The 2019 Breakthrough: What You Need to Know About the National Association of Clinical Nurse Specialists’ Latest Guidelines

The National Association of Clinical Nurse Specialists (NACNS) is pivotal in shaping the future of clinical nurse specialists (CNSs) and ensuring that their practice remains relevant and effective. Established with the goal of advancing the unique role of CNSs, the NACNS has continuously worked on updating and refining the standards that define the profession. The most recent update, published in 2019, is a comprehensive document that not only revises the existing guidelines but also introduces new concepts critical to the practice.

The 2019 update is particularly significant because it refines the competencies of the three spheres of influence—now called spheres of impact—associated with CNS practice. These include patient direct care, nursing practice, and organizational systems. Each sphere requires a unique set of competencies that distinguish CNSs from other advanced practice registered nurses (APRNs).

The NACNS has played a central role in developing the competencies that form the backbone of CNS education and practice. The original Statement on Clinical Nurse Specialist Practice and Education was published in 1998 and has undergone several revisions to keep up with the evolving landscape of healthcare. The most recent 2019 update reflects the latest thinking in CNS practice and education, ensuring that CNSs are well-equipped to meet the demands of modern healthcare environments.

The 2019 document highlights the importance of differentiating CNS practice from that of other APRNs. While CNS practice was initially conceptualized as subroles, the latest revision has refined these roles and emphasized the unique contributions of CNSs in patient care, nursing practice, and healthcare organizations. This differentiation is crucial as it underlines the distinct impact CNSs have in their respective spheres of practice.

The NACNS also played a significant role in the development of the APRN Consensus Model. As work on the model neared completion, the NACNS and the APRN Consensus Work Group collaborated to create nationally recognized education standards and competencies for CNSs. The result was a model that synthesizes the spheres of impact, Hamric’s seven advanced practice nursing competencies, and the Synergy Model, ultimately shaping the future of CNS education and practice.

The 2019 update to the CNS model also changed the language from “spheres of influence” to “spheres of impact,” enhancing the focus on the social mandate of the CNS. This update not only reflects the evolving nature of CNS practice but also emphasizes the critical role that CNSs play in improving patient outcomes, advancing nursing practice, and optimizing healthcare systems.

How the NACNS Supports Doctoral-Level CNS Practice

Initially, the NACNS maintained a position of neutrality regarding the Doctor of Nursing Practice (DNP) as an option for CNS education. However, recognizing the evolving needs of the profession, the NACNS developed core competencies for doctoral-level practice in 2009. This move acknowledged that some CNSs would pursue advanced clinical doctorates, further enhancing their expertise and impact on healthcare.

Three years later, in 2012, the NACNS published a Statement on the APRN Consensus Model Implementation. This statement outlined the importance of grandfathering currently practicing CNSs and monitoring the implementation of the Consensus Model to ensure that it did not negatively affect the ability of CNSs to practice. The competencies outlined in the 2019 Statement apply to CNSs with graduate preparation, whether at the master’s or doctoral level, ensuring that they remain at the forefront of advanced practice nursing.

The Path Forward: DNP as Entry into Practice by 2030

In 2015, the NACNS took a definitive stance by endorsing the DNP as the entry-level degree for CNS practice, effective by 2030. This endorsement underscores the NACNS’s commitment to advancing the profession and ensuring that CNSs are equipped with the highest level of education and training to meet the complex demands of healthcare.

The NACNS’s support for CNSs pursuing other graduate education pathways ensures that those already in practice can continue without interruption. However, the push for the DNP as the standard for future CNS practice highlights the NACNS’s forward-thinking approach and dedication to maintaining the highest standards in nursing.

FAQs

What is the National Association of Clinical Nurse Specialists (NACNS)?
The NACNS is a professional organization dedicated to advancing the role of Clinical Nurse Specialists (CNSs) through education, practice standards, and advocacy.

What are the spheres of impact in CNS practice?
The spheres of impact refer to the three key areas where CNSs make a difference: patient direct care, nursing practice, and organizational systems. Each sphere requires specific competencies unique to the CNS role.

Why is the DNP becoming the entry-level degree for CNSs by 2030?
The NACNS has endorsed the DNP as the entry-level degree to ensure that CNSs have the highest level of education and training to meet the evolving demands of healthcare.

How has the NACNS influenced CNS education? The NACNS has been instrumental in developing and refining the competencies and standards that define CNS practice, ensuring that CNSs are well-prepared to excel in their roles.

What was the significance of the 2019 update to the CNS practice guidelines? The 2019 update refined the competencies of CNS practice, introduced the concept of spheres of impact, and emphasized the social mandate of CNSs, ensuring that they remain relevant and effective in modern healthcare environments.