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Authors

  1. FULTON, JANET S. PHD, RN

Article Content

Greetings, and welcome to a new year. This year promises to be a busy one. The annual board retreat will be held in January, which is an important time for the board. Strategic initiatives will be reviewed, modified, and updated. Plans will be made for the year's activities, and resources allocation is recommended. New board members will be oriented to the organization's structure, board responsibilities, and NACNS positions on various issues. The retreat will culminate with a board meeting at which the plans are approved.

 

Board and committee members have been busy raising NACNS visibility. NACNS representatives are increasing NACNS's participation in dialogue with professional groups and organizations with which it has common interests. As a member organization, NACNS representatives attended the National Alliance for Nursing annual fall meeting in Indianapolis, Ind. In December 2002, NACNS representatives met with representatives of the American Association of Colleges of Nursing (AACN) to begin dialogue concerning clinical nurse specialist (CNS) graduate programs.

 

In November 2002, board and committee representatives met with the National Council of State Boards of Nursing (NCSBN) to dialogue about legislative and regulatory initiatives. In December 2002, NACNS representatives met with the NCSBN's Advanced Practice Registered Nurse (APRN) Round Table and discussed NACNS's recommendations for regulatory credentialing. NACNS prepared a white paper on regulatory credentialing, which included specific recommendations. The recommendations for regulatory credentialing set forth by NACNS are:

 

1. The CNS title should be protected by state statute. Lack of title protection in a state results in use of the title by those without formal preparation as CNSs. 1,2

 

2. The CNS scope of practice should be explicated in regulations; and

 

3. Graduation from an accredited state board-approved master's or doctoral program that prepares CNSs is adequate to prepare CNS to practice in nursing's domain of practice.

 

4. Optional additional regulation is recommended for CNSs who desire to extend their practice outside the domain of nursing not authorized by the initial registered (RN) license.

 

 

The most important differentiating feature of CNS practice that extends into the medical domain is the inclusion of the independent diagnoses of disease/medical conditions and pharmaceutical prescriptive authority. Because these activities are not authorized in the RN scope of practice, CNSs should meet the same licensure requirements as any other advanced practice nurse (APN) whose practice similarly extends into the medical domain. Where CNS practice extends into the medical domain and includes the independent diagnosis and treatment of disease, optional regulations should specifically speak to practice in the medical domain and should not be extended to be requirements for CNS practice in nursing's autonomous domain of practice authorized by the RN license. Prescriptive authority for disease treatment is an element of medical practice that is not included in nursing's autonomous domain. CNSs desiring prescriptive authority should meet regulatory requirements for APN prescriptive authority.

 

The Lyon and Minarik 3 analysis of statutes and regulations revealed that of the 26 states that specifically authorize the CNS to practice as a CNS, 15 of those states provide the option for prescriptive authority (Arkansas, Colorado, Idaho, Indiana, Louisiana, Minnesota, Missouri, Nevada, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Wisconsin, and South Carolina). Additionally, of the 7 states that only recognize psychiatric-mental health CNSs, 4 authorize prescriptive authority (Florida, Massachusetts, Vermont, and Minnesota). In all instances in which a CNS can obtain prescriptive authority there are requirements for additional course work in pharmacodynamics and pharmacotherapeutics. The course work requirements in pharmacology are the same as those required of nurse practitioners (NPs). In Rhode Island, the psychiatric-mental health CNS must obtain NP certification to obtain prescriptive privileges. 3

 

A complete copy of NACNS's position paper on Regulatory Credentialing of Clinical Nurse Specialists (December 7, 2002) is available to members by contacting the NACNS office at 717-234-6799.

 

NACNS Statement on Clinical Nurse Specialist Practice and Education

This document articulates the competencies requisite to CNS practice, outlines the necessary outcomes of nursing, and provides direction to schools of nursing regarding the preparation of CNSs. You can purchase your copy of this landmark document through the NACNS Office. The cost is $15 per copy for members of NACNS and $25 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.

 

References

 

1. US Department of Health & Human Services. Federal Support for the Preparation of the Clinical Nurse Specialist Workforce Through Title VIII. National Advisory Council on Nurse Education and Practice. Report to the Secretary of Health and Human Services. HRSA 99-40. Health Resources & Services Administration. Bureau of Health Professions. Division of Nursing. Rockville, Md: Author; 1997 [Context Link]

 

2. Wood CM, Caldwell MA, Cusack MK, laar-Rice U, Dibble SL. Clinical nurse specialists in California: Who claims the title? Clin Nurse Spec. 1996; 10( 6):283-292. [Context Link]

 

3. Lyon BL, Minarik P Statutory and regulatory issues for clinical nurse specialist (CNS) practice: ensuring the public's access to CNS services. Clin Nurse Spec. 2001; 15( 3):108-114. [Context Link]