The CNS regulatory quagmire--we need clarity about advanced nursing practice.

The current quagmire in the regulation of CNS practice is largely due to confusion about definitional approaches to advanced nursing practice. Establishing clarity about the nursing focused and medical focused definitions of advanced practice can greatly assist in developing and implementing appropriate levels of regulation for the CNS role and scope of practice. It has been my experience that state boards of nursing want to do their very best in helping to protect the public while not creating insurmountable problems that essentially put APRNs such as CNSs out of work and raise restraint of trade issues. Currently, in some states, there is real economic harm being experienced by CNSs because they cannot get jobs as CNSs when they have been practicing within the domains of the RN license for 10 or more years. I believe the inappropriate regulation of CNSs in some states is occurring because CNSs did not have an organization to represent them at national policy tables until 1995. Therefore, we weren't "at the table" in the early development of recognition strategies for APRNs to help state boards and other policy making groups understand how the CNS practice and role is different from other APRN roles. We must help state boards of nursing clarify the level of regulation needed for both the CNS without and the CNS with prescriptive authority. Then we must help them identify and implement reasonable solutions that do not create unnecessary barriers to CNS practice while assuring society's access to the full range of CNS services.