21 NCAC 36 .0228             CLINICAL NURSE SPECIALIST PRACTICE

(a)  Only a registered nurse who meets the qualifications outlined in Paragraph (b) of this Rule shall be approved by the Board as a clinical nurse specialist to perform activities listed in Paragraph (e) of this Rule.

(b)  The Board shall approve an applicant who:

(1)           has an active, unencumbered license to practice as a registered nurse in North Carolina or a state that has adopted the Nurse Licensure Compact;

(2)           has an unrestricted 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-level degree program that is accredited by a nursing accrediting body approved by the United States Secretary of Education or the Council for Higher Education Accreditation; and

(4)           has current certification as a clinical nurse specialist from a national credentialing body approved by the Board.

(c)  An applicant certified as a clinical nurse specialist by a national credentialing body prior to January 1, 2007 who has maintained that certification, held an active approval, registration, or license as a clinical nurse specialist, and holds a master's or higher degree in nursing shall be approved by the Board as a clinical nurse specialist.

(d)  An applicant seeking Board approval who has not held an active approval, registration or license as a clinical nurse specialist for two or more years shall complete a clinical nurse specialist refresher course approved by the Board in accordance with 21 NCAC 36 .0220(o) and (p), consisting of common conditions and their management related to the clinical nurse specialist's area of education and certification. A clinical nurse specialist refresher course participant shall be granted limited registration as a clinical nurse specialist for the purposes of completing the clinical activities in the refresher course.

(e)  The scope of practice of a clinical nurse specialist shall incorporate 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 within which competency is maintained, including:

(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 the essential core competencies for professional nursing education;

(3)           assessing for and monitoring the usage and effect of pharmacologic agents within the essential core competencies for professional nursing education;

(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 using 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.

(f)  A registered nurse seeking registration by the Board as a clinical nurse specialist shall submit the following:

(1)           a completed application through the Board's website at www.ncbon.com that includes:

(A)          the applicant's name, telephone number and email address;

(B)          the applicant's primary address of residence;

(C)          the educational degrees obtained by the applicant with the program name and completion date;

(D)          the number and expiration date of the applicant's national certification from a national certifying body;

(E)           other professional or occupational licenses with the license number and jurisdiction in which the license was issued, if applicable; and

(F)           the registration number shall be provided on the application if the application is for the renewal or reinstatement of an existing North Carolina recognition as a certified nurse specialist.

(2)           official copy of the transcript from master's or higher-level degree program or a post-graduate certificate program; as set out in Subparagraph (b)(3) of this Rule; and

(3)           current certification in a clinical nursing specialty from a national credentialing body, set out in Subparagraph (b)(4) of this Rule.

(g)  The clinical nurse specialist shall submit a renewal application every two years at the time of registered nurse renewal.

(h)  An applicant recognized by the Board as a clinical nurse specialist without national certification prior to April 1, 2023 who seeks to maintain this recognition shall:

(1)           not allow the Board's recognition status to expire;

(2)           submit an application as set out in Subparagraph (f)(1) of this Rule; and

(3)           submit certificates of completion consistent with the following:

(A)          at least 75 contact hours of continuing education which includes 25 contact hours of pharmacotherapeutics as a portion of the mandatory 75 contact hours for the previous five years and attest to 1,000 hours of practice; or

(B)          at least 150 hours of continuing education which includes 50 contact hours of pharmacotherapeutics as a portion of the 150 contact hours for the previous five years.

(i)  All clinical nurse specialists shall maintain documentation of clinical practice hours and continuing education for the previous five years which shall be made available upon request of the Board.

History Note:        Authority G.S. 90-171.20(4); 90-171.20(7); 90-171.21(d)(4); 90-171.23(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;

Readopted Eff. January 1, 2019;

Amended Eff. December 1, 2023; April 1, 2023; November 1, 2020.