Three APN groups get new federal occupational classification

Trauma Columnist · Mar 19, 2009

Darn - some CNS's are APNs and should be classified as that occupation.

Advanced Practice Columnist / Guide · Mar 20, 2009

Oh I agree, the CNS is definitely an advanced role for nurses regardless of whether they can diagnose and prescribe. The educational preparation is definitely higher than a Registered Nurse and the knowledge and skill level is at an advanced stage. Unfortunately, the committee that decided on the change did not see that the tasks performed by CNS are unique enough from that of a Registered Nurse and I disagree with that. I believe that the entire nursing community is making a mistake for not supporting further growth and recognition of the CNS role.

core0 · Mar 20, 2009

Oh I agree, the CNS is definitely an advanced role for nurses regardless of whether they can diagnose and prescribe. The educational preparation is definitely higher than a Registered Nurse and the knowledge and skill level is at an advanced stage. Unfortunately, the committee that decided on the change did not see that the tasks performed by CNS are unique enough from that of a Registered Nurse and I disagree with that. I believe that the entire nursing community is making a mistake for not supporting further growth and recognition of the CNS role.

The problem is that the State BONs don't support that. They want to differentiate APNs based on diagnosis and prescriptive authority. The CLN seems to be the answer to some of the traditional CNS roles outside of the APN. The DNP was supposed to merge the NP and CNS in the original white paper. I think that this lack of consensus is what OB&M picked up on. There are a number of other roles that are in this neither fish nor fowl category. Wound/Ostomy nurse or PICC nurses for example. Both have additional preperation beyond the RN and both preform procedures and skills at an advanced stage. What is needed here is another level for those who do not have general diagnosis and prescriptive authority but preform advanced roles.

David Carpenter, PA-C

Trauma Columnist · Mar 20, 2009

Yes, agree with both of you. However, when many states don't even consider CNS to be APNs, its going to be hard to get the government to agree though I bill Medicare just like my NP and PA peers!

Advanced Practice Columnist / Guide · Mar 21, 2009

Per the Concensus Model for APRN Regulation document endorsed by ANA, NCSBN, AACN, CCNE, NLN, and a host of other advanced practice nursing entities, an APRN is defined as a nurse who:

1. has completed graduate level educational program for any of the four recognized APRN roles.

2. has passed national certification for any of the four recognized APRN roles.

3. significant focus of education is in pacticing direct care of individuals.

4. practice builds on competencies as a Registered Nurse.

5. practice involves health promotion and/or maintenance, assessment, diagnosis, and management of patient problems including prescriptive authority.

6. has clinical experience of sufficient depth and breadth to reflect intended license.

7. has a license to practice as a CNP, CNS, CNM, or CRNA.

It all makes sense but clearly, the statements are more of a vision than actual reality. Item number 5 is problematic as some states do not grant CNS' to practice as reflected in that statement. Items number 4 and 6 are quite vague. Is it implying clinical experience offered in the APRN program or clinical experience gained from being a Registered Nurse? this is problematic for direct-entry APRN programs where students come in with no "sufficient" clinical experience.

Hopefully, nursing will get its act together and agree to implement the novel ideas they always come up with on paper.

Trauma Columnist · Mar 23, 2009

So right - wouldn't it be nice if all the states had the same rules/roles for ALL of us?