1. Muller, Anne C. MSN, RN, ACNS-BC

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I cheered when I read Sharon Van Fleet's letter to the editor about doctor of nursing practice (DNP) programs (Letters, February). I, too, am disappointed to see that clinical DNP programs have strayed far from their original intent. My NP peers enrolled in DNP programs describe content very similar to that of my clinical nurse specialist (CNS) graduate program; my CNS peers say much of the DNP program content does little to advance their skills.


Ensuring quality patient care, implementing evidence-based practice guidelines, mentoring clinical nurses, leading interdisciplinary teams, evaluating effective systems change, and caring for complex populations are all CNS role-specific competencies. Our CNS graduate programs are faltering, and our applicant pool is dwindling. Deemphasizing a specialty focus in graduate programs and the loss of a significant number of CNS certification exams has thrown this nursing role into utter confusion during a time of dynamic transition brought on by the Affordable Care Act. Those at the greatest disadvantage are the patients whose care will suffer without the coaching and expertise of the bedside CNS.


We need our nursing schools, credentialing agencies, and professional organizations to collaborate and agree on a meaningful role for all advanced practice RNs-but most particularly for the estimated 69,000 practicing CNSs in the United States. We especially need the CNS expert practice role as we transition to community-based, patient-focused care. Our patients need it, our nurses need it, and the future of nursing depends on it.


Anne C. Muller, MSN, RN, ACNS-BC