It is what it is[horizontal ellipsis]But it will become what you make of it.
-Author unknown
Years ago, an intensive care unit registered nurse shared that first sentence with me. Later while thumbing through a catalog, I read the second line. The second sentence turns the first one from a statement of resignation to one of encouragement.
I was recently reading about the scientific comments on planet Pluto in my husband's issue of Planetary Society. There was an article that caught my attention because it described putting a human on Mars. My first thought was "That seems crazy!" But when I thought about it some more, I realized that considering such a possibility is not insanity, but "vision." As president of NACNS, part of my job is to articulate our vision for the future, and I feel that vision is becoming ever clearer.
Since the last issue of the journal, the Doctor of Nursing Practice (DNP) Task Force including past NACNS presidents Carol Manchester, MSN, ACNS, BC-ADM, CDE, and Rachel Moody, MSN, RN, CNS; Melissa Craft, PhD, APRN-CNS, AOCN; Ruth Lundquist, PhD, RN, FAHA FAAN; Linda Scott, PhD, RN, NEA-BC, FAAN; Patti Rager Zuzelo, EdD, RN, ACNS-BC, ANP-BC, CRNP; and staff advisor Maureen Shekleton, PhD, FAAN, brought their recommendations to the Board, which voted to ratify them in a position statement. In July 2015, NACNS publicly announced its endorsement of the DNP degree as a requirement for entry into practice for clinical nurse specialists (CNSs) by 2030. NACNS has historically supported both master's and doctorate preparation for entry, but patient care has become increasingly complex, and DNP preparation positions the CNS to better meet the healthcare demands of our patients. The Task Force has also been charged with preparing recommendations regarding the PhD for CNSs. Open forums for the members to discuss questions on the DNP position statement were held September 8 and 10.
Also in July, NACNS held its second annual Educator's Forum in Crystal City, Virginia. There were 53 attendees discussing a range of topics as today's market for CNSs, population-based examinations, and school program challenges, including preceptor placement. It was followed by NACNS 14th Annual Summit in which past NACNS president Melanie Duffy discussed the legislative issues affecting the CNS, as Title VIII, chronic care, and telehealth. Two representatives from the American Nurses Credentialing Center, Christine Leyden and Lee Skinner, explained options for portfolio credentialing and presented its preliminary content outline. Andrea Brassard, from the American Nurses Association (ANA) talked about the importance of regulations allowing the CNSs to prescribe durable medical equipment. NACNS president-elect Sharon Horner updated the 69 attendees about the work involving CNS Core Statement revision.
The take-away from these sessions is that CNSs are not dead. We must continue to be evolving, adapting to changes that are part of CNS talents. But we must not allow our profession to become stagnant. NACNS will work diligently on CNS core competencies. We must work to ensure that every advanced practice registered nurse (APRN) will be able to test for all populations. Even though writing examinations involves time, costs, and psychometrics problems, the possibility of portfolio development must be available to the APRN role. We must keep in mind that 1 main challenge may be having the volume to maintain, revise, and update that process. We need to continue discussions about multistate licensing and examine graduate schools curricula side-by-side in educational program development.
In August, I was privileged to attend the APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee Licensure Accreditation Certification Education meeting with NACNS executive director Melinda Ray. Joan Stanley with the American Association of the Colleges of Nursing presented a report on schools aligned with the APRN Consensus Model, which included some data on programs that have been discontinued, and it was unclear if some have revised to DNP programs. Stanley emphasized that employers and insurers should participate in these conversations about credentialing to avoid any confusion. On December 1, 2015, ANA will host a meeting to discuss the state of the APRN Consensus Model at ANA headquarters. NACNS is represented on the planning committee for this meeting.
The Board convened in Philadelphia, Pennsylvania, on October 3 and 4 to plan for the business of the membership for 2016-2017. There were discussions on budget, policy, and team building.
Finally, all the ballots are in, and the announcement of the 2016 elected Board will be sent by e-mail and posted on the Web site. The new and continuing Board will be seated at the 2016 Annual Conference, which will include a variety of informative and exciting speakers, sessions, and activities. So begin making your plans to join all CNSs in Philadelphia this upcoming March 3 to 5.
I wish all NACNS members Happy Holidays with your loved ones and look forward to a prosperous new year in 2016.
NACNS Position Statement on the Doctor of Nursing Practice June 17, 2015
The National Association of Clinical Nurse Specialists (NACNS) endorses the Doctor of Nursing Practice (DNP) degree as entry into practice for Clinical Nurse Specialists (CNSs) by 2030.a While NACNS has consistently supported both masters and DNP preparation for entry into the CNS role, considering the complex needs of patients and the future direction of nursing practice, we believe that DNP preparation for practice in the CNS role will better position the CNS to meet the demands of an evolving healthcare system. Consistent with the strategic recommendations proposed to facilitate health care transformation, NACNS believes it is imperative to increase the number of doctorally-prepared Advanced Practice Registered Nurses (APRNs), which will increase the number of doctorally prepared nurses overall (IOM Future of Nursing, 2010; Educating Nurses: A Call for Radical Transformation, 2009). As a result, NACNS endorses the DNP degree as an important opportunity for CNS education and supports the need to increase doctoral preparation for nursing practice (IOM, 2010).
Over the past decade since the American Association of Colleges of Nursing (AACN) recommended a transition to the DNP degree as the level of entry into APRN practice, NACNS has carefully considered the opportunities, impact, and influences of the DNP degree. NACNS responded to the AACN endorsement of the DNP degree with the White Paper on the Nursing Practice Doctorate (2005). In 2010, NACNS re-examined the DNP degree at the request of its members and affirmed a "position of neutrality" (NACNS, 2010) along with a commitment to continue its examination of the DNP degree specific to trends in CNS education and practice. These organizational positions have been consistent with NACNS" definition of CNSs as "licensed registered professional nurses with graduate preparation (master's or doctorate) from a program that prepares CNSs" (NACNS Statement on Practice and Education, 2004, p. 12). Through this ongoing examination, NACNS now endorses the DNP for educational preparation of individuals seeking to enter CNS practice.
NACNS concurs with the IOM Report (2010, S 6) assertion that seamless transitions to higher degree programs are essential. NACNS recognizes that there are two routes for completing a clinical doctorate in nursing: post-baccalaureate (i.e., post-BSN) and post-masters. Post-BSN programs must use validated CNS competencies and education standards to guide the curriculum and ensure that graduates are prepared to practice in the CNS role. NACNS has developed and published nationally vetted CNS competencies (Core Competencies, 2010). In addition, graduate programs must use the Criteria for the Evaluation of Clinical Nurse Specialist Master's, Practice Doctorate, and Post-Graduate Certificate Educational Programs (2012) for guidance during CNS education program evaluation and/or development. Completion of the CNS specialty didactic and clinical courses in a population of interest, along with completion of the DNP role/practicum hours will enable graduates to meet or exceed the 1,000 clinical hour requirement and to sit for national certification. Post-MSN students who hold current advanced practice certification with verified specialty clinical hours will be required to complete the DNP role/practicum to meet the DNP Essentials competencies and the remaining clinical hour requirement.
While NACNS supports the DNP as the appropriate degree for future clinical practice as a CNS, the organization supports the right of CNSs who pursued other graduate education to retain their ability to practice within the CNS role without having to obtain the DNP for future practice as an APRN after 2030.
References
Institute of Medicine (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.thefutureofnursing.org/sites/default/files/Future%20of%20Nursing%20Re
Educating Nurses: A Call for Radical Transformation, 2009 Educating Nurses: A Call for Radical Transformation (2009). http://archive.carnegiefoundation.org/elibrary/educating-nurses-highlights
NACNS (2005). White Paper on the Nursing Practice Doctorate. http://www.nacns.org/docs/PaperOnNPDoctorate.pdf
NACNS (2009). Position Statement on the Nursing Practice Doctorate. http://www.nacns.org/docs/PositionOnNursingPracticeDoctorate.pdf
NACNS (2004). Statement on Clinical Nurse Specialist Practice and Education (2nd ed.). http://www.nacns.org/docs/NACNS-Statement.pdf
NACNS (2006-2008). Core Competencies Executive Summary. http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
NACNS (2012). Criteria for the Evaluation of Clinical Nurse Specialist Master's, Practice Doctorate, and Post-Graduate Certificate Educational Programs. http://www.nacns.org/docs/CNSEducationCriteria.pdf
AACN Essentials. http://www.aacn.nche.edu/education-resources/essential-series#.VYBwkorDaHE.mailt
APRN Consensus Model. https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
NACNS DNP TASK FORCE MEMBERS
Carol Manchester, MSN, ACNS, BC-ADM, CDE, Chair, University of Minnesota Medical Center, Minnesota
Melissa Craft, PhD, APRN-CNS, AOCN, University of Oklahoma, Oklahoma
Ruth Lundquist, PhD, RN, FAHA, FAAN, University of Minnesota, Minnesota
Rachel Moody, MSN, RN, CNS, Franciscan Alliance, Indiana
Linda Scott, PhD, RN, NEA-BC, FAAN, University of Illinois at Chicago, Illinois
Maureen Shekleton, PhD, FAAN (Staff Advisor), NACNS Consultant, Illinois
Patti Rager Zuzelo, EdD, RN, ACNS-BC, ANP-BC, CRNP, FAAN, Drexel University, Pennsylvania
NACNS 2015 WEBINAR SERIES*
NACNS is excited to continue our high-quality webinar programming in 2015. This series of webinars is designed to provide the CNS with cutting-edge clinical and role information. In addition, we have intentionally designed some of the sessions to provide much needed pharmacology CE! Please sign up for 1 or more:
Webinar Cost: Series of 6 Webinars
Members $260
Non-Members $295 Student $150
All webinars have been archived for later viewing.
Single Webinar
Members $45
Non-Members $60 Student $30
Malnutrition and the Hospitalized Adult-Essential Considerations in Identification and Management
November 17, 2015, at 4:00 PM EST
MAKE PLANS NOW TO ATTEND THE NACNS ANNUAL MEETING IN PHILADELPHIA, PENNSYLVANIA
The Future is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist March 3 to 5, 2016, Loews Philadelphia Hotel, Pennsylvania
Join CNSs from around the country at the original capital of America. If you have never been to Philadelphia, this is your chance! Philly is a melting pot of history, traditions, and immigrant cultures. This means lots to do and amazing culinary options! The city, home to the Liberty Bell and the Declaration of Independence, highlights the key role Philadelphia played in the founding of our nation. Annual meeting details will be posted on the NACNS Web site, http://www.nacns.org.
Registration Open: End of November 2015
Early-Bird Deadline: Mid-January 2016
NACNS DNP POSITION STATEMENT: Q&A
Why did the Board wait until now to publish a position on the DNP?
The NACNS Board passed a position related to the DNP in 2005. This position was one of neutrality, based on limited information as to the impact of the DNP as a practice degree for the CNS. The NACNS Board appointed a Task Force in 2015 and asked them to evaluate the DNP as a required degree for CNS entry into practice based on the information and analysis available at this point in time. This analysis resulted in the current position statement.
Why was 2030 selected as the date for implementation of the DNP as the entry-level degree for the CNS?
The NACNS Board elected to provide a 15-year transition to the DNP as entry level for the CNS. The NACNS Board believes that this timeline allows schools, universities, and individuals to plan for implementation of the DNP as entry level for CNS practice.
What about those individuals who currently have a master's degree?
Individuals currently in practice with a master's degree as a CNS should be considered eligible to practice as long as they comply with the regulatory requirements of their state. NACNS strongly supports grandfathering for these individuals when the 2030 implementation date is reached. The NACNS Board believes that no individual should be disenfranchised by this change to DNP as entry level for CNS practice in 2030.
Why do you specify the DNP as the required degree and not the PhD?
The NACNS Board differentiates between the DNP as a terminal degree for practice and the PhD a terminal degree that is focused on nursing research. The nursing profession needs nurses prepared with both types of degrees with their respective different skill sets and encourages CNSs to critically identify which professional track is most interesting to them.
How will the DNP assist the CNS in achieving specialty practice?
Specialty practice is integral to the CNS role as an APRN. The APRN Consensus Model for Regulation, Licensure, Accreditation, Certification, and Education (2008) (APRN Consensus Model ) requirements for licensure states that a CNS must be educated for a population focus and pass a certification examination that assesses that knowledge of a population. The populations identified in the APRN Consensus Model includes adult/gerontology, family/individual across of the life-span, neonatal, pediatric, women's health/gender specific, and psychiatric/mental health.
A CNS program at the DNP level can focus on the core competencies needed for a CNS to achieve certification in 1 of these populations. The DNP program can then utilize the additional clinical and didactic hours to allow an individual to gain in-depth knowledge of their specialty. Ideally, upon graduation, the CNS DNP student should be prepared to meet the requirements for certification in a population and then seek certification within their specialty if available.
AFFILIATE UPDATES
Central Indiana Organization, Clinical Nurse Specialists, Inc, Recognitions to Celebrate
The Central Indiana Organization of the Clinical Nurse Specialists recently elected new Board Members for 2015-2016. Congratulations to the newly elected board:
Other area CNSs recognized for their contribution to nursing practice include the following:
President Jennifer Woodard
Vice President Kerista Hansell
Treasurer Debbie Ferguson
Board Member Francesca Levitt
Board Member Brandee Wornhoff
Michelle Kidd, MS, RN, ACNS-BC, CCRN, has been elected to the American Association of Critical-Care Nurses (AACN) Board of Directors. Kidd will serve a 3-year term. Kidd has been active in AACN as an ambassador, chapter planner, NTI program planning committee member, and abstract review panel member, among other duties.
Staci Wuchner, MSN, RN, ACNS-BC, CCRN, CNRN, SCRN, has been awarded the 2014 Certificant of the Year from the American Board of Neuroscience Nursing.
Kathleen E. Hubner, MSN, RN, ACNS-BC, ANVP, CNRN, has been awarded the 2015 Excellence in Advanced Practice Nursing from the American Association of Neuroscience Nurses.
Jennifer Louise Embree, DNP, RN, NE-BC, CCNS, has been elected to serve on the Nominations and Elections Committee of the ANA.
Washington Affiliate
The Washington Affiliate of NACNS has made substantial progress toward obtaining appropriate inclusion in the state's advanced practice rules. Currently, the state licenses all certified nurse midwives, certified registered nurse anesthetists, and certified nurse practitioners as ARNPs. Since 2006, the Washington Affiliate has been working to gain stakeholder agreement and support for CNS inclusion.
In 2012, a formal request (CR101) was submitted to the Nursing Commission by the Washington Affiliate and the Washington State Nursing Association to request revision of the rules. Following substantial work with the Nursing Commission (the state nursing board) and the ARNP subcommittee, draft rules that are fully supported by ARNP United (the Nurse Practitioner special interest group in the state) and the ARNP subcommittee have been completed. The draft rules align with the current rules within the state: a graduate degree in nursing is required, certification as a CNS will be required, and documented evidence of recent practice will be required. The rules will be reviewed at the Nursing Commission's regular business meeting and will go to public hearing in November. Information on the current status of the rule progression is on the Nursing Commission Web page for advanced practice nurses, http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/RulesinPr. Interested individuals may also contact Heather Schoonover, MN, RN, PHCNS-BC, at mailto:[email protected].
The leadership of the Washington Affiliate is also changing. Heather Schoonover, chair of the affiliate since 2008, is concluding her leadership of the affiliate, and Susan Eardley, RN ACNS-BC, CHFN, will serve as the chair.
aThe NACNS Board of Directors reserves the right to modify this date based on issues that may emerge related to legislation, accreditation, certification and education. [Context Link]
*This activity has been approved for contact hours by the PA State Nurses Association. The PA State Nurses Association is accredited as an approver of continuing education by the American Nurses Credentialing Center's Commission on Accreditation. [Context Link]