It is time to come to terms with certification for clinical nurse specialists (CNSs). Over the past 10 years, CNSs have grappled with the necessity for certification, bemoaning a lack of specialty certification options at the advanced level and the ever-changing eligibility requirements for existing certifications. Since the inception of the CNS role in the 1950s, it was defined by a graduate degree in nursing, historically the "gold standard" for excellence in advanced nursing practice and not required by the other advanced practice nursing roles. For over half a century, CNSs have practiced without a requirement for certification.

Clinical nurse specialists practicing today did not all graduate from identical programs. Some CNSs are graduates of programs designated CNS, and some are graduates of a track option simply designated clinical. Some programs designated clinical specialties broadly, such as adult or pediatrics, whereas others were more narrowly defined, such as pulmonary, trauma, or pediatric mental health. Even in the face of diverse graduate programs, CNSs have managed to practice safely and competently. Certification was a mark of excellence. Graduates needed a minimum of 3 years of practice to be eligible for the original CNS certifications offered by the American Nurses Credentialing Center (ANCC). Some CNSs obtained certification; others did not. Where certification was not encouraged or required by state boards, hospital credentialing boards, employers, or third-party reimbursement, it was often considered nonessential and optional. Against this backdrop, hundreds of CNSs have been and are currently practicing-with excellence-in specialty areas without certification.

Now things have changed. Certification is considered a measure of minimum competency for entry into practice rather than an optional professional credential. State boards of nursing are requiring evidence of advanced level certification for recognition as an advanced practice nurse. Certification bodies are changing eligibility requirements and specifying required courses and minimum clinical practicum time. Maybe more standardized curricula will prove a wise move and maybe not, but in reality, today's highly competent CNS workforce was prepared under old curriculum models. Graduate education is an investment not to be discounted easily.

As certification bodies changed certification eligibility requirements, announcements were posted, and noncertified CNSs were encouraged to seek certification. Many CNSs took advantage of the opportunity; others did not. For many CNSs, the problem was and remains a lack of certification options at the advanced level for specialty practice. Recently, the ANCC and the National Association of Clinical Nurse Specialists collaborated to create a CNS core competency certification examination as a way of addressing specialty practice. This new core certification validated competency in the CNS role and addressed nursing practice across the life span. In launching the new certification, ANCC provided a window of opportunity for experienced CNSs prepared in older curricula to obtain certification. In the Legislative and Regulatory Update column in this issue, Jeff Albaugh describes his journey to achieving the ANCC CNS core competency certification. After many years in successful practice as a urology CNS, he was locked out of third-party reimbursement by rules that specified certification requirements. His situation is typical for experienced CNSs in specialty practices, and the new certification option was a solution. Unfortunately, after 1 test period, ANCC opted to shelve the CNS core examination and thus eliminating this certification option. The National Association of Clinical Nurse Specialists is aware of approximately 100 individuals who have identified themselves as needing to or intending to take the examination, if it were available, and both individuals and CNS groups have written ANCC to express disappointment and anger over the withdrawal of core certification option.

There is no evidence that experienced CNSs are failing to meet role competency expectations, and no evidence of harm to the public. All CNSs have a graduate degree in nursing. The continuing problems of lack of specialty certification options and pathways to certification for experienced CNSs are ripe for some creative ventures. If state-level regulatory boards are seen as a barrier to certification options, remember that governmental regulatory boards are accountable to the public. We have a voice at the regulatory level. The opportunity exists for a certifying body, established or newly created, to take on the challenge of devising a realistic certification option for CNSs. It is time to solve this problem.