CNS Advocacy Issues

NACNS is committed to highlighting the unique contributions clinical nurse specialists bring to addressing key issues in health care.

APRNs at VA Facilities

NACNS has been urging the Department of Veterans Affairs (VA) to amend its restrictions on APRNs in VA facilities and allow them to provide health care services to the full extent of their education.  After years of advocacy by NACNS and other nursing groups, the VA issued a final rule that recognizes the full practice authority of three of the APRN roles – clinical nurse specialists, nurse practitioners, and certified nurse-midwives in December, 2016.

In response to the final rule, NACNS is requesting that the VA also include certified registered nurse anesthetists, the fourth APRN role, as one of the APRNS allowed to practice to the full extent of their education and certification.

NACNS Statements and Media Coverage

NACNS Public Comments

MACRA Final Rule

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) shifts the health care payment system towards value and repeals the Medicare Sustainable Growth Rate methodology for updates to the Physician Fee Schedule and replaces it with a new approach to payment called the Quality Payment Program.  The major provisions of MACRA, the Quality Payment Program and their implications for NACNS members is included in this summary.

2018 Standard Occupational Classification

In recommendations to the Office of Management and Budget for the 2018 Standard Occupational Classification, the Standard Occupational Classification Policy Committee (SOCPC) declined to include clinical nurse specialists in a separate broad occupation and detailed occupation category stating:

Multiple dockets requested a new detailed occupation for Clinical Nurse Specialists.  The SOCPC did not accept this recommendation based on Classification Principle 2 which states that occupations are classified based on work performed and on Classification Principle 9 on collectability.

Read the extensive 2014 filing on why the clinical nurse specialist should be included in the Standard Occupational Classification as a “broad category.” NACNS then commented in September 2016, responding directly to the committee’s recommendation and rationale to not accept the request for a new detailed occupation “Clinical Nurse Specialist”. Regarding the latest November 2017 SOCPC announcement to not accept the request, NACNS issued a public statement.

Additional Resources


APRN Consensus Model

NACNS calls for careful implementation of the APRN Consensus Model in order to preserve patient and health care system access to clinical nurse specialist services, particularly given the significant influence the CNS role has on cost and quality of health care outcomes.

Additional Resources