Over the course of the past year, I have had the opportunity to participate in a program offered by the American Nurses Association (ANA)—namely, the ANA Advocacy Institute (ANAI). This program is designed to enhance nurse’s advocacy skills and provide mentorship and networking through coalition building, political action, and media engagement. Participation was sparked by a professional development interest and a desire to further expand advocacy skills. As a clinical nurse specialist (CNS) committed to advancing my professional development, I saw this as an important opportunity to broaden my advocacy efforts beyond my state and local communities. A recent editorial underscored the need to embed advocacy within our role—not as an extension of practice but as an essential component of it—and I could not agree more.1 Through ANAI, I gained a deeper understanding of ANA’s policy and advocacy platforms, as well as meaningful avenues to ensure our voices are represented at the highest levels of health policy. As I delved into ANA’s practice and advocacy efforts, I learned about the various programs focused on the health and well-being of nurses. One of their flagship programs, Healthy Nurse, Health Nation, provides a wide range of free wellness resources and challenges for nurses to improve their health through 6 targeted self-care domains: mental health, rest/sleep, physical activity, nutrition, safety, and quality of life.2 Why does this matter? ANA reports that nurses often experience higher stress, worse sleep, more injuries, and poorer overall health than the general public—making these well-designed, accessible wellness challenges essential. In alignment with the ANA’s Code of Ethics (Provision 5), nurses must consider the same duty to themselves as their patients, which includes promoting their own health and safety.3 This ethical guidance frames self-care as a responsibility, not an optional practice. Similarly, CNSs should frame self-care not as a luxury but as a professional duty that sustains our capacity for expert advanced practice and leadership. Self-care cannot compensate for unsafe or unhealthy systems. The American Association of Critical Care Nurses (AACN) Health Work Environment standards—Skilled Communication, True Collaboration, Effective Decision Making, Appropriate Staffing, Meaningful Recognition, and Authentic Leadership offer a plethora of tips and resources for building and sustaining these healthy work environments.4 The Quadruple Aim adds improving the work life of clinicians and care teams alongside patient experience, population health, and reducing cost, and reminds us that unhealthy work undermines all other aims and contributes to poor outcomes at the bedside and enterprise level.5 CNSs are pivotal to clinical excellence, practice transformation, and system performance, yet the sustainability of the CNS workforce is increasingly challenged by workload complexity and cumulative stress. National workforce data show that although some indicators have stabilized since the pandemic, others such as heavy workloads, burnout, and stress remain primary forces pushing nurses out of the profession, with nearly 40% of nurses indicating intent to leave the workforce by 2029.6 As reported by other authors,7 more than 138,000 nurses left the workforce since 2022, with stress, burnout, workload, understaffing, and inadequate pay cited as major drivers. NACNS defines the CNS role across 3 interrelated spheres of impact to include patient/family direct care, nurses/nursing practice, and organizations/systems.8 In CNS practice, activities in one sphere can amplify the others. The role’s power emerges when we operate across all 3 spheres, which makes us natural integrators and role models of self-care and advocacy. At the same time, beyond clinical expertise, whether driving practice changes or leading quality improvement, or mentoring and facilitating interdisciplinary teams, CNSs practicing across these spheres may also be navigating competing organizational priorities and administrative demands. These examples of CNS work are not intended to be an exhaustive list, but rather a sample of the workload that can easily become inundated with requests from our teams and various stakeholders. Managing these requests and priority setting should be considered a wellness or stress management strategy in our playbook of self-care. It is unlikely that the heavy workload will ever go away in today’s high-complexity healthcare systems. Instead, we must learn to gracefully negotiate with others and politely say NO. This can be challenging for many of us—including myself—because CNSs are naturally driven to demonstrate teamwork, contribute meaningfully, and support the success of the team. What are some strategies that align with reclaiming our strength, managing workload, and promoting self-care and wellness? Consider the following: Establish boundaries and clear priorities—“Thank you for thinking of me for this project. I need to stay focused on my current priorities, so I cannot take this on right now.” Delegation—“This isn’t within my scope, but I’m happy to point you toward the right resource or department.” Complete a Workload Check—“I’m at capacity with my current responsibilities, taking on this project would pull me away from other required work, perhaps another team member could assist.” Aside from these examples, another approach for consideration would be to align wellness and workload with CNS competencies. For example, education and coaching—consider implementing peer support programs and time management skills into competency development, evidence-based practice—implement mindfulness and self-compassion interventions along with organizational support, and policy and advocacy—tie wellness policies to safe workplace environments, staffing plans, and safe patient care. As we embrace the renewal of spring, it’s a good time to check in and evaluate our self-care priorities. Let us treat self-care as an essential component of professional practice and continue advocating for environments that allow us—and all healthcare professionals—to thrive. Consider which self-care strategies best support your ability to recognize and manage stress responses effectively. Just as flight attendants remind us to secure our own oxygen masks before helping others, we as CNSs must prioritize our own well-being so we can strengthen systems, advance nursing practice, and deliver the highest quality care to our patients. Our commitment to self-care today ensures the longevity of our practice tomorrow, safeguarding a CNS workforce capable of meeting the evolving needs of complex healthcare systems.
Carmen Rene Davis (Wed,) studied this question.