1. Fulton, Janet S. PhD, RN

Article Content

This journal, the official journal of the National Association of Clinical Nurse Specialists (NACNS), is a strong voice advocating for clinical nurse specialists (CNSs) and CNS practice. In addition to peer reviewed scientific articles, the journal now publishes annually peer-reviewed abstracts from the NACNS Annual Conference. Important NACNS Board approved position statements and correspondences are included at the request of the Board. The more recent publication of the directory of CNS programs in the United States was well received and updated directories are planned for the future. NACNS membership has grown steadily as both the journal and the organization it reflects continue to be the voice for CNSs.


The revised NACNS Statement on Clinical Nurse Specialist Practice and Education is now available (see The revised Statement builds on the work of the first edition, and like the first edition, is grounded in scientific and professional literature and was reviewed by both organizations and individuals. The Statement's bibliography, which represents the literature review that helps support the revised Statement, is included in this issue of the journal. It should be quite useful for anyone looking for information about the scope of CNS practice and issues relevant to CNSs.


This issue also offers a remarkable Legislative and Regulatory Update Column by Dr Brenda Lyon. In her article, The CNS Regulatory Quagmire: We Need Clarity About Advanced Nursing Practice, Dr Lyon outlines issues that underpin the current regulatory quagmire and its effect on so many CNSs. She thoughtfully discusses the fundamentals of licensure authority as granted by state legislatures, noting that in the United States, the registered nurse license uniformly authorizes registered nurse practice in 2 domains: (1) the autonomous domain of nursing practice and (2) delegated authority within the medical domain. The autonomous domain of nursing practice encompasses the diagnosis of health conditions (nursing diagnoses) that are amenable to nursing interventions/therapeutics, the implementation of interventions, and evaluation of the effectiveness of nursing interventions/therapeutics. It is in this autonomous domain, with its inherent self-directed authority, that CNS practice is focused. The aforementioned NACNS Statement defines the competencies for CNS practice in the autonomous domain, along with the educational content/experiences necessary to achieve the competencies. Thus, understanding nursing's authority to practice is key to understanding the competencies outlined in the Statement.


The barriers to CNS practice are tangible in the regularity arena; however, barriers also exist in the form of misinformation, misunderstandings, and biases within the nursing community. To resolve the regulatory quagmire, it is necessary to look at CNS practice as it differs from the practice of other advanced practice groups. It is not the intent of the journal to offer 1-way conversation about advanced practice nursing, nor is it the intent to discuss CNS practice by way of comparing it to the practice of other advanced practice nursing groups. It is, however, necessary to look at the practice of the other advanced practice nursing groups in order to untangle the apparent knot in the regulatory arena that is causing so much harm to CNSs. It is right and necessary that we have the discussion about practice by advanced practice nurses that is and is not within nursing's legally authorized scope of the RN license. Until we do, there can be no meaningful legislation protecting the practice of any advanced practice nurse. NACNS is engaged in dialogue with the National Association of Nurse Practitioner Faculties (NONPF) about the similarities and differences between CNS and nurse practitioner practice. It is imperative that this and other collaborative initiatives with advanced practice nursing organizations continue. As the conversations and discourse unfold, you can look forward to finding reports of information, dialogue, and debate right here in your journal, a voice for CNSs.