The Office of Management and Budget has again classified CNSs as general RNs rather than advanced practice nurses. One CNS explains why this is a cause for concern.
If you head over to the Bureau of Labor Statistics website and search "advanced practice nurses" function here are the results you'll get—nurse anesthetists, nurse midwives, and nurse practitioners.
Where's the fourth category of APRNs—clinical nurse specialists?
The U.S government's Office of Management and Budget does not recognize CNSs as APRNs. Instead, it classifies CNSs as general registered nurses.
The system is now up for revision (to be published in 2018), and on July 22, much to the dissatisfaction of CNSs, the Standard Occupational Classification Policy Committee again categorized CNSs as general RNs.
"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 clinical nurse specialists across the United States who work in hospitals and other health care settings," said Sharon Horner, PhD, RN, MC-CNS, FAAN in a news release.
Horner is president of the 2016-2017 National Association of Clinical Nurse Specialists Board of Directors. "Clinical nurse specialists are advanced practice registered nurses who have education and training in advanced nursing care, physiology, pharmacology, and physical assessment. The demand for CNS's science-based expertise is rising as our nation's health care needs multiply and become more complex."
An Out-of-touch Policy
This certainly is out of step with the policies of other groups.
The National Council of State Boards of Nursing recognizes CNSs in its APRN Consensus Model, the VA included CNSs in its recent proposal to give its APRNS full-scope of practice, and Congress recognized CNSs as APRNs in the Balanced Budget Act of 1997.
These groups have more sway over ARPNs' practice and reimbursement than OMB, but this incorrect classification of CNSs is still significant says Ann M. Mayo, RN, DNSc, FAAN, a professor at the Hahn School of Nursing & Health Science and Beyster Institute for Nursing Research at University of San Diego and member of the NACNS.
"The Bureau of Labor statistics accesses this data to look at nursing workforce issues, and I believe other federal agencies access the data too, which is the worrisome part," she says.
"Policy positions are made based on this data that various agencies are accessing. For example, if someone decided they wanted to make some decisions about educational funding and accessed this data, the CNS would not be evident as part of that."
Mixed Data Skews Outcomes
Mayo represents NACNS at the Interagency Collaborative on Nursing Statistics, an organization that promotes generation and research of data on the nursing workforce, so she understands the importance of data and how it drives decisions.
"Organizations across the United States want to know what's driving certain healthcare outcomes," she says.
By lumping CNSs together with general RNs, researchers won't be able to accurately collect the data and statistics that represent the CNS workforce or general RNs.
"The CNS data is embedded within the RN data, so it's never really clear what contribution the CNS makes independently nor is it clear what contribution the RN makes independently," she says. "So if you're looking at fall rates or pressure ulcer prevention or any of these outcomes that we're concerned about then that data isn't valid."
It also makes it difficult to compare outcomes between CNSs and the other ARPNs categories, she says.
The NACNS, its members, and other nursing organizations will submit comments on the recommendations for revising the 2010 Standard Occupational Classification for 2018 during the second comment period, which closes Sept. 20.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.