Looking over the efforts of the Board of Directors of NACNS we are challenged to address and respond to the vast needs and concerns of CNSs. Currently, we are involved in numerous activities and pursuits that move us towards meeting these challenges. Major involvements include:
News from the Board
This has been an extremely productive summer for the NACNS Board! About three times a year the board meets "face to face" for a board retreat, supplementing the usual monthly board meetings held by phone conference. This year, a summer retreat was held June 13-15, 2003, at Jawacdah Farms, a beautiful site boasting 657 acres of farmlands in southeastern Indiana. Our gracious host was Bill Dunlevy, who represented the Hillendbrand Industries. Hillenbrand manufactures Hillrom beds among other healthcare industry products. This was a perfect setting for conducting NACNS business with few distractions during our three-day retreat.
President Jan Fulton opened the retreat by reviewing the agenda. Board members reported on the status of various initiatives such as CNS certification, regulatory credentialing, portfolios as a potential alternative certification in areas lacking a national certification exam, model language, plans for the 2004 national conference in San Antonio, Texas, and the NACNS Statement on CNS Practice and Education.
Additional benefits from the board retreat included its excellent leadership development opportunities led by Winifred Carson-Smith, an attorney and general counsel for the American Nurses Association (ANA). Her presentation was informative and refreshing. Other presenters included Miriam Limo, a former PA member of the Board of Nurse Examiners, discussed leadership education and important language and conceptual issues unique to various nurse practice acts about CNS practice.
Of particular importance was the discussion concerning regulatory and legislative concerns impacting CNS practice. Two past presidents, Dr. Brenda Lyon and Jo Ellen Rust, currently serve as chairs of the Legislative-Regulatory Committee and met with the board to discuss pertinent issues on the present and future horizon. Dr. Lyon gave a report about her presentation to the Federal Trade Commission on June 11, 2003 concerning barriers to CNS certification and credentialing. On the final day, a formal board meeting was held with committee status reports and strategies to address key NACNS issues.
Board Members on the Move: Washington, DC
In May, 2003, NACNS President Dr. Jan Fulton and President-Elect Dr. Angela Clark met with several national leaders in Washington, D. C. about NACNS issues. Meetings were held with leaders at the Division of Nursing, including Director Dr. Denise Geolot, Deputy Director Donna English, and Advanced Nursing Education Acting Chief Dr. Annette Debisette. They also met with representatives of the American Nurses Credentialing Center (ANCC) Mary Smolenski and Dr. David Paulson. In addition, meetings were held with leaders of the American Association of Colleges of Nursing (AACN), including Dr. Joan Stanley, Director of Education, and Dr. Linda Berlin.
The National Association of Clinical Nurse Specialist Receives the Nurse Competence in Aging Grant
NACNS has received a 2-year grant for $ 11,800 to improve geriatric competence among its membership! The Nurse Competence in Aging is a prestigious 5-year initiative funded by The Atlantic Philanthropies (USA) Inc. It is awarded to the American Nurses Association (ANA) through the American Nurses Foundation (ANF), and represents a strategic alliance between ANA, the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, The Steinhardt School of Education, and Division of Nursing. NACNS is one of a few nursing organizations to receive the first funding from this initiative which is designated as a Specialty Nursing Association Partners (SNAP) in Geriatrics Implementation Grant. The grant will be used to support several initiatives within NACNS: including:
1. Develop and support a preconference devoted to improving competence in geriatric nursing for its members at the 2004 NACNS National Conference in San Antonio, Texas. The half-day conference will be free to participants because of the grant funding.
2. Support for a nationally-recognized plenary speaker during the national conference to advance knowledge and skills about geriatrics.
3. Develop a website for networking and strengthening geriatric resources for NACNS members.
4. Analyze existing CNS curricula to identify barriers and enhancers for additional geriatric content and clinical experiences.
Co-Principal Investigators for the grant are Dr. Angela Clark, President-Elect of NACNS, and board member Dr. Kathleen Baldwin.
Proactive Community Activities: Legislative and Regulatory Initiatives
THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING (NCSBN)
History and Timeline
NACNS has attempted to work collaboratively with the APRN Task Force of the National Council of State Boards of Nursing on the uniform requirements of APRNs including CNSs. The following historical review depicts these efforts and explores data driven approaches to address these issues.
1995-NCSBN began APRN roundtable meetings to discuss common issues of concern with APRN organizations. From 1995 through 2000 Brenda Lyon represented NACNS at these meetings. One of the primary tasks of the group during these meetings was to discuss issues related to and give feedback to the NCSBN APRN Task Force regarding the Uniform APRN Licensure/Authority to Practice Requirements' document. It was during these meetings that language was developed to allow for the use of "alternative mechanisms" for competency verification when no certification exams were available in an APN specialty area. This language was viewed as very important by the nursing organizations represented at the table for two important reasons: 1) there are many specialty areas for which there is no specialty exam available for the various APRN roles; and 2) requiring competency verification by exam only would preclude the evolution of new specialties as exams are only prepared after the specialty area is developed with experienced providers-exams are not developed a-priority.
June 22, 2000- NACNS (Brenda Lyon and Chris Filipovich) attended the NCSBN-APRN roundtable meeting. June 1999 "Uniform APRN Licensure/Authority to Practice Requirements" were once again reviewed and discussed. At that time, the requirements still included authorization to practice through an alternative mechanism to ensure initial competence when no appropriate certification exam is available in the APN's specialty area.
August 2000- NCSBN Delegate Assembly adopted the APRN core licensure/authority to practice requirements
May 2001- NACNS (Chris Filipovich) attended the NCSBN-APRN roundtable meeting. The agenda focused primarily on reports of each participating organization. NCSBN distributed draft criteria for evaluating certification programs.
August 2001- NACNS (Chris Filipovich and Sue Davidson) attended NCSBN annual meeting in Pittsburgh, PA.
October 2001- NACNS (Davidson and Filipovich) attended the NCBSN PERC Task Force meeting (Practice Education Regulation Congruence). Sue Davidson made a presentation about regulatory barriers to CNS practice.
April 25, 2002- NACNS Executive Director Christine Filipovich participated in the NCSBN APRN roundtable meeting at which revisions were distributed in the afternoon at the request of participants, but were not on the meeting agenda and therefore, there was a limited discussion period. NACNS questioned the requirement for certification, noting that certification exams are not available for the majority of CNSs; however, there was not time for discussion.
June 2002- NACNS submitted a detailed response to the proposed uniform requirements, noting the areas of concern and potential for harm to CNSs
August 2002- NACNS attended the annual NCSBN meeting and delegate assembly and distributed the June 2002 response to delegates along with a paper authored by Lyon and published in the September 2002 edition of the CNS Journal outlining why second licensure for CNSs is not necessary. Sue Davidson addressed the NCSBN House of Delegates to outline concerns about the proposed uniform requirements and potential harm to thousands of CNSs practicing in compact states
November 2002- NACNS (Davidson, Fulton, Lyon, Filipovich) met with NCSBN Executive Director (K. Apple) and N. Chornick (Director of Professional Development and Credentialing) to present and discuss our position on regulatory credentialing of CNSs. Lyon outlined NACNS's interest in working with NCSBN to develop an appropriate model for CNS regulation, and Lyon and Fulton addressed CNS practice and a conceptual framework of nursing and medical practice domains. Lyon suggested in her remarks that restraint of trade is an issue inherent in these discussions and that NACNS, if necessary, must pursue all avenues available to ensure that CNSs are not harmed by inappropriate regulations.
December 2002- Brenda Lyon and Jan Fulton were invited to meet with the APRN Task Force. They presented NACNS's positions/concerns regarding the proposed uniform APRN requirements.
April 2003- NACNS attended the NCSBN APRN roundtable meeting. APRN Task Force leaders opened the meeting with comments to the effect that there had been no substantive opposition to the compact and uniform requirements. Jan Fulton and Brenda Lyon outlined, once again, the NACNS concerns and the fact that harm experienced by CNSs was a restraint of trade issue as an inappropriate restriction of practice. The APRN Task Force leadership expressed that they were not interested in working together to find a solution to the problems expressed by NACNS. Members of the APRN Task Force additionally expressed that they were confident that all CNSs wanted prescriptive authority and to practice as NPs in terms of diagnosing and treating disease and therefore requiring a second license to practice with certification was an appropriate regulation. Additionally, the APRN Task Force included in its recommendations that all APRNs would take a core exam as an APRN.
Late May 2003- NCSBN invited NACNS to further discuss with the APRN Task Force how to resolve CNS concerns within the framework of the current model of nursing regulation.
June 6, 2003- NACNS requested that NCSBN and NACNS collaborate to collect data clearly defining current practice in each state regarding regulation of CNSs, the population of CNSs in each state, scopes of practice in each state and other data upon which to base regulatory recommendations. The request to make regulatory decisions based on data is consistent with a scholarly approach to practice and should help clarify actual regulatory needs.
June 11 2003- Brenda Lyon presented testimony at joint hearings of the Federal Trade Commission and the Department of Justice, addressing Noerr Pennington Doctrine and restraint of trade concerns when an association such as NCSBN) requires its member Boards to comply with association recommendations that are arbitrary, not data based, and may be influenced by an economic conflict of interest if a core APRN exam is developed and administered by the NCSBN.
July 2003- NCSBN requested a meeting of NCSBN and NACNS Executive Directors and Presidents.
The NACNS Legislative/Regulatory Committee
a) The purpose of this committee is to develop proactive strategies, including monitoring trends and legislative and regulatory issues that impact CNS practice.The NACNS will hold its first CNS Regulatory Summit, July 25, 2003, in Indianapolis, Indiana.
b) Various organizations will attend this first summit. We look forward to collaborating with certifying bodies, and specialty nursing organizations representing CNSs to discuss current and potential regulatory barriers to CNS practice, and share the status of our initiatives to address them.
c) NACNS takes very seriously our responsibility to advocate for the interests of clinical nurse specialists. Our current legislative and regulatory initiatives require open dialogue and collaboration with specialty nursing organizations and certifying bodies. We are pleased that the Wound, Ostomy, and Continence Nursing Certification Board has offered to provide leadership at the summit discussion of regulatory issues from the certifying bodies' perspective.
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.
2003 National Association of Clinical Nurse Specialists Board of Directors
President
Janet Fulton
Immediate Past President
Sue B. Davidson
President-Elect
Angela Clark
Vice-President
Nancy E. Dayhoff
Treasurer
Karen Lyon
Secretary
Theresa Posani
Directors
Deborah Antai-Otong
Kathleen Baldwin
Gail DeLuca Havens
Theresa Murray
Newsletter Editors
Theresa Posani
Deborah Antai-Otong
NACNS Staff
Executive Director
Christine Carson Filipovich
NACNS
3969 Green St
Harrisburg, PA 17110
Telephone: 717-234-6799
Fax: 717-234-6798
E-mail: [email protected]
Internet: http://www.nacns.org
Bragging rights are in order concerning the high quality of articles published in the Clinical Nurse Specialist journal. Your help is needed to continue this trend. Consider writing and submitting your manuscript to the journal and see you name in print. There is nothing more exciting than seeing your name in print and sharing your expertise with colleagues. Consider submitting an article on some of your unique experiences as a CNS.