THE ONLINE CNS APPLICATION IS NOW AVAILABLE! ONLINE APPLICATION DEADLINE: AUGUST 31, 2015.

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1 THE ONLINE CNS APPLICATION IS NOW AVAILABLE! ONLINE APPLICATION DEADLINE: AUGUST 31, If you have already requested that documents be sent to the NCBON based on the flowchart and form requirements outlined in the initial New CNS Rule Notices of April 2015 or May 2015, please do not resend. If the NCBON requires additional information, you will be contacted. P.O. Box 2129 Raleigh, North Carolina FAX MEMO: NEW CNS RULE REQUIREMENTS TO: All North Carolina RNs who: Currently hold voluntary recognition as a Clinical Nurse Specialist (CNS) Identify themselves as a Clinical Nurse Specialist but are not currently voluntarily recognized as a CNS by the North Carolina Board of Nursing. FROM: North Carolina Board of Nursing DATE: Revised July 23, 2015 RE: New CNS Rule (21 NCAC ) Requirements - All Clinical Nurse Specialists MUST be recognized by the North Carolina Board of Nursing in order to practice as a CNS in North Carolina. Why did the CNS rules change? The North Carolina Board of Nursing's mission is to protect the public by regulating the practice of nursing. CNS is one of the four advanced practice nursing roles. The NCBON's required recognition of the CNS ensures that those providing advanced practice registered nursing services are qualified at the advanced practice level. What do the new rules mean for me? Please Read the Following Carefully. All CNSs (even those that are currently voluntarily recognized by the NCBON) must complete the online application and submit supporting documentation in order to be considered for recognition to perform advanced practice registered nursing activities as a CNS in North Carolina: Complete the online CNS application by August 31, The online application is now available at the Nurse Gateway at Submit supporting documentation immediately if not already submitted. It will take time for your school and certifying body to fulfill your requests. If your application and supporting documentation are not completed in a timely manner, the NCBON cannot guarantee recognition by October 1, 2015, and you will not be able to practice as a CNS until your completed application has been fully evaluated. Please begin that process now. What supporting documentation must be provided? The Flow Chart on Page 3 will assist you in determining what information you must provide to the NCBON in order to be considered for CNS recognition to practice as an advanced practice nurse. When will I be notified of my CNS recognition status? All CNS applications will be evaluated between July 1, 2015 and October 1, By no later than Oct 1, 2015, your application and supporting documentation will be reviewed, and you will be notified of your NCBON CNS recognition status

2 Martha Ann Harrell, Public Member Chair Jacqueline F. Ring, RN, MBA, MHA Vice-Chair Julia L. George, RN, MSN, FRE Executive Director P.O. Box 2129 Raleigh, North Carolina FAX Nurse Aide II Registry How long will I be recognized as a CNS by the NCBON before I must renew? Your Initial Clinical Nurse Specialist Recognition will be granted for 3-27 months in order to sync with your Registered Nurse birth month renewal. Effective with Registered Nurse licenses expiring January 31, 2016 and thereafter, your Clinical Nurse Specialist renewal will appear as a tile on your Nurse Gateway profile. You will be required to renew your CNS NCBON Recognition every two years (at the time of your RN renewal). What is the fee for CNS recognition? At this time there is no fee for CNS recognition. When will my current voluntary recognition end? All voluntary recognitions will be discontinued on the date your required recognition is granted or by October 1, What if I don't meet the new requirements for required recognition as a CNS? Individuals who do not meet the new requirements will not be granted CNS recognition and will not qualify to practice as a CNS in North Carolina. See Flow Chart on Page 3-2 -

3 Revised to clarify: - national certification requirements and - professional recommendation specifications These revisions are reflected in red font within this chart. What Must I Provide to the NCBON in order to be considered for CNS recognition? Use the chart to help you determine what to provide to the NCBON. Do you have an unrestricted license to practice as an RN in NC or a multistate license in a Compact State? You are not eligible for CNS recognition by the NCBON. No Yes Do you have restrictions on a previous approval, registration or license as a clinical nurse specialist in another state? No Yes You will need to provide additional information from the state in question. Have you successfully completed a master?s or higher degree in nursing or a related field? You are not eligible for CNS recognition by the NCBON. No Yes Do you hold CNS national certification from a national credentialing body that requires you to hold an unrestricted RN license (NC or compact) and only accepts master?s, post-master?s, or doctorally prepared applicants? OR Do you hold CNS national certification by a national credentialing body prior to and have maintained that certification and active clinical nurse specialist practice to date, and hold a master's or higher degree in nursing or a related field? CNS Portfolio No Yes National Certification and Transcript Provide the NCBON the following documentation for review: Via regular mail only - Official transcript of master?s, post-master?s certificate or doctoral degree and course descriptions sent directly from the school to NCBON. Transcripts and course descriptions sent from the CNS applicant will not be accepted. - Three written professional recommendations sent directly from colleagues outlined in the attached Professional Recommendation Form indicating evidence of at least 1,000 hours of Clinical Nurse Specialist practice (part of which must have been within the previous 2 years). Via , fax, or regular mail: - Current curriculum vitae - Work history - Documentation of certificates indicating 75 contact hours of continuing education applicable to Clinical Nurse Specialist practice during the previous 5 years. Provide the NCBON the following documentation for review: Via regular mail only: - Official transcript of master?s, post-master?s certificate or doctoral degree sent directly from the school to NCBON. AND - National certification sent directly from the national credentialing body to NCBON. Transcripts and/or certification sent from the CNS applicant will not be accepted. MAILING ADDRESS Paulette Hampton Practice Coordinator NCBON - PO Box 2129 Raleigh, NC paulette@ncbon.com FAX ATTN Paulette If you previously sent CNS materials to the NCBON via fax, , or regular mail, do not resend your materials

4 CLINICAL NURSE SPECIALIST (CNS) PORTFOLIO REVIEW PROFESSIONAL RECOMMENDATION LETTER NCBON office use only RN verified ICRL verified Effective July 1, 2015, per 21 NCAC CLINICAL NURSE SPECIALIST PRACTICE, an applicant seeking NCBON recognition as a CNS who does not hold a clinical nurse specialist certification in his/her specialty must provide the NCBON with supporting documentation to be reviewed for the purpose of determining equivalence to national certification. Note: this provision applies when CNS national certification is not available in the specialty. The supporting documents must include three written professional recommendations sent directly from colleagues (type listed below) indicating evidence of at least 1,000 hours of Clinical Nurse Specialist practice (part of which must have been within the previous 2 years). General Information Name of Applicant Applicant's RN Number Name of Individual Completing Recommendation Letter Title Type of Practitioner (check appropriate box) DON/CNO Direct Supervisor APRN PA MD or DO Practice Name/Address Approval/License Number Phone Evaluation of Applicant's CNS Practice Related to CNS Core Competencies Below, please describe your evaluation of the applicant's CNS practice as it relates to the CNS Core Competencies. To review said competencies, please go to The CNS Core Competencies are located under the March 2010 heading. Number of hours the applicant has been active in CNS practice as your colleague Dates during which the applicant has been active in CNS practice as your colleague Recommendation (competent or not competent to function as a CNS) Signature of Individual Completing Recommendation Letter Date By signing/dating above, you attest that you have direct knowledge of the applicant's Clinical Nurse Specialist practice as it relates to the CNS Core Competencies, and the information you have provided is accurate to the best of your knowledge. Please send this Recommendation Letter (original signature/dated) via regular mail to: Paulette Hampton - Practice Coordinator - NCBON - PO Box Raleigh NC If you have already requested that documents be sent to the NCBON based on the form requirements outlined in the initial New CNS Rule Notice of April 2015, please do not resend. If the NCBON requires additional information, you will be contacted

5 21 NCAC CLINICAL NURSE SPECIALIST PRACTICE (a) Effective July 1, 2015, only a registered nurse who meets the qualifications as outlined in Paragraph (b) of this Rule shall be recognized by the Board as a clinical nurse specialist to perform advanced practice registered nursing activities as outlined in Paragraph (f) of this Rule. (b) The Board of Nursing shall recognize an applicant who: (1) (2) (3) (4) has an unrestricted license to practice as a registered nurse in North Carolina or a state that has adopted the Nurse Licensure Compact; has an unrestricted previous approval, registration or license as a clinical nurse specialist if previously approved, registered, or licensed as a clinical nurse specialist in another state, territory, or possession of the United States; has successfully completed a master's or higher degree program accredited by a nursing accrediting body approved by the United States Secretary of Education or the Council for Higher Education Accreditation and meets the qualifications for clinical nurse specialist certification by an approved national credentialing body under Part (b)(4)(a) of this Rule; and either: (A) (B) has current certification as a clinical nurse specialist from a national credentialing body approved by the Board of Nursing, as defined in Paragraph (h) of this Rule and 21 NCAC (26); or if no clinical nurse specialist certification is available in the specialty, meets requirements determined by the Board to be equivalent to national certification. The Board shall determine equivalence based on consideration of an official transcript and course descriptions validating Subparagraph (b)(3) of this Rule, current curriculum vitae, work history, and professional recommendations indicating evidence of at least 1,000 hours of clinical nurse specialist practice, and documentation of certificates indicating 75 contact hours of continuing education applicable to clinical nurse specialist practice during the previous five years. (c) An applicant certified as a clinical nurse specialist by a national credentialing body prior to January 1, 2007 and who has maintained that certification and active clinical nurse specialist practice, and holds a master's or higher degree in nursing or a related field shall be recognized by the Board as a clinical nurse specialist. (d) New graduates seeking first-time clinical nurse specialist recognition in North Carolina shall hold a Master's, post-master's or higher degree from a clinical nurse specialist program accredited by a nursing accrediting body approved by the U.S. Secretary of Education or the Council for Higher Education Accreditation as acceptable by the Board, and meets all requirements in Subparagraph (b)(1) and Part (g)(5)(a) of this Rule. (e) A clinical nurse specialist seeking Board of Nursing recognition who has not practiced as a clinical nurse specialist in more than two years shall complete a clinical nurse specialist refresher course approved by the Board of Nursing in accordance with 21 NCAC (o) and (p) and consisting of common conditions and their management related to the clinical nurse specialist's area of education and certification. A clinical nurse specialist refresher course participant shall be granted clinical nurse specialist recognition that is limited to clinical activities required by the refresher course. (f) The scope of practice of a clinical nurse specialist incorporates the basic components of nursing practice as defined in Rule.0224 of this Section as well as the understanding and application of nursing principles at an advanced practice registered nurse level in the area of clinical nursing specialization in which the clinical nurse specialist is educationally prepared and for which competency has been maintained that includes the following: (1) (2) (3) (4) (5) (6) assessing clients' health status, synthesizing and analyzing multiple sources of data, and identifying alternative possibilities as to the nature of a healthcare problem; diagnosing and managing clients' acute and chronic health problems within an advanced practice nursing framework; assessing for and monitoring the usage and effect of pharmacologic agents within an advanced practice nursing framework; formulating strategies to promote wellness and prevent illness; prescribing and implementing therapeutic and corrective non-pharmacologic nursing interventions; planning for situations beyond the clinical nurse specialist's expertise, and consulting with or referring clients to other health care providers as appropriate; - 5 -

6 (7) promoting and practicing in collegial and collaborative relationships with clients, families, other health care professionals and individuals whose decisions influence the health of individual clients, families and communities; (8) initiating, establishing and utilizing measures to evaluate health care outcomes and modify nursing practice decisions; (9) assuming leadership for the application of research findings for the improvement of health care outcomes; and (10) integrating education, consultation, management, leadership, and research into the clinical nurse specialist role. (g) A registered nurse seeking recognition by the Board as a clinical nurse specialist shall: (1) complete the appropriate application that shall include the following: (A) evidence of a masters, post-master's certificate or doctoral degree as set out in Subparagraph (b)(3) or Paragraph (d) of this Rule; and, either (B) evidence of current certification in a clinical nursing specialty from a national credentialing body as set out in Part (b)(4)(a) of this Rule; or (C) meet requirements as set out in Part (b)(4)(b) of this Rule; (2) renew the recognition every two years at the time of registered nurse renewal; and (3) either: (A) submit evidence of initial certification and re-certification by a national credentialing body at the time such occurs in order to maintain Board of Nursing recognition consistent with Paragraphs (b) and (h) of this Rule; or (B) if subject to Part (b)(4)(b) of this Rule, submit evidence of at least 1,000 hours of practice and 75 contact hours of continuing education every five years. (h) The Board of Nursing may approve those national credentialing bodies offering certification and recertification in a clinical nursing specialty that have established the following minimum requirements: (1) (2) an unrestricted registered nurse license; and certification as a clinical nurse specialist shall be limited to masters, post-master's certificate, or doctorally prepared applicant. History Note: Authority G.S (4); (7); (d)(4); (b); (b); (b); Eff. April 1, 1996; Amended Eff. January 1, 2015; April 1, 2008; January 1, 2007; November 1, 2005; August 1, 2005; April 1,