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Issues

Issue # 1:

Changes in APRN Regulation in the Future-the

"Consensus Model of APRN Regulation"

Background: In February 2006, the National Council of State Boards of Nursing (NCSBN) circulated a "Vision" paper for public comment and feedback on the future regulation of advanced practice nurses. In it, they proposed that Clinical Nurse Specialists not be regulated as APNs in the future. Needless to say, the furor that followed was almost 100% in support of the CNS role continuing as one of the four APN roles. Dozens of national nursing organizations and leaders wrote a response to the NCSBN, including the American Nurses Association, the American Association of Colleges of Nursing (AACN-East), the American Association of Critical Care Nurses (AACN-West), Oncology Nurses Association, and others.

Outcome: The National Association of Clinical Nurse Specialists (NACNS) represented us in negotiations that resulted in the new Consensus Model of APRN Regulation (see link below). The CNS will continue to be one of the four APRN roles in the U.S. and in Texas! We would suggest that everyone review it and become aware of it as a plan for the regulation of all 4 APRN roles in the future. While it is a model for regulation, it also contains implications for education and certification. The Texas Board of Nursing plans to implement it in the coming years.

Here are some related links:

 

Issue # 2:

Educating Legislators and the Public about the Value and Abilities of the CNS in Practice Settings

As a member of the Coalition of Advanced Practice Nurses (CNAP), we are active in the efforts to educate legislators, other providers, and the public about the value of the CNS in improving healthcare. We are also supportive of efforts to educate people about all of the advanced practice nursing roles. It is important for every CNS in Texas to become vocal and active in educating people about our role. Having a 1-minute "elevator message" is one way to do this-when people say to you, "What is a Clinical Nurse Specialist" be prepared to concisely describe your role and influence on health care. (The photo is Gendy Joiner-Rogers, PhD, CNS, a Gero CNS and CNS faculty member at UT Austin preparing to address the CNAP Leg/Reg Day audience about the most important things they should know about CNS practice in Texas).

Another strategy is to use the media to educate others-consider writing a brief, concise editorial or short article for your local newspaper. Check your paper's editorial guidelines, or just read editorials to learn the format. The Internet is full of articles on how to write an editorial. Editorials are not only opinion. They include facts to support the opinion, and should be as well researched as any news article.

The Texas legislative website is: www.capitol.state.tx.us. The most current information about Texas APN legislative efforts can be found on the CNAP website. We are active members of CNAP to represent the role of the CNS.

 

Issue # 3:

Doctorate of Nursing Practice:

The American Association of Colleges of Nursing (AACN) has proposed that all Advanced Practice Nurses be educated at the doctoral level by 2015—the title is suggested as the Doctorate of Nursing Practice, or DNP. The National League for Nursing (NLN) says that it will continue to accredit master’s degree programs for APNs. Quite a lot of controversy on this topic! It is important that we be thoughtful about this issue and consider pros and cons. Here are two links to several articles that provide some good analysis.

The editorial by Drs. Kathleen Dracup and Christopher Bryan-Brown on the Practice Doctorate, published in the July 2005 issue of American Journal of Critical Care, 14(4), 278-281. Click here for link to full text article.

A series of articles in Nursing Outlook, July-August 2005, including an editorial by Dr. Marion Broom, a pro article by Dr. Mary Mundinger, and a con article by Drs. Kathleen Dracup, Linda Cronenwett, Afaf Meleis, and Patricia Benner. Click here for link to full text articles.

No CNS with an MSN degree will be required to obtain a DNP to practice in Texas. The Texas Board of Nursing is very clear on this point. Several DNP programs have opened in Texas; MSN programs also continue to be offered. The trend in the U.S. also appears to be moving to online programs for many DNP programs. The dilution of the potential pool of PhD students continues to be a concern for the profession and for future research in nursing science. The DNP is a "practice" doctorate focused on application of existing research whereas the PhD is a "research" doctorate focused on training for conducting research. We recommend that future CNS students carefully evaluate these options.

 

Issue # 4:

Standard Occupational Classification-CNS Role Not Included Thus Far

Background: Federal agencies are required to use the Standard Occupational Classification (SOC) when collecting, calculating, and publicizing occupational data. In the past, all APN roles have been grouped together under the heading of "registered nurses". Beginning in 2010, when federal agencies conduct research on occupations, they will separate nurse anesthetists, nurse midwives, and nurse practitioners from the RN category. The committee decided to continue to classify the CNS role under the RN category since they perceived the CNS tasks to be similar. Numerous organizations submitted justifications to separate the CNS role-a sample of some of the letters is found below-the ANA letter prepared by one of their attorneys provides an excellent overview of the issue (see links below).

Current Status: At this time, we do not believe that letter writing is a strategy that will yield any positive results. The most important response at this point is for CNSs to describe clearly the negative impact of this decision on their practice. We need to gather any factual information that we can use to prove "harm" and forward it to NACNS. Please contact NACNS or TxCNS if you can provide any data on this issue.

Action Plan: The NACNS Board has filed a Freedom of Information Act (FOIA) disclosure request in an effort to examine the evidence upon which the decision was made. And at the February 2009 meeting of the ANA Congress on Nursing Practice and Economics, (CNPE), the Congress asked ANA to take action. NACNS is currently working with ANA on an action plan.

Sample of Letters that were sent to the SOC Policy Committee in 2008: