Advanced practice nurses (APNs) play a role in leadership, policy development, education, and management. As APNs move through their career from novice to expert, ONS can play a large role in professional development.

Clara Beaver, MSN, RN, AOCNS®, ACNS-BC, a clinical nurse specialist (CNS) at the Karmanos Cancer Center, discussed her own career trajectory and tips for advancing your career in a question-and-answer format during a session at the 42nd Annual Congress in Denver, CO.

Can you describe your current role?

Karmanos is a National Cancer Institute cancer center. I am currently the only CNS for entire center. I cover four inpatient floors of patients with cancer.

What drew you to the CNS role?

CNS is education based and a change agent. There is this big fork in the road: CNSs take the education track that includes patient education and quality outcomes, while nurse practitioners are more of the frontline patient providers, covering assessments, management, and care models. I love to teach, so the CNS role fits what I wanted to do. I like the patient, family, and nurse interaction.

Can you explain Benner’s model of moving from novice to expert in your practice?

There are five levels: the novice nurse has no experience, is taught general rules to help perform tasks, has rule-governed behavior that is limited and inflexible, rules are context-free and independent of specific cases, and rules are applied universally. Usually two to three years into the same or similar job, you will move on to advanced beginner and then competent nurse. Then, you become proficient and it can take four to five years to get to expert level, where you no longer rely on rules and performance is fluid, flexible, and highly proficient.

APNs do not have an orientation. There are modules and paperwork but no one to stand next to and show and tell what to do. I looked to mentors to help me get there. When senior leaders asked me to lead committees and prepare education, that is when I knew I reached the competent level.

I paved my own path to become an expert. I am now considered a chemotherapy expert at my institution and across the state of Michigan and looked at as an expert in the field.

Tell us about your growth as an APN.

My first job was a pulmonary medical/surgical CNS, which helped me get my feet wet. Next, I was an ambulatory CNS, and this was my dream job. An opportunity later came up to become a CNS at an inpatient bone marrow transplant unit. Then I became a CNS manager of infusion, but I did not like management. It was a great experience, but I missed being a CNS. I then transitioned back to my current role as an inpatient/ambulatory CNS. I am rebuilding the CNS program at Karmanos, which is a new challenge for me that I am excited about.

What did you use for growth?

The following things helped me grow:

  • Finding mentors
  • Publishing work
  • Presenting posters and giving lectures at national and local conferences
  • Coordinating CNS special interest groups
  • Getting certified by the Oncology Nursing Certification Corporation (ONCC)
  • Becoming a reviewer for journals such as the Clinical Journal of Oncology Nursing
  • Helping to conduct research as part of the DEFENS (Drug Exposure Feedback and Education for Nurses’ Safety) study.

I just keep finding things to do.

How would you advise APNs to find a mentor?

ONS Congress is one of biggest resources we have. The community allows us to reach out to people. When I started out in 2004, it was all local connections. Now it is much easier to connect broadly.

How do you become a journal reviewer?

Brag about yourself! This was hard for me to at first. By putting yourself out there, others will reach out to you. Also, network with people; reach out and let people help you.

What activities should new APNs seek out?

Get involved with your local ONS chapter; this is a great networking opportunity. And drug representatives are great to work with as well. If you have questions, talk to them. They can connect you with other people.

What role has ONS played in your career?

ONS has provided classes, education, conferences, leadership opportunities (such as advisory boards and task forces), mentors (through their member directory where you can look people up), Oncology Nursing Certification Corporation item writers (I would not have figured this out without ONS), review opportunities, board memberships, and consultations. ONS is a huge resource to me. You also get access to great journals with free continuing nursing education credit.

What role did certification play for you?

I sought certification early as an oncology-certified nurse and later as an oncology clinical nurse specialist. Certification proves that I am confident in my field and respect what I do, and it is highly sought after. I recommend getting certified.

How do you deal with “imposter syndrome”?

This is normal, and it takes a while to get over this. Believe in yourself. Progression happens over time. One study suggests using optimistic self-talk, such as “keep working” or “you are prepared to do this.” Ask questions: this does not make you look like you do not know what you are doing; it is a way to gain confidence.

What advice do you have for someone new on how to learn references for chemotherapy and diagnostic tests?

The number one resource I use when I am teaching is ChemoCare.com. ONS also has many resources that I recommend, including the Core Curriculum for Oncology Nursing and Oncology Nurse Drug Handbook. However, new drugs come out every week, so you have to use other resources in addition to books, which could be behind on the latest approvals since going to press. [Editor’s note: ONS Voice provides the latest oncology drug approvals.]

Other than ONS, what organizations do you use for reference?

I would say the Infusion Nurse Society and American Nurses Credentialing Center.

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