21 NCAC 36 .0228†††††††††††† CLINICAL NURSE SPECIALIST PRACTICE
(a)† Effective July 1, 2015, only a registered nurse who meets the qualifications as outlined in Paragraph (b) of this Rule shall be recognized by the Board as a clinical nurse specialist to perform advanced practice registered nursing activities as outlined in Paragraph (f) of this Rule.
(b)† The Board of Nursing shall recognize an applicant who:
(1)†††††††††† has an unrestricted license to practice as a registered nurse in North Carolina or a state that has adopted the Nurse Licensure Compact;
(2)†††††††††† has an unrestricted previous approval, registration or license as a clinical nurse specialist if previously approved, registered, or licensed as a clinical nurse specialist in another state, territory, or possession of the United States;
(3)†††††††††† has successfully completed a master's or higher degree program accredited by a nursing accrediting body approved by the United States Secretary of Education or the Council for Higher Education Accreditation and meets the qualifications for clinical nurse specialist certification by an approved national credentialing body under Part (b)(4)(A) of this Rule; and
(A)††††††††† has current certification as a clinical nurse specialist from a national credentialing body approved by the Board of Nursing, as defined in Paragraph (h) of this Rule and 21 NCAC† 36 .0120(26); or
(B)††††††††† if no clinical nurse specialist certification is available in the specialty, meets requirements determined by the Board to be equivalent to national certification.† The Board shall determine equivalence based on consideration of an official transcript and course descriptions validating Subparagraph (b)(3) of this Rule, current curriculum vitae, work history, and professional recommendations indicating evidence of at least 1,000 hours of clinical nurse specialist practice, and documentation of certificates indicating 75 contact hours of continuing education applicable to clinical nurse specialist practice during the previous five years.
(c)† An applicant certified as a clinical nurse specialist by a national credentialing body prior to January 1, 2007 and who has maintained that certification and active clinical nurse specialist practice, and holds a masterís or higher degree in nursing or a related field shall be recognized by the Board as a clinical nurse specialist.
(d)† New graduates seeking first-time clinical nurse specialist recognition in North Carolina shall hold a Master's, post-masterís or higher degree from a clinical nurse specialist program accredited by a nursing accrediting body approved by the U.S. Secretary of Education or the Council for Higher Education Accreditation as acceptable by the Board, and meets all requirements in Subparagraph (b)(1) and Part (g)(5)(A) of this Rule.
(e)† A clinical nurse specialist seeking Board of Nursing recognition who has not practiced as a clinical nurse specialist in more than two years shall complete a clinical nurse specialist refresher course approved by the Board of Nursing in accordance with 21 NCAC 36 .0220(o) and (p) and consisting of common conditions and their management related to the clinical nurse specialistís area of education and certification.† A clinical nurse specialist refresher course participant shall be granted clinical nurse specialist recognition that is limited to clinical activities required by the refresher course.
(f)† The scope of practice of a clinical nurse specialist incorporates the basic components of nursing practice as defined in Rule .0224 of this Section as well as the understanding and application of nursing principles at an advanced practice registered nurse level in the area of clinical nursing specialization in which the clinical nurse specialist is educationally prepared and for which competency has been maintained that includes the following:
(1)†††††††††† assessing clients' health status, synthesizing and analyzing multiple sources of data, and identifying alternative possibilities as to the nature of a healthcare problem;
(2)†††††††††† diagnosing and managing clients' acute and chronic health problems within an advanced practice nursing framework;
(3)†††††††††† assessing for and monitoring the usage and effect of pharmacologic agents within an advanced practice nursing framework;
(4)†††††††††† formulating strategies to promote wellness and prevent illness;
(5)†††††††††† prescribing and implementing therapeutic and corrective non-pharmacologic nursing interventions;
(6)†††††††††† planning for situations beyond the clinical nurse specialist's expertise, and consulting with or referring clients to other health care providers as appropriate;
(7)†††††††††† promoting and practicing in collegial and collaborative relationships with clients, families, other health care professionals and individuals whose decisions influence the health of individual clients, families and communities;
(8)†††††††††† initiating, establishing and utilizing measures to evaluate health care outcomes and modify nursing practice decisions;
(9)†††††††††† assuming leadership for the application of research findings for the improvement of health care outcomes; and
(10)†††††††† integrating education, consultation, management, leadership, and research into the clinical nurse specialist role.
(g)† A registered nurse seeking recognition by the Board as a clinical nurse specialist shall:
(1)†††††††††† complete the appropriate application that shall include the following:
(A)††††††††† evidence of a masters, post-master's certificate or doctoral degree as set out in Subparagraph (b)(3) or Paragraph (d) of this Rule; and, either
(B)††††††††† evidence of current certification in a clinical nursing specialty from a national credentialing body as set out in Part (b)(4)(A) of this Rule; or
(C)††††††††† meet requirements as set out in Part (b)(4)(B) of this Rule;
(2)†††††††††† renew the recognition every two years at the time of registered nurse renewal; and
(A)††††††††† submit evidence of initial certification and re-certification by a national credentialing body at the time such occurs in order to maintain Board of Nursing recognition consistent with Paragraphs (b) and (h) of this Rule; or
(B)††††††††† if subject to Part (b)(4)(B) of this Rule, submit evidence of at least 1,000 hours of practice and 75 contact hours of continuing education every five years.
(h)† The Board of Nursing may approve those national credentialing bodies offering certification and recertification in a clinical nursing specialty that have established the following minimum requirements:
(1)†††††††††† an unrestricted registered nurse license; and
(2)†††††††††† certification as a clinical nurse specialist shall be limited to masters, post-master's certificate, or doctorally prepared applicant.
History Note:††††††† Authority G.S. 90-171.20(4); 90-171.20(7); 90-171.21(d)(4); 90-171.23(b); 90-171.27(b); 90-171.42(b);
Eff. April 1, 1996;
Amended Eff. January 1, 2015; April 1, 2008; January 1, 2007; November 1, 2005; August 1, 2005; April 1, 2003.