Understanding Clinical Nurse Specialist Regulation by the Boards of Nursing

Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions

AIM

To explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority.

BACKGROUND

Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses.

METHODS

A retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007-2016. The data were analysed using a quantitative design with descriptive statistics.

RESULTS

We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under one month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety.

CONCLUSION

This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organizations ensure patient safety when unprofessional conduct is suspected.

IMPLICATIONS FOR NURSING MANAGEMENT

Retaining nursing professionals is vital due to global shortages and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State

PURPOSE

The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007.

DESCRIPTION OF THE PROJECT

The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes.

OUTCOME

On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses.

CONCLUSIONS

Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Clinical Nurse Specialist Regulation

High-quality care will continue to be a driver in the evolution of today’s health care environment. Ensuring effective, cost-conscious, quality care is the core of clinical nurse specialist (CNS) practice. The CNS practice varies by state, depending on each state’s Nurse Practice Act. Some states have separate scopes of practice for CNSs, including prescriptive authority, whereas some states do not recognize CNS practice as different from the practice of the registered nurse. The journey to state recognition and title protection for the CNS role in the state of Maryland is described.