Impact of the North Carolina Board of Nursing Regulation Change on Clinical Nurse Specialist Practice

Abstract

Entry level preparation for the clinical nurse specialist (CNS) role is completion of a graduate degree or post-master’s certificate in nursing, with clinical specialization and preparation for expanded role functioning. However, nurses without CNS education fulfill CNS positions in a number of healthcare organizations in North Carolina (NC). The NC Board of Nursing (NCBON) implemented a regulation change for mandatory recognition to practice as a CNS. The purpose of this scholarly project was to explore the impact of the regulation relevant to job title and description changes; thus, access to CNS care. A non-experimental, descriptive project was conducted through an internet survey on a convenience sample of 11,478 master’s or higher degree prepared nurses. A majority (88.5%) of the sample size (n = 218) reported sustainment of their CNS job title; while 13% reported a job title change. Of those with a job title change, 6% reported a job description change and 12% were uncertain of changes in job performance. There was no significant association (p < .05) between changes in job title, job description or performance of responsibilities with reason for portfolio submission. Accurate data analysis of CNSs in NC was tenuous due to the self-report nature prior to regulation. The findings suggest CNSs engaged in policy advocacy for their title and role at the organizational level. The NCBON improved the CNS practice by the regulation change; still, for those who submitted a portfolio and/or reported changes in job titles and job descriptions, compels reevaluation to ensure the regulation is upheld for recognition in order to practice at an advanced practice level. Further education is necessary on the distinct four APRN roles. The results of this project warrant further investigation on the long-term effect of CNS practice at the individual, organizational and community level.