1. Section Editor(s): Fulton, Janet S. PhD, RN, ACNS-BC, FAAN

Article Content

This is the summer issue, and as I write this message, I hope you are making some time to enjoy a slower pace, if not at work, as least in your private life. Notice I said make time over the more frequently used find time because no one finds time. When asked for tips on writing for publication, my advice is always to manage your calendar, which is to say, manage your time. Guard time for writing as you would guard time for meetings. Now that it's summer, guard some time for enjoyment of the things that come only with summer.


Something else is important for you to attend to this summer. As the Advanced Practice Registered Nurse Consensus Model begins a trajectory toward implementation in all 50 states, assess your level of understanding of the law regulating clinical nurse specialist (CNS) practice in your state. Consider these basic questions:


* Does my state title protect CNSs?


* What are the requirements for being recognized as a CNS in my state?


* Are CNSs in my state required to be certified by a professional nursing organization?


* Which certification credentials are accepted by my state?


* Can CNSs practice independently? Or is physician collaboration/supervision required? For all practice or only diagnosis and treatment of disease?


* Do CNSs have prescriptive authority in my state? Clinical nurse specialists in all specialties or just some specialties like psychiatric/mental health?


* Are CNSs required to have prescriptive authority, or is prescriptive authority optional?


* How do I obtain prescriptive authority, if it's available?



Knowing the law and regulations governing practice in your state is a professional expectation. Every state has a Web site, and with some persistence, it is possible to find the board that regulates nursing and the regulations governing advanced practice. Get together with colleagues and share information. Learn about the members of the regulatory board from their Web profiles. Minutes of meetings are public documents, so read them and identify issues of concern to CNS practice. Go to a board meeting with colleagues; make it a day away from work with a purpose. Initiate discussions at your local National Association of Clinical Nurse Specialists Affiliate meetings.


Changes are coming. The details of the changes will vary from state to state for lots of reasons including the language of the law and regulations already in place. Other factors to consider are the makeup of the board membership, the legislative committee assigned to any practice related bills, that committee's membership, and groups with lobbying influence. The National Association of Clinical Nurse Specialists has a new resource to help you prepare to participate in and eventually to lead the changes. The Starter Kit for Impacting Change at the Government Level: How to work with Your State Legislators and Regulators is totally free and Web based. Download it from


Failure to engage in state-level regulatory changes can result in barriers to practice that deny the public access to CNS services. Getting involved is the best way to ensure that you will be able to continue practicing. Consistent with the Advanced Practice Registered Nurse Consensus Model, states are moving to require title protection for CNSs in all states and to require professional certification for recognition as a CNS. Many CNSs practice in specialties that do not have advanced level certification, and many CNSs will not be eligible for the newly revised population-based certifications. The CNS role has been around for more than 50 years, and although that's a good thing for the public, it has created challenges in the current environment that is moving to greater regulatory uniformity among all advanced practice roles. Clinical nurse specialist educators never created curricular standards specific for the role. Schools prepared CNSs to meet the needs of the local community it served. Again, good for the public, but now challenging for graduates as each program offered varying clinical experiences and unique courses, not the newer recommended standards of a minimum of 500 clinical hours of supervised experience and courses in pharmacology, physiology, and physical/health assessment. In the past, academic programs may not have been labeled "CNS" but were considered the clinical track to differentiate it from other options such as the education or administration track. Graduates of these clinically focused programs have been practicing successfully as specialty CNSs and have earned the right to have their practice legally protected. Grandfathering will be needed to bridge the gap between the present workforce and the preferred future. It is imperative that CNSs have voice in crafting new regulatory language that preserves the contributions of our most experienced CNSs. It's good for the public.


Children's literature is replete with tales of identity confusion: the swan that thought he was an ugly duckling; Kipling's Mowgli who was raised in a jungle by wolves and did not realize he was a human boy; Pinocchio, a wooden puppet who wanted to be a human boy. It seems somewhat silly to have to remind CNSs that they are indeed CNSs. Yet all this new model talk has some CNSs wondering if they can call themselves a CNS because they are not certified, or their academic program was not labeled CNS, or the focus of study was a specialty population and not one designated in the model. Don't be confused by all the movement toward a new model. A CNS by preparation and practice, then and now, is a CNS. It is ours to determine how CNS identity is preserved through the changes, so get busy and make sure it has a satisfactorily happy ending for all CNSs, our patients, and the public good. Make the time.