To the Editor:

We would like to voice our concerns regarding "Clinical Nurse Specialist Prescriber Characteristics and Challenges in Oregon" published in the May/June issue [29(3)] of the journal. Although the content of the article contributes to an emerging understanding of prescriptive authority for clinical nurse specialist (CNS) practice, we found parts of the analysis problematic.

The study's stated purpose was to assess role characteristics of CNSs with prescriptive authority. The sample size consisted of only 23 respondents of a possible total of 40 CNSs in Oregon who have ever been granted prescriptive authority by the Oregon Board of Nursing. No information was provided about those who did not participate, leaving open the possibility that those who did participate had strong biases in 1 direction or a particular issue they wanted disclosed. Although the findings were shared as aggregate data, the CNS community in Oregon is a cohesive network, and with a small number of CNSs holding prescriptive authority, the possibility of individually identifying participants by the comments was greatly increased by naming the participant's place of employment. The Veterans Affairs (VA) healthcare system was the only healthcare system identified by name and specifically associated with barriers for CNSs obtaining or using prescriptive authority. No other healthcare systems were identified, and no data were presented to indicate which or how many Oregon healthcare systems even allow CNS prescriptive privileges. Singling out participants' challenges with the VA unfairly portrayed this healthcare system negatively. The VA in Oregon has a long history of supporting advanced practice nursing including CNS practice and is, like most systems, adjusting to the many changes occurring in healthcare nationally.

Jenny Richardson, DNP, RN, CNS-BC

Ann Busch, MS, RN, ACNS-BC-PP, FAAN

Portland, Oregon