1. Doutrich, Dawn PhD, RN, CNS (Oregon)

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Dear Editor,


I am writing at the urging of my fellow members at the National Association of Clinical Nurse Specialists (NACNS) Education Task Force to express disappointment that our Washington State University community students will no longer have the option of being clinical nurse specialists (CNSs). Several years ago, our community-based, population-focused (CBPF) master's program made curricular changes to fit the American Nurses Credentialing Center (ANCC) requirement of 500 supervised clinical hours. We have had several students pursue the community CNS certification. Two of our faculty are graduates of our CBPF program and are ANCC CNS certified in community health, and several of our graduates have proudly attended the NACNS conference.


We have well more than 50 students in our community master's degree. Many would prefer the CNS designation to the new advanced public health nurse-board certified and would also prefer NACNS as their national advanced practice organization. Our curriculum requires 42 semester credits, and most CBPF students graduate with between 52 and 56 semester credits. Taking the "3 Ps" (pathophysiology, pharmacology, physical assessment) courses does not fit with these students' professional competency needs. I understand that there was input from Association of Community Health Nurse Educators and the Quad Council regarding the community/public health advanced practice designation and wonder if the 3 Ps requirement for the CNS certification played a role in their advice.


Although I recognize that the title change from clinical nurse specialist in public/community health to advanced public health nurse-board certified has been driven by ANCC rather than by NACNS, it does have implications for NACNS. Our College of Nursing, like many, is shifting from the master's level of advanced practice to the doctoral level. We have been developing our curriculum for a doctorate of nursing practice, which would take the community CNS competencies to the next step. It is unfortunate that our students will no longer have the option of this certification, and we will be looking beyond NACNS for curricular guidance. I have truly appreciated the care and process of NACNS and have wanted our students to have the option of being CNSs with NACNS as our advanced practice organization. It is with deep sadness that I see this as no longer a logical alternative.




Dawn Doutrich, PhD, RN, CNS (Oregon)


NACNS Education Task Force member


Associate professor, Washington State University


Intercollegiate College of Nursing


NACNS Board Responds:


The National Association of Clinical Nurse Specialists (NACNS) shares your concern and disappointment regarding the decision to delete community/public health clinical nurse specialists (CNS) from the designation of advanced practice registered nurse effective in 2015. However, this decision was supported by the leadership of the public and community health nursing community. The association supports the rights of any organization to make their own choices no matter how difficult that decision is to accept.


The Advanced Practice Registered Nursing (APRN) Consensus Group was originally convened by the American Nurses Association and the American Association of Colleges of Nursing to explore issues related to advanced practice nurses. The group's goal was to build consensus for directing APRN education, accreditation, licensure, and certification. As the work of the group progressed, representatives of the Quad Council of Public Health Nursing Organizations, which includes the American Nurses Association Congress on Nursing Practice and Economics, the American Public Health Association Public Health Nursing Section, the Association of Community Health Nursing Educators, and the Association of State and Territorial Directors of Nursing, objected to the group's insistence on including pathophysiology, pharmacology, and physical/health assessment (the 3 Ps) in all APRN curricula. Although there was and remains much discussion about these subjects being singled out as defining content for advanced nursing practice, it was nonetheless the decision of the APRN Consensus Group to move forward with recommending these subjects in all APRN educational programs. The Quad Council took the position that other subjects were core to public health education and that advanced practice public health nursing should be addressed in a different model.


The National Association of Clinical Nurse Specialists (NACNS) understands that the American Nurses Credentialing Center, in response to the requests from the Quad Council, made changes to the eligibility criteria for and credential awarded to community health CNSs. The association shares your concern over dropping community health CNSs from the APRN designation. It was, however, the Quad Council leadership that made the decisions that resulted in changing the APRN status of community health CNSs. You are encouraged to share your concerns with Quad Council leadership.


Sue Sendelbach PhD, RN