What is the difference between a nursing intervention and an intervention delivered by a nurse? It's an important question before this journal. The purpose of the journal, adopted by the National Association of Clinical Nurse Specialists (NACNS) Board of Directors, is to publish scholarly works by clinical nurse specialists and other advanced practice nurses whose manuscripts advance the practice of nursing-manuscripts that describe nurse-initiated interventions delivered in response to a diagnosis that can be treated within nursing's autonomous scope of practice. More specifically, the journal invites articles about innovative interventions. Innovations may be created by: (1) invention that leads to an entirely new intervention, (2) adaptation that adopts or modifies something already in existence, (3) novel application of an intervention from one patient population to another, or (4) adoption of an intervention into nursing practice that is used by another provider. 1 Manuscripts that describe innovative nursing interventions meet the requirements of advancing the practice of nursing and the purpose of this journal.
Autonomous practice is related to but different from independent practice. Autonomy refers to a legal scope of practice and includes the ability to determine a problem and initiate action to resolve the problem. Autonomy is secured under a license granted by a governing body. Nursing's autonomy to practice comes from law. Individual state boards of nursing operate to enact the laws put in place by governing bodies, the state legislatures. State boards of nursing do not make laws-they craft regulations to enact laws. Therefore, autonomous nursing practice is, by nature, independent nursing practice granted by the legislature.
Recently, the journal has received a growing number of manuscripts that review diseases and describe medical interventions delivered by nurses or what the nursing interventions classification (NIC) describes as physician-initiated treatments. 2 Manuscripts such as those that explain the best pharmacotherapy for complicated urinary tract infections are describing known physician-initiated interventions delivered by nurses and are not congruent with the requirement to describe innovative nursing interventions. A review of the literature about a disease should be more than a summary of information available from other sources-the requirement for advancing the practice of nursing means that the manuscript views disease as context and provides direction for creating nurse-initiated interventions.
An old debate about the difference between nursing extension and expansion has bounced around nursing for many years. Does extension of nursing mean extending into another profession's practice, particularly physicians, by assuming responsibility for those duties historically belonging to medicine, or does nursing expand autonomous nursing practice by building new interventions and practice components within the autonomous scope of nursing practice, thereby adding depth and breadth to nursing practice? NACNS describes expansion as the acquisition of scientific knowledge and skills for the purpose of creating innovative nurse-initiated interventions that result in improved health outcomes. 3 The American Nurses' Association's (ANA) Scope and Standards defines expansion of nursing, in the context of advanced practice nursing, as the "acquisition of new practice knowledge and skills, including the knowledge and skills that authorize role autonomy within areas of practice that may overlap traditional boundaries of medical practice."4 ANA describes expansion as the extension of nursing into medical practice; it does not provide direction for the expansion of nursing practice within the autonomous domain of nursing. NACNS believes that one of the main contributions of CNSs is to advance nursing practice through innovative evidence-based nurse-initiated interventions.
In the ebb and flow of professional boundaries, practices shift as science and technology bring new opportunities and challenges to those of us charged with a public trust for the health of the populous. Discussion about boundaries will continue. Critical to the discussion of overlapping boundaries is the need to give voice and creditability to autonomous nursing practice-those activities that address client problems that are amenable to resolution by the nurse-initiated interventions. Manuscripts about innovative nurse-initiated interventions are of interest to the journal. With an increase in innovative interventions to existing evidence-based interventions, there will be an increasing need for independent nursing practice. For this reason, supporting the development of and disseminating information about innovative nurse-initiated interventions is critical.
It took our forebears in nursing much blood, sweat, and tears to carve out a place for nursing at the national forum for science-the National Institutes of Health-and other major arenas for scientific knowledge development. Many thanks to those pioneers for incredible contributions that position nursing to advance practice by expanding nursing's depth and breadth. In the last 20 years there has been an explosion in the knowledge generated by nursing science and there are now considerable substantive areas of nursing knowledge upon which to expand nursing practice. Expansion of nursing should mean something different than the far simpler path of acquiring existing knowledge and skills-presumably from medicine. Expansion of nursing goes hand in hand with knowledge scientifically generated by nurses about the phenomena of interest to nurses.
By developing innovative, scientifically-grounded interventions, clinical nurse specialists are key players in the expansion of nursing. What is the difference between a nursing intervention and an intervention delivered by a nurse? It's the difference between advancing the practice of nursing or not. This journal is looking for manuscripts that will expand nursing practice. Expansion: application of knowledge and development of competencies for the purpose of expanding the depth and breadth of nursing within the autonomous boundaries of nursing practice.
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