On behalf of the Virginia Chapter of the National Association of Clinical Nurse Specialists (VaCNS) we are writing to request that the Virginia Board of nursing examine its regulations governing the practice of Clinical Nurse Specialists (CNS) as defined in § 54.1-3000 and in 18VAC90-20-275 et seq for their consistency and congruence with the National Council of State Boards of Nursing’s (NCSBN) consensus model for Advanced Practice Registered Nurse (APRN) regulation (https://www.ncsbn.org/July_7_2008_Consensus_Model_for_APRN_Regulation.pdf).
In addition to our request to consider recognition of the CNS as an APRN, we also seek grandfathering protection and recognition for a uniform scope of nursing practice. The VaCNS looks forward to working closely with members of the Board to accomplish this goal.
Clinical Nurse Specialists are licensed registered nurses (RN) who have graduate preparation (Master’s or Doctorate) in nursing as Clinical Nurse Specialists. Clinical Nurse Specialists are certified by nationally accredited examination boards as expert clinicians in specialized areas of nursing practice. The specialties may be identified in terms of:
o Population (e.g. pediatrics, geriatrics, women’s health, neonatal)
o Setting (e.g. critical care, emergency room)
o Disease or Medical Subspecialty (e.g. diabetes, oncology, pulmonary, cardiology)
o Type of Care (e.g. psychiatric/mental health, rehabilitation, palliative care)
o Type of Problem (e.g. pain, wounds, stress, cardiac surgery, trauma)
Clinical Nurse Specialists practice in a wide variety of health care settings. In addition to providing direct patient care, Clinical Nurse Specialists influence care outcomes by providing expert consultation for nursing staffs and other health care professionals and by implementing improvements in health care delivery systems. The CNS practice integrates nursing practice, which focuses on assisting patients in the prevention or resolution of illness, with medical diagnosis and treatment of disease, injury and disability.
Research about Clinical Nurse Specialist practice demonstrates outcomes such as:
- Reduced Hospital Costs and Lengths of Stay
- Reduced Frequency of Emergency Room Visits
- Improved Pain Management Practices
- Increased Patient Satisfaction with Nursing Care
- Reduced Medical Complications in Hospitalized and Ambulatory Care Patients
The National Council of State Boards of Nursing (NCSBN) consensus model clearly describes the practice of CNSs within the aegis of advanced practice nursing; yet, Virginia’s law and regulations define the CNS role as equivalent to the practice of registered nursing. The recent Institute of Medicine’s (IOM, 2010) report recommends that nurses practice to the “full extent of their education and training” (Summary cited in http://thefutureofnursing.org/sites/default/files/Summary%20(1-14).pdf). Virginia regulation currently recognizes the Nurse Practitioner, Certified Nurse Midwife, and Certified Registered Nurse Anesthetist as APRNs. We request that the title APRN also be applied to the CNS.
According to the IOM (2010) report nurses work on the front lines of patient care and can play vital roles in helping realize the objectives set forth in the 2010 Affordable Care Act. The report further outlines a number of barriers that prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health. One of the identified barriers is prohibiting nurses from practicing to the full extent of their education and training (IOM, 2010). By recognizing the CNS as an APRN we believe this barrier can be removed.
Because the current regulations governing the practice of the CNS have not been re-visited in more than a decade, the regulations fail to take into account the various settings in which the CNS practices and the roles taken on by the CNS in the delivery of quality health care. These settings include community-based settings such as private practice and acute- and long-term care facilities. In the CNS role, the CNS may practice independently and provide supervision of evidenced-based care of specialty clients. In acute and long-term care, the CNS may also provide supervision of evidence-based care of specialty clients. None of these roles is acknowledged in the current regulations. Therefore, the Virginia Chapter of the NACNS asks that the Board of Nursing study its regulations to determine what changes will be required to more accurately reflect the practice, education, and functions of CNSs in clinical practice and patient care.
Therefore, as members of the Virginia Association of Clinical Nurse Specialists, we request the board, in its review of the regulations governing the practice of CNSs, determine whether the regulations and/or statutes need to be changed in order to:
· Recognize and license the CNS as an APRN in the commonwealth of Virginia;
· Ensure that the CNS practice to the full extent of their education, skills, and competencies;
· Recognize national standards for comprehensive, entry level competencies and behaviors of graduates of academic programs that prepare CNSs;
· Provide the public, regulators and employers with a standardized definition of the role and scope of practice for the CNS;
· Allow for regular monitoring of CNS workforce supply and demand; and
· Continue to provide title protection for the CNS.
Task Force Members
· Donna C. Bond, DNP, RN-BC, CCNS, AE-C Carilion Clinic-Roanoke Memorial (President VaCNS)
· Stephanie D. Baynton, MSN, RN, CDE Salem Veteran’s Affairs Medical Center (Vice President VaCNS)
· Phyllis Whitehead, PhD, MSN, APRN, ACHPN Carilion Clinic-Roanoke Memorial (Treasurer VaCNS)
· Sheila Delp, MSN, RN, GCNS-BC Carilion Clinic-Roanoke Memorial (Secretary VaCNS)
· Nancy Altice, DNP, RN, CCNS, ACNS-BC Carilion Clinic-Roanoke Memorial
· Jill Bass, DNP, RN, GCNS-BC, Carilion Clinic-Roanoke Memorial
· Pam Bernardo RN-BC, Salem Veteran’s Affairs Medical Center (MSN Candidate)
· Eris Bill, RN, BSN, CCRN, CJW Medical Center (MSN Candidate)
· Deborah Bratton, RN, MSN, GCNS-BC. Northern Hospital of Survy County
· M. Cybil Britton, APRN-BC
· Patrick Coyne, MSN, APRN, FAAN, Virginia Commonwealth University
· Charmaine Hall, MSN, RN, Carilion Clinic-Roanoke Memorial (CNS Candidate)
· Kim Hall, MSN, RN, GCNS-BC, CWCN Carilion Clinic-Roanoke Memorial
· Ellen M. Harvey, MN, RN, CCRN Carilion Clinic-Roanoke Memorial
· Sherry Hester, MSN, RN, PMHCNS-BC Parish Nurse
· Cathy Jennings, DNP, RN, CNS Carilion Clinic-Roanoke Memorial
· Debbie Sauve King, MSN, RN, CDE Carilion Clinic-Roanoke Memorial
· Cheryl Schmitz, MS, RN-BC, CNS-BC, CEN, Inova Loudoun Hospital
· M. Bernadette MacDonald, MSN, APRN, PMH, CNS Self Employed
· Jackie Martin, DNP, RN, NNP-BC, CCNS Carilion Clinic-Roanoke Memorial
· Jennifer Matthews, PhD, RN, A-CNS-BC, Shenandoah University
· Elaine Nailler, MSN, RN, PMHCNS-BC Standard Technology, Inc
· Leigh Pollard, BSN, RN Roanoke City Schools (MSN Candidate)
· Beth Quatrara, DNP, RN, ACNS-BC University of Virginia
· Deidre Rea, MSN, RN, CNS, Carilion Clinic-Roanoke Memorial
· Desiree Snuffer, BSN, RN Carilion Clinic-New River Valley (MSN Candidate)
· Roselle Stark MN, PMHCNS-BC, Self employed
· Linda Thurby-Hay, MS, RN, CNS-BC, CDE, Virginia Commonwealth University
Institute of Medicine (2010). The future of nursing summary at http://thefutureofnursing.org/sites/default/files/Summary%20(1-14).PDF
National Council of Boards of Nursing (2010). https://www.ncsbn.org/July 7 2008 Consensus Model for APRN Regulation. PDF
Virginia Board of Nursing (2011). www.dhp.virginia.gov