National Nursing Leader Says CNSs Need to Be Categorized Correctly
“Sadly, yet again the Office of Management and Budget has incorrectly classified clinical nurse specialists (CNSs) as a title within the broad occupation of general registered nurses (RNs) in the federal government’s Standard Occupational Classification (SOC) System’s 2018 revision. NACNS had once again requested to be treated as other advanced practice registered nurses (APRNs) and be assigned a stand‐alone SOC broad occupational code. This decision is disappointing and problematic as clinical nurse specialists’ skills and work is sufficiently distinct to reliably collect workforce data as an SOC detailed occupation.
As one of the four types of APRNs, clinical nurse specialists are required to hold graduate degrees, either a master’s or doctoral degree, and are licensed and certified based on a clear and nationally recognized body of knowledge. CNS work includes specialized skills that allows them to perform as an independent health care provider and clinical expert with prescriptive authority and autonomous patient management. All APRNs are required to have advanced anatomy and physiology, pharmacology and assessment prior to graduation. CNSs have prescriptive authority in 39 states.
Lumping CNSs into the general RN category prevents federal researchers from accurately capturing health care workforce data. Incorrectly categorizing clinical nurse specialists skews the quality and utility of federal health care policy data because CNSs perform specialized advanced nursing tasks versus the generalist tasks of the RN. This decision erects barriers to full scope of practice.
While CNSs embrace their initial RN practice, their work as a clinical nurse specialist is clearly different. Misconstruing CNSs within the RN title is out of step with the broader health care community. The seminal 2010 Future of Nursing report from the Institute of Medicine, now the National Academies of Sciences, Engineering, and Medicine, recommends that all APRNs, including CNSs, be allowed to practice to the full scope of their education and training. In 2016, the Department of Veterans Affairs (VA) proposed to amend its regulations to permit full practice authority of all VA APRNs, including CNSs, when they are acting within the scope of their VA employment. Furthermore, Congress recognized and defined the unique, valuable role of CNSs in the Balanced Budget Act of 1997 when it allowed CNSs to directly bill their services through the Centers for Medicare & Medicaid Services.
The SOC Policy Committee was established by OMB to ensure the coordination of occupational statistics across federal programs. By wrongly classifying clinical nurse specialists as registered nurses, OMB is devaluing CNS work and diluting the explanatory power of their data. This is happening at a time when the increasing health care needs of the nation require both improved quality and reduced costs that are afforded by the specialized, advanced level competencies of the CNS.
We will continue to work to make sure that the role CNSs play in acute, chronic and primary care is respected, valued and accurately represented. “
Note: Vince Holly, MSN, RN, CCRN, CCNS, ACNS-BC is the President of the 2017-2018 NACNS Board of Directors.
I fully support this statement. Thank you for representing and advocating for our profession as CNSs.
Thank-You for your hard work.
An example of how policy can blur the role of the CNS; important for each of us to verbalize our role.
As a member of the Institute of Emergency Nursing Advanced Practice, I had the honor and privilege to review the draft CNS Core Competencies. I can see how people outside of Nursing could be confused about our role. In fact, I recommended that anything in the CNS Core Competencies that was RN scope be removed. Those competencies are “covered” in the RN requirement to be a CNS. The CNS should be looked at as the role that would “backfill” a NP not a RN. What a great time to be a CNS and help to educate others about our work!