Many Faces, One Voice: Ensuring Our Legacy

This will be the final message I send to you because my term of office ends December 2002. What a tremendous year this has been, filled with opportunities to move the National Association of Clinical Nurse Specialists' (NACNS's) issues ahead as well as make personal contact with NACNS members in their affiliate meetings. Central to all of this activity has been my focus on extending the message about NACNS's mission and core values internally to our members and externally to others. Building on the theme of our 2003 conference, while acknowledging our "many faces" in clinical practice, education, and organizational change, we are also building the "one voice" of and for clinical nurse specialist (CNS) practice.

Our membership now stands at more than 1,200. In part, our growth has also increased because of our efforts to establish NACNS affiliates through whom practicing CNSs can learn what their national organization is doing that represents their interests. This year, the Board's decision making has been made against the backdrop of our core values and positions, and this has allowed us to articulate those core values and positions in several ways.

In August, NACNS exhibited at the yearly assembly of the National Councils of State Boards of Nursing (NCSBN). This meeting is the time when all of the member boards of nursing come together to consider and vote on issues of importance. This year, one very important issue to be considered was a revision of the language that would govern regulation of CNSs (as part of the advance practice registered nurse [APRN] category) in compact states. The compact was originally created by a roundtable of APRN organizations in 2000. However, in the 6 months before this year's assembly, the NCSBN's APRN task force unilaterally changed the wording in sections of the compact. After carefully reading the proposed new language, NACNS's Legislative/Regulatory Committee, chaired by Jo Ellen Rust, recommended that the NACNS oppose some changes because they would create additional barriers to CNS practice and conflicted with the core values/positions that NACNS has identified as critical for CNS practice. Throughout one month, 3 documents were created that went with the NACNS to the NCSBN meeting. One was a summary of the NACNS position on these changes, another was a table comparing the past with the proposed language and indicating the NACNS's position on the proposed changes, and the last was an article by Dr Brenda Lyon regarding the regulation for CNS practice, further outlining NACNS's opposition to second licensure for CNSs. NACNS's exhibit table was placed next to the door where delegates from various states entered, giving Chris Filipovich, NACNS Executive Director, and I an incredible opportunity to talk with members of boards explaining the NACNS opposition. When this issue was discussed in the assembly, NACNS's voice was heard in opposition to the proposed changes along with that of American Nurses Association, American Nurses Credentialing Center, and American Association of Colleges of Nursing. I am sorry to say that the assembly voted to adopt the proposed compact language. You may be wondering why I would share what seems to be a defeat for NACNS at this national nursing policy group. The answer is this: although the NCSBN Assembly voted to adopt this compact language, individual boards of nursing in various states will have also have to adopt such changes. Thus, CNSs and NACNS have, in the affected states, another opportunity to move the NACNS message to the state boards of nursing in compact states. How will we do this? Through you, our members, and through the continued voice of NACNS on your behalf. Expect to see more about this in upcoming issues of the journal and at convention in March in Pittsburgh.

There is another equally important venue toward which NACNS has directed its attention. But first, a short history about the issue. When NACNS began its work in 1995, one of the first positions it took publically related to blending the CNS and NP roles. Dr Brenda Lyon wrote an article about this in the Online Journal of Nursing,1 and, in the past several years, NACNS has monitored national trends in graduate nursing education to determine where the initial pilot programs that blended the CNS and NP roles were going. Within the past year, several national nursing groups have recommended blending the CNS and NP roles in 3 different specialties. Although NACNS continues to oppose this trend, it is taking steps to respond to this challenge. First, it will conduct a survey related to the skills, competencies, and outcomes of CNS practice, comparing the findings for those who are dually prepared versus those who have CNS preparation. These data will be used to provide underpinnings for the NACNS position related to this issue. Second, it is seeking the input of its members to this trend. Finally, as the NACNS interacts with other national nursing organizations on this issue, it is calling for a national dialogue about the cost, benefit, and rationale for this trend.

Let me reiterate the other core positions of NACNS that have provided the basis for its work at the national level. They are:

* The CNS role builds on the knowledge and experience of the baccalaureate-prepared nurse;

* CNS's major customers are patients/families and communities, nurses and other healthcare providers, and systems/organizations;

* There are domains of influence associated with each CNS customer;

* Competencies and outcomes are linked to the domains of influence;

* The 5 traditional subroles of the CNS are used throughout the 3 domains of CNS practice.

* Certification examinations for CNSs should address the domains, competencies, and outcomes of CNS practice; and

* An equivalent alternative must be developed, tested, and made available to the CNS for whom there is no certification examination at the advanced level; NACNS supports the professional portfolio as the alternative.

From many faces and no voice, this organization has moved to one voice related to CNS practice. Its current efforts ensure that its contribution to the health and well being of the citizens of this country will continue to be available in the future. Thank you for the opportunity to serve during this time of growth and strength.

NACNS Statement on Clinical Nurse Specialist Practice and Education

This document articulates the competencies requisite to CNS practice, outlines the necessary outcomes of nursing, and provides direction to schools of nursing regarding the preparation of CNSs. You can purchase your copy of this landmark document through the NACNS Office. The cost is $15 per copy for members of NACNS and $25 per copy for nonmembers. Discounts are offered on purchases of 15 copies or more. Contact the NACNS Office today to order your copy of the Statement.

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