DNP Role Development for Doctoral Advanced Nursing Practice, Second Edition

110 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION

■ RECENT WORK EFFORTS AND ONGOING ISSUES

Consistent with the experiences of other APRN groups, CNSs have needed to grapple
with the implications of the Doctor of Nursing Practice (DNP) degree. The benefits of a
CNS workforce that is prepared with doctoral education are obvious and understood.
However, NACNS and its constituency have needed to carefully analyze the costs and
benefits associated with taking an organizational position that calls for a DNP degree as
a necessary requirement for entering CNS practice. This consideration process has been
arduous and thoughtful. The NACNS Board of Directors recently endorsed the recom-
mendations of the NACNS DNP Task Force (2015b) and its call for the DNP degree as
required for entry into CNS practice by 2030 (NACNS, 2015b). Concurrently, NACNS
endorsed a draft position statement on the PhD that is following NACNS process for
member vetting prior to adoption (2016). This position statement asserts the importance
of the terminal research degree as necessary to the development of nursing science.
Other ongoing issues have been revealed through the 2014 NACNS Census of
CNSs (2015a). This first national consensus effort focused on CNSs provided data expli-
cating barriers to CNS practice including state- regulated prescriptive authority and
direct billing opportunities. One significant and persistent challenge is the U.S. Bureau
of Labor Statistics (BLS) Standard Occupational Classification (SOC) system that fed-
eral agencies use to collect and manage data concerning 840 detailed occupations (BLS,
2010a). CNSs are currently grouped within the registered nurses classification. Other
APRNs are specifically excluded and are categorized under health diagnosing and
treating practitioners (BLS, 2010b). Various data collection efforts rely on SOC classifica-
tions and the failure of correctly classifying CNSs has potentially broad and negative
public policy implications.
The authors have appropriately commented on wide state- level variation in regu-
lation and scope of CNS practice, and have observed that there is a history of overlap in
roles and functions between CNS and NP. The work of NACNS has provided a vehicle

Specialty Practice

Specialty Skills/Competencies

Specialty Standards of Practice

Specialty Knowledge

Client

Direct Care

Nurses &

Nursing Practice

Organizations &

Systems

FIGURE 3.1 Conceptualization of clinical nurse specialist practice.

Source : Copyright Janet S. Fulton, PhD, RN, ACNS- BC, FAAN, professor of nursing, Indiana University,
Indianapolis, IN. Reprinted with permission of the author. Contact author at jan_ [email protected]