Clinical nurse specialists given roles across health systems, but few allowed full scope of practice

Nurse-Patient-Hospital-Credit: Getty/monkeybusinessimages
Many clinical nurse specialists are unable to apply their full scope of practice, according to a new survey. Getty/monkeybusinessimages

Clinical nurse specialists are deployed in roles across health systems, but many are unable to apply their full scope of practice, according to a new survey.

The National Association of Clinical Nurse Specialists surveyed more than 3,100 nurse specialists and found that just 1 in 5 are authorized to prescribe medications, though more than half (58%) had responsibility across the health system they worked for, and not just in one or two units. Sixteen percent were authorized to prescribe durable medical equipment.

Prescriptive authority is up to state law: In 19 states, nurse specialists have independent prescribing authority, while in 19 others, they can prescribe medications through a collaborative agreement with physicians, according to NACNS.

“More work needs to be done to allow CNSs to practice to the full extent of their education and training and break down barriers to CNSs working at their full scope of practice,” said Vince Holly, R.N., the association’s president, in an announcement. “Our country needs healthcare that is effective, patient-focused, high-quality and based on evidence—the clinical nurse specialist role is uniquely qualified to deliver this type of care.”

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Using advanced practice nurses to the full extent of their skills is regarded as a possible solution to healthcare’s physician shortage. Some smaller hospitals are employing nurse practitioners as hospitalists, and the Department of Veterans Affairs has taken the approach to ensure more timely access to care—though doctors and nurses are split on the issue.

Allowing advanced practice nurses to work at their full scope of practice could especially benefit primary care, which is in demand.

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Another issue noted in the NACNS survey is reimbursement. Some clinical nurse specialists working in independent ambulatory care practices, or who have been awarded special privileges from hospital medical boards, can bill insurers directly for their work instead of using a third party, which reduces insurance costs. But just 6% of the surveyed nurses had the authority to do so.

The vast majority of the surveyed nurses (80%) work in hospitals, and three-quarters specialize in adult health or gerontology.