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More Clinical Nurse Specialists Now Able to Practice, Prescribe Without Physician Supervision

Survey of State Laws and Regulations Reveals Clinical Nurse Specialists Authorized to Practice to Top of Education and Skills in More than Two-Thirds of U.S. States

A review of state laws and regulations reveals that since 2010, eight states have granted clinical nurse specialists (CNSs) the authority to practice without a physician’s supervision and six have given CNSs independent authority to prescribe drugs and durable medical equipment. These represent 32 percent and 40 percent increases, respectively, in the number of states that grant such authority; CNSs can now practice to the full extent of their education and training in 28 states and prescribe without supervision in 19.

An additional 13 states allow CNSs to practice with the collaboration of a physician bringing the total to 43 states (85%). CNSs have the authority to prescribe drugs and durable medical equipment with the collaboration of a physician in an additional 20 states, bringing the total to 39 states (76%).

One state (Maryland) that has recently granted full practice authority granted it only to psychiatric and mental health CNSs.

CNSs are advanced practice registered nurses who hold leadership roles in health care settings. They provide diagnosis, treatment, and ongoing management of patients. They also provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout the organization, and ensure the use of best practices and evidence-based care to ensure the best possible patient outcomes.

In its landmark report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine recommended that nurses be able to practice to the full extent of their education and skills. The National Association of Clinical Nurse Specialists (NACNS) commissioned the review to determine how much progress has been made since the publication of that report. The work was done in consultation with the National Council of State Boards of Nursing.

“This is an important and exciting trend in state health care policy,” said Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC, President of NACNS. “The number of people who have access to health care services has increased dramatically because of the Affordable Care Act. At the same  time, the number of people who have chronic conditions, including multiple chronic conditions is increasing. More than ever, we need to ensure that every health care provider, including the highly skilled CNS, is able to perform to the top of his or her skills, education and expertise.”

The eight states that have authorized CNSs to practice to the full extent of their education and skills since 2010 are: Alaska, Arizona, Delaware, Maryland (psychiatric mental health CNSs only), Minnesota, Nevada, North Dakota and Oregon. CNSs were able to practice independently prior to 2010 in Arkansas, Colorado, Connecticut, Washington, D.C., Hawaii, Idaho, Iowa, Kentucky, Maine, Montana, Nebraska, New Mexico, North Carolina, Oklahoma, Rhode Island, Utah, Vermont, West Virginia, Wisconsin and Wyoming.

The six states that have authorized CNSs to prescribe independently since 2010 are Alaska, Delaware, Hawaii, North Dakota, Oregon and Rhode Island. CNSs were already able to prescribe in Colorado, Connecticut, Washington, D.C., Idaho, Iowa, Maine, Minnesota, Montana, Nevada, New Mexico, Utah, Vermont and Wyoming.

Maps indicating states that have authorized CNSs to the full extent of their education and skills and that have authorized them to prescribe independently are available here.

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