EDU-15-14-00003-A Certification As a Clinical Nurse Specialist (CNS)
10/1/14 N.Y. St. Reg. EDU-15-14-00003-A
NEW YORK STATE REGISTER
VOLUME XXXVI, ISSUE 39
October 01, 2014
RULE MAKING ACTIVITIES
EDUCATION DEPARTMENT
NOTICE OF ADOPTION
I.D No. EDU-15-14-00003-A
Filing No. 812
Filing Date. Sept. 16, 2014
Effective Date. Oct. 01, 2014
Certification As a Clinical Nurse Specialist (CNS)
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Amendment of sections 52.12, 64.4 and 64.8 of Title 8 NYCRR.
Statutory authority:
Education Law, sections 207 (not subdivided), 212(3), 6504 (not subdivided), 6507(2)(a), 6910(1), (2), (3), (4) and (5), 6911(1) and (2); and L. 2013, chapter 364
Subject:
Certification as a clinical nurse specialist (CNS).
Purpose:
To implement Chapter 364 of the Laws of 2013.
Text or summary was published
in the April 16, 2014 issue of the Register, I.D. No. EDU-15-14-00003-P.
Final rule as compared with last published rule:
No changes.
Text of rule and any required statements and analyses may be obtained from:
Kirti Goswami, State Education Department, Office of Counsel, State Education Building Room 148, 89 Washington Ave., Albany, NY 12234, (518) 474-6400, email: legal@mail.nysed.gov
Initial Review of Rule
As a rule that requires a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2019, which is the 4th or 5th year after the year in which this rule is being adopted. This review period, justification for proposing same, and invitation for public comment thereon, were contained in a RFA, RAFA or JIS:
An assessment of public comment on the 4 or 5-year initial review period is not attached because no comments were received on the issue.
Assessment of Public Comment
Since publication of a Notice of Proposed Rule Making in the April 16, 2014 State Register, the State Education Department received the following comments:
1. COMMENT:
Concern was expressed regarding limitations on areas of practice. Including sub-specialization, beyond the traditional M&S, Family or Adult, Maternal & Child Health, and Psychiatric practice, has proven problematic in some jurisdictions. Pigeonholing CNSs [clinical nurse specialists] to a single subspecialty beyond the areas of education would place an undue burden on them and is not done for other professions.
DEPARTMENT RESPONSE:
Neither the Education Law nor the proposed regulations require the Department to certify clinical nurse specialists to be “subspecialized” in any practice areas. The Department will certify clinical nurse specialists to practice in four specialty areas: Pediatrics; Adult; Mental Health; and, Oncology, and will not issue clinical nurse specialists certificates in sub-specialty areas of practice (i.e., pediatric hematology or neuro-oncology).
2. COMMENT:
The proposed regulations do not specify which certifying bodies will be acceptable under § 64.8(b)(4)(ii) to provide certification for the clinical nurse specialist (CNS) by a “national certifying body acceptable to the department.” The Department should consider the Oncology Nursing Certification Corporation and American Association of Critical-Care Nurses as national certifying bodies acceptable to meet the CNS certification requirement. These organizations are longstanding certifying bodies that offer CNS certification with criteria acceptable to other states with similar legislation and certify CNS expertise within specialty areas, such as oncology and critical care.
DEPARTMENT RESPONSE:
The Department will certify Oncology Clinical Nurse Specialists and accept Oncology Clinic Nurse Specialist certifications from the Oncology Nursing Certification Corporation, and will certify Pediatric Clinical Nurse Specialists and Mental Health Clinical Nurse Specialists. The Department will also accept Pediatric Clinical Nurse Specialist certification and Psychiatric / Mental Health Clinical Nurse Specialist certification from the American Association of Critical-Care Nurses Certification Corporation.
3. COMMENT:
The Department should consider accepting a broader variety of nursing education programs (for example, a master’s degree in nursing or a master’s degree in nursing practice) to satisfy the education requirements for CNS certification.
The proposed § 64.8(b)(4)(i) identifies the education requisite for licensure to be a “master’s degree program in clinical nursing practice, which is determined by the department to be substantially equivalent to the preparation provided by a registered clinical nurse specialist education program.” The commenter notes that its institution has successfully employed CNSs with varying advanced nursing degrees and which has been especially necessary given the nation-wide drop in CNS specific programs.
Nurses with a master’s degree in nursing, coupled with the proposed amount of practice experience, should be eligible for licensure as a CNS to allow for those working in a role where the core components of the CNS (clinical practice, research, education, consultation, and leadership) are exemplified and verified to obtain CNS licensure to allow those practicing as CNSs to be recognized based on their experience and practice.
Why specify, in § 64.8(b)(4)(i), that the educational program must be a Master’s program? Why exclude RNs [registered nurses] who have completed relevant post-Master’s or doctoral programs from this provision?
DEPARTMENT RESPONSE:
Education Law § 6911, which becomes effective on September 27, 2014, will authorize the Department to certify clinical nurse specialists to practice in a specialty practice area. Since the purpose of Education Law § 6911, as added by Chapter 364 of the Laws of 2013, is to maintain safe patient care by ensuring that only those who are properly educated and qualified are performing clinical nurse specialist services, the proposed amendment requires all applicants to have advanced education in clinical nursing practice, such as a master’s degree, doctoral degree or post master’s certificate program which prepares graduates to practice as a clinical nurse specialist, in order to qualify for certification as a clinical nurse specialist.
4. COMMENT:
Will this certificate be worded as a “Clinical Nurse Specialist” or as a “Clinical Nurse Specialist in a Specific Specialty”? Only “Clinical Nurse Specialist” should be used.
DEPARTMENT RESPONSE:
Education Law § 6911 will authorize the Department to certify clinical nurse specialists to practice in a specialty practice area. The Department will issue clinical nurse specialist certificates that identify the specific specialty practice area in which the holder of the certificate is certified.
5. COMMENT:
The commenter, citing § 64.6, states it supports deleting all sections relating to Alternative Criteria for Certification as a nurse practitioner (NP) as these criteria were established many years ago to cover registered nurses who needed such alternatives and the criteria’s timeframe ended in 2007.
DEPARTMENT RESPONSE:
The proposed regulations make no changes to § 64.6, however, to the extent that the commenter is expressing support for the repeal of obsolete provisions relating to NP certification in § 64.4, the commenter’s support is noted.
6. COMMENT:
The Department should consider permitting registered nurses, who are not CNSs or NPs, but have a master’s or doctoral degree in a nursing specialty, to supervise the clinical practice education of students enrolled in clinical nurse specialist education programs.
In addition, the proposed language in § 52.12(b)(3)(iii) requiring the CNS curriculum include “clinical practice education of at least five hundred hours which is supervised by a clinical nurse specialist, nurse practitioner or physician practicing in the specialty area of the clinical of the clinical nurse specialist program” seems too narrow. There is currently a limited pool of certified CNSs to draw from in providing preceptors for CNS students, and the proposed regulation may impede CNS clinical education. Language should be added to include supervision by “another nurse with a master’s or doctoral degree in nursing”.
DEPARTMENT RESPONSE:
The intent of Education Law § 6911 is to protect the title of clinical nurse specialist and to maintain safe patient care by ensuring that only those who are properly educated and qualified are performing clinical nurse specialist services. Registered professional nurses who are not certified by the Department as CNSs or NPs may lack the knowledge, skill and experience to properly supervise the clinical practice education of a student enrolled in a clinical nurse specialist education program. The suggested change to the proposed amendment would be inconsistent with the law and therefore, no change is necessary.
7. COMMENT:
Clarification is sought regarding whether § 64.8(b)(4) applies to all applicants for CNS certification. Also, the numbering of paragraphs in this section is incorrect.
DEPARTMENT RESPONSE:
Section 64.8(b)(4) does not apply to all applicants, but applies only to those applicants who seek to qualify for CNS certification by fulfilling the professional education and experience criteria set forth in section 64.8(b)(4)(i) or (ii) by the dates specified. The proposed language provides sufficient clarification on this issue. In addition, the numbering of the paragraphs is correct. Therefore, no changes are necessary.
8. COMMENT:
In relation to requiring that the certificates specifically mention the clinical practice area, the profession has learned from its experience with such language in the nurse practitioner certificates, that being so specific can become a barrier to the advanced practice registered nurse’s ongoing practice. The Department should consider seeking legislation to change the nurse practitioner section of the Nurse Practitioner Act, so that this level of specificity is no longer required for this advanced practice registered nurse.
DEPARTMENT RESPONSE:
The Department acknowledges the suggestion but currently has no plans to seek the proposed change.
9. COMMENT:
There may be an error in wording in 64.4(b) Professional study where it states “To meet the professional education requirements for certification as a nurse practitioner in this State…” it should be written as “To meet the professional education requirements for certification as a clinical nurse specialist in this State…”
DEPARTMENT RESPONSE:
The proposed regulations repeal obsolete provisions relating to the certification of nurse practitioners in § 64.4, in addition to implementing the provisions of Chapter 364 of the Laws of 2013 relating to clinical nurse specialists. The reference to “nurse practitioner” in § 64.4(b) is accurate since this provision applies only to nurse practitioners. Therefore no further changes are necessary.
10. COMMENT:
Will there be any “grandfathering” of clinical nurse specialists who are currently using the title and have the requisite educational credentials?
It appears § 64.8(b)(4)(i) is intended to provide a grace period during which nurses may be certified who currently hold a master’s degree in a program that is not registered with the Department as a CNS program, but which provided preparation “substantially equivalent” to that provided by a registered CNS program (provided that the RN also has the specified clinical experience). However, this provision might also be read as providing a period during which nurses who do not currently hold a Master’s degree from a CNS or “substantially equivalent” program may be certified if they complete such a degree (and the specified clinical experience) before September 15, 2017. This latter interpretation would create some complication, however. An individual could be certified as a CNS before completing graduate education - or even without actually enrolling in a graduate program. There would be no way to ensure, prior to September 15, 2017, that an individual has met any education or practice requirements.
Also, does “at least three thousand hours of clinical practice as a registered professional nurse in a clinical nurse specialty area” mean that the nurse must practice as a CNS, or practice as an RN in a specialty area in which CNSs practice (e.g., gerontology, pediatrics, critical care, etc.)? If the intent is to allow graduate-prepared RNs who are practicing as a CNS, or in roles that are similar to those of a CNS, to be certified - providing, essentially, a limited “grandfathering” period, that should be made clearer - either through revised language or other regulatory guidance.
DEPARTMENT RESPONSE:
The proposed amendment includes a “grandfather clause”, section 64.8(b)(4), which allows applicants two additional options for qualifying for CNS certification for a limited period of time. The Department believes that the deadline of September 15, 2017 for meeting education criteria under section 64.8(b)(4)(i) is reasonable, and that many registered professional nurses will complete a master’s degree prior to that date and qualify for CNS certification pursuant to proposed section 64.8(b)(4)(i).
Applicants who seek to qualify for CNS certification pursuant to section 64.8(b)(4)(i), will also be required to complete a form that describes their clinical practice experience. The Department intends to accept 3,000 hours of clinical practice as a registered professional nurse in a clinical nurse specialty area in a New York State general hospital as qualifying experience. The Department will accept experience in the following clinical nurse specialty areas: adult, pediatrics, mental health or oncology, and will review the form submitted to ensure that it meets the statutory and regulatory requirements for certification.
In addition, applicants under 64.8(b)(4)(ii) may meet certification requirements through current certification as a CNS by a national certifying body acceptable to the Department.
Certificates will be issued to applicants who seek qualification under 64.8(b)(4) when the applicant presents evidence of having met its criteria to the Department.
Although the “grandfather clause”, § 64.8(b)(4) will expire after September 15, 2017, an applicant can always satisfy other education criteria set forth in § 64.8(b) in order to qualify for certification as a clinical nurse specialist. The Department respectfully disagrees with the commenter who says the language is insufficiently clear. Therefore, no further changes are necessary.
