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'Problematic': OMB Ignores Clinical Nurse Specialists' Request

Analysis  |  By Jennifer Thew RN  
   December 05, 2017

Despite a request to be classified as advanced practice registered nurses, the Office of Management and Budget once again categorizes clinical nurse specialists as general RNs.

Clinical nurse specialists are disappointed with the U.S. government's Office of Management and Budget. The office released its 2018 revisions to the Standard Occupational Classification System, and once again, CNSs are classified as general registered nurses rather than advanced practice registered nurses, despite a request for change from the National Association of Clinical Nurse Specialists.

When I wrote about this issue in 2016, the OMB had opened a second public comment period for input on its recommendations for revisions to the SOC. At that time, only nurse practitioners, certified nurse anesthetists, and certified nurse midwives were included in the APRN category. The NACNS, its members, and other nursing organizations submitted comments requesting CNSs be categorized as APRNs as well.

But those requests have gone unheeded.

"Sadly, yet again the Office of Management and Budget has incorrectly classified clinical nurse specialists as a title within the broad occupation of general registered nurses in the federal government's Standard Occupational Classification System's 2018 revision. NACNS had once again requested to be treated as other advanced practice registered nurses," Vince Holly, MSN, RN, CCRN, CCNS, ACNS-BC, president of the 2017-2018 NACNS Board of Directors says in a news statement.

The Dilemma of Inaccurate Data

The OMB's decision does not mesh with the policies of many other influential groups.

The National Council of State Boards of Nursing recognizes CNSs in its APRN Consensus Model. The VA extended full-practice authority to CNSs in January (though it did not do so for CRNAs).

Congress recognized CNSs as APRNs in the Balanced Budget Act of 1997 when it allowed them to directly bill their services through the Centers for Medicare & Medicaid Services.

Though these groups have more sway over APRNs' practice and reimbursement than OMB, there is still cause for concern over the categorization.

"This decision is disappointing and problematic as clinical nurse specialists' skills and work are sufficiently distinct to reliably collect workforce data as an SOC detailed occupation," Holly says.

Indeed, CNSs education and training go beyond that of a general RN. They hold either a master's or doctoral degree, take advanced anatomy and physiology, pharmacology, and assessment prior to graduation, and can function as independent healthcare providers and clinical experts with prescriptive authority and autonomous patient management.

"Lumping CNSs into the general RN category prevents federal researchers from accurately capturing healthcare workforce data. Incorrectly categorizing clinical nurse specialists skews the quality and utility of federal healthcare policy data because CNSs perform specialized advanced nursing tasks versus the generalist tasks of the RN," he says.

"By wrongly classifying clinical nurse specialists as registered nurses, OMB is devaluing CNS work and diluting the explanatory power of their data. This is happening at a time when the increasing healthcare needs of the nation require both improved quality and reduced costs that are afforded by the specialized, advanced level competencies of the CNS," Holly says.

Despite this setback, NACNS intends to continue its work to ensure that the role CNSs play "in acute, chronic and primary care is respected, valued, and accurately represented."

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

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