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Clinical Nurse Specialists Object to Government Classification

The Office of Management and Budget (OMB) has classified clinical nurse specialists (CNSs) as general registered nurses, outraging the president of the National Association of Clinical Nurse Specialists (NACNS).

"Yet again, we are incredibly disappointed that the Standard Occupational Classification (SOC) Policy Committee is erecting barriers to full scope of practice for the more than 72,000 CNSs across the United States who work in hospitals and other healthcare settings," said Sharon Horner, PhD, RN, MC-CNS, FAAN, president of the 2016-17 NACNS Board of Directors.

NACNS defines CNSs as advanced practice registered nurses (APRNs) due to their graduate level training and education in advanced nurse care, physiology, pharmacology and physical assessment. The SOC Policy Committee, established by OMB, placed CNSs into the general registered nurse category, which will prevent accurate data and statistical reporting on the CNS workforce.

"By refusing to recognize the CNS as an APRN, the SOC Policy Committee's recommendation skews the quality and utility of federal healthcare policy data," Horner said. "This classification is out of step with the other federal agencies, practice in the states, and the larger nursing community."

In 2010, the Institute of Medicine's Future of Nursing report recommended allowing APRNs to practice to the full scope of their education and training. CNSs are APRNs eligible to directly bill the Centers for Medicare and Medicaid Services, treat patients in real time and use practice within the Veterans Affairs health system.

Horner said, "We will continue to collaborate with other nursing organizations to show that if every healthcare setting employed CNSs, more care would be based on research and best practices, our healthcare system would be more efficient and our patient population would be healthier."

NACNS plans to submit comments recommending revision of the standard occupational classification for 2018. Final decisions on the 2018 SOC Manual will be made in summer 2017.

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