get to know you and to learn about the issues you guys are doing. And keep up the amazing work. It's really exciting. It's it's really I love interviewing nurses because I feel like They really are in every way the backbone and win of the healthcare system. You know, we'd be lost without nurses.
Dr. Jackie Iseler
For sure. It's one of the oldest professions.
Robin Strongin
It is one and the most respected real really and pharmacists too, I would say. But you you guys are really up there when you know so many in healthcare are in the toilet, to be very honest. And nurses are always at the very pinnacle of the trust chart. So for a good reason too. And everybody knows at least one nurse, right? Yeah. I mean somebody knows a nurse. So a lot of respect to what you're doing. And Going to give you back the rest of your time. Thank you so much for talking with me. And I'll be in touch.
Dr. Jackie Iseler
Okay, sounds great.
Robin Strongin
All right. That's good. Bye bye now.
