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OMB Snubs Clinical Nurse Specialists

By Jennifer Thew RN  
   August 09, 2016

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.


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Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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