Frequently Asked Questions
Printer-Friendly Version

Clinical Nurse Specialist

  1. [Registration / Recognition (Initial and Subsequent Renewal)] What is Clinical Nurse Specialist (CNS) Recognition?

  2. [Registration / Recognition (Initial and Subsequent Renewal)] Is current national certification required to renew the Clinical Nurse Specialist Recognition?

  3. [Registration / Recognition (Initial and Subsequent Renewal)] Are Clinical Nurse Specialists required to have a NPI number?

  4. [Registration / Recognition (Initial and Subsequent Renewal)] What is the turn-around time for completed applications?

  5. [Registration / Recognition (Initial and Subsequent Renewal)] Do I need an Registered Nurse license to be recognized as a Clinical Nurse Specialist?

  6. [Registration / Recognition (Initial and Subsequent Renewal)] My Clinical Nurse Specialist Recognition was made inactive for failure to renew. How do I reinstate?

  7. [Supervision / Scope of Practice] How is the Clinical Nurse Specialists scope of practice defined in North Carolina?

  8. [Supervision / Scope of Practice] Is physician supervision a requirement for Clinical Nurse Specialist practice in North Carolina?

  9. [Prescriptive Authority] Do Clinical Nurse Specialists have prescriptive authority in North Carolina to prescribe controlled substances?

  10. [Prescriptive Authority] Are Clinical Nurse Specialists eligible for DEA registration?

  11. [Prescriptive Authority] Where can I find information about the new controlled substance prescribing rules?

  12. [Practice] Do North Carolina rules for Clinical Nurse Specialists apply to those employed by the federal government and working in a federal facility?

  13. [Practice] What information must be on the Clinical Nurse Specialist's name badge when the Clinical Nurse Specialist is involved in the direct provision of health care to patients?

  14. [Practice] What does the Medical Board’s Position Statement on Referral Fees and Fee Splitting mean?

  15. [Practice] Can Clinical Nurse Specialists engage in telehealth/telemedicine?

  16. [Practice] Can Clinical Nurse Specialists practice in roles that are outside of their area of certification?

  17. [Education] Does the North Carolina Board of Nursing approve post-licensure and graduate-level nursing education programs in North Carolina and in other states?

  18. [Education] Do Clinical Nurse Specialist students need a Registered Nurse license to do clinical rotations in North Carolina?

  19. [Education] Is a Doctorate required for entry into practice as a Clinical Nurse Specialist?

  1. [Registration / Recognition (Initial and Subsequent Renewal)] What is Clinical Nurse Specialist (CNS) Recognition?

    Recognition is the process utilized by the North Carolina Board of Nursing (NCBON) to ensure that a licensee has met the requirements to practice as a Clinical Nurse Specialist in North Carolina. Recognition as a Clinical Nurse Specialist by the North Carolina Board of Nursing is required to practice as a Clinical Nurse Specialist in the state. Effective July 1, 2015, all Clinical Nurse Specialists must be recognized by the North Carolina Board of Nursing in order to practice as a Clinical Nurse Specialist in North Carolina as noted in 21 NCAC 36.0228. Direct clinical care is a necessary component of the Clinical Nurse Specialist role.

    Recognition Requirements:

    • A permanent North Carolina Registered Nurse (RN) license or another Compact State Registered Nurse license valid for practice in North Carolina (Compact license information must first be submitted on the “Compact State Application”).
    • Master's or higher degree in Nursing or a related Master's
    • Current National Certification as Clinical Nurse Specialist

    OR

  2. [Registration / Recognition (Initial and Subsequent Renewal)] Is current national certification required to renew the Clinical Nurse Specialist Recognition?

    Yes. In accordance with 21 NCAC 36.0228(b)(3), (4), initial and ongoing recertification as a Clinical Nurse Specialist by is requirement for recognition and practice as a Clinical Nurse Specialist in North Carolina.

    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.

  3. [Registration / Recognition (Initial and Subsequent Renewal)] Are Clinical Nurse Specialists required to have a NPI number?

    No. A National Provider Identifier (NPI) number is not a requirement for recognition as a Clinical Nurse Specialist in North Carolina. A NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI is a payer/reimbursement requirement. The North Carolina Board of Nursing does not have jurisdiction in payer issues. You are advised to contact payers directly to determine in a NPI number is required for reimbursement.

  4. [Registration / Recognition (Initial and Subsequent Renewal)] What is the turn-around time for completed applications?

    All online applications are received by the Board of Nursing office on a daily basis. Due to the volume of applications received, please allow fifteen (15) business days for processing the application from the time all required documents are received in the Board office.

  5. [Registration / Recognition (Initial and Subsequent Renewal)] Do I need an Registered Nurse license to be recognized as a Clinical Nurse Specialist?

  6. [Registration / Recognition (Initial and Subsequent Renewal)] My Clinical Nurse Specialist Recognition was made inactive for failure to renew. How do I reinstate?

    Clinical Nurse Specialist recognition renewal may be completed following the prompts under the Clinical Nurse Specialist link in the Nurse Gateway.

  7. [Supervision / Scope of Practice] How is the Clinical Nurse Specialists scope of practice defined in North Carolina?

    In accordance with 21 NCAC 36.0228(f), the scope of practice of a Clinical Nurse Specialist incorporates the basic components of nursing practice 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:

    • 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;
    • 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;
    • initiating, establishing and utilizing measures to evaluate health care outcomes and modify nursing practice decisions;
    • assuming leadership for the application of research findings for the improvement of health care outcomes; and
    • integrating education, consultation, management, leadership, and research into the clinical nurse specialist role.
  8. [Supervision / Scope of Practice] Is physician supervision a requirement for Clinical Nurse Specialist practice in North Carolina?

    No. In accordance with 21 NCAC 36.0228, there is no statutory requirement for physician supervision of Clinical Nurse Specialist practice in North Carolina.

    Clinical Nurse Specialists are regulated under the authority of the North Carolina Board of Nursing (NCBON). The Clinical Nurse Specialist has the unique Advanced Practice Registered Nurse role to integrate care across the continuum and through three spheres of influence: patient, nurse, system. The three spheres overlap and are interrelated, but each sphere possesses a distinctive focus. In each of the spheres of influence, the primary goal of the Clinical Nurse Specialist is continuous improvement of client outcomes and nursing care. The Clinical Nurse Specialist does not have prescriptive authority nor does the Clinical Nurse Specialist make medical diagnoses.

  9. [Prescriptive Authority] Do Clinical Nurse Specialists have prescriptive authority in North Carolina to prescribe controlled substances?

    No. Clinical Nurse Specialist (CNS) practice does NOT include prescribing a medical treatment regimen or making a medical diagnosis in North Carolina.

  10. [Prescriptive Authority] Are Clinical Nurse Specialists eligible for DEA registration?

    No. The Clinical Nurse Specialist (CNS) is not eligible for Drug Enforcement Administration (DEA) registration under the DEA’s category of Mid-level practitioner in concert with federal law; DEA regulation §1300.01 Definitions relating to controlled substances

  11. [Prescriptive Authority] Where can I find information about the new controlled substance prescribing rules?

  12. [Practice] Do North Carolina rules for Clinical Nurse Specialists apply to those employed by the federal government and working in a federal facility?

    Federally employed Advanced Practice Registered Nurses (CNM, CNP, CNS, CNS) are governed by federal rules and regulations in regard to how they practice while working within federal facilities. However, a federally employed CNM or CNP who holds a North Carolina approval to practice and wants to maintain the approval to practice must comply with North Carolina rules that pertain to maintaining an active approval to practice (i.e. annual renewal, continuing education and payment of fees). Also, any CNM or CNP actively approved to practice is expected to practice competently, act professionally and be of requisite good character no matter where, or for whom, he or she works.

  13. [Practice] What information must be on the Clinical Nurse Specialist's name badge when the Clinical Nurse Specialist is involved in the direct provision of health care to patients?

    The North Carolina Badge Law (GS 90-640) requires every health care professional to wear or display a readily visible form of identification to include the individual’s name and the license, approval to practice or listing title when providing patient care. Standard abbreviations for such titles may be used as in Jane Smith, RN, CNM. Exceptions to this requirement are outlined in Rule 21 NCAC 36.0231 Exceptions to Health Care Practitioners Identification Requirements.

    Consistent with agency policy, the Clinical Nurse Specialist (CNS) may choose to include academic or certification designations on the name badge, but these must be in addition to the Clinical Nurse Specialist’s legally approved practice title(s). For example, one might use Jane Smith, RN, CNS, MSN or Jane Smith, RN, CNS, DNP depending upon one’s level of academic preparation.

  14. [Practice] What does the Medical Board’s Position Statement on Referral Fees and Fee Splitting mean?

    The position statement is intended to prevent physicians from sharing revenue they have generated on a percentage basis with a non-physician. The Medical Board’s position statement is not intended to prevent the Nurse Practitioner employees from receiving a percentage of revenue they have generated (often referred to as a productivity bonus).

  15. [Practice] Can Clinical Nurse Specialists engage in telehealth/telemedicine?

    Yes. A Clinical Nurse Specialist (CNS) may practice within his/her designated scope of practice set forth in North Carolina Laws and Rules using telehealth/telemedicine methods of healthcare delivery. Telehealth (interchangeably termed telemedicine) is the practice of healthcare within a professionally designated scope of practice using electronic communication, information technology, or other means between a licensee in one location and a client in another location with or without an intervening healthcare provider. The North Carolina Medical Board has a position statement on Telemedicine that can be used for guidance on training of staff utilizing telehealth, evaluations and examinations, licensee-client relationship, prescribing, health records, and licensure.

    Any Clinical Nurse Specialist using telehealth to regularly provide services to clients located in North Carolina need not reside in North Carolina but must be recognized as a Clinical Nurse Specialist with the North Carolina Board of Nursing and hold either a valid, unencumbered multi-state Registered Nurse license, or a valid, unencumbered North Carolina single-state Registered Nurse license. See the position statement on Telehealth/Telenursing.

  16. [Practice] Can Clinical Nurse Specialists practice in roles that are outside of their area of certification?

    No. The Scope of Practice for the Clinical Nurse Specialist (CNS) is defined by formal academic, graduate educational preparation, national certification and maintained competence.

  17. [Education] Does the North Carolina Board of Nursing approve post-licensure and graduate-level nursing education programs in North Carolina and in other states?

    No. The North Carolina Board of Nursing neither approves nor disapproves post-licensure and graduate-level nursing education programs in North Carolina and in other states. Please see the following links:

  18. [Education] Do Clinical Nurse Specialist students need a Registered Nurse license to do clinical rotations in North Carolina?

    Yes. A Registered Nurse license is a requirement for Advanced Practice Registered Nurse practice. Academic programs are responsible for ensuring that post-licensure students participating in clinical rotations in North Carolina must have a North Carolina license or a multi-state license as defined by the Nurse Licensure Compact. Advanced Practice Registered Nurse student clinical rotations are conducted under the supervision of an appropriately credentialed preceptor as required by individual state regulation. However, the student must have the foundational Registered Nurse license required by the state where the clinical experience occurs. If the student’s license is not a multi-state license as noted in Nurse Licensure Compact, s/he will need Temporary License.

    See the following Frequently Asked Questions which provide interpretation and application of current law and rule:

  19. [Education] Is a Doctorate required for entry into practice as a Clinical Nurse Specialist?

    No. In Accordance with 21 NCAC 36.0228, completion of a Master’s or higher degree in nursing or Post-Master’s certificate in nursing, with clinical specialization and preparation for expanded role functioning in areas such as mental health, neonatology, gerontology, cardiology, oncology or community.

    On October 25, 2004, the member schools affiliated with the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing. This decision called for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level by the year 2015. This endorsement was preceded by almost three years of research and consensus-building by an AACN task force charged with examining the need for the practice doctorate with a variety of stakeholder groups. While market forces may preferentially choose a Clinical Nurse Specialist with doctoral preparation, the North Carolina Board of Nursing regulations currently require a master's or higher degree for Clinical Nurse Specialist recognition requirements in North Carolina.

North Carolina Board of Nursing

Protect the public by regulating the practice of nursing.
Sitemap

Copyright © 2018
North Carolina Board of Nursing
All rights reserved

Terms of Service Privacy Policy

Contact Information

(919) 782-3211
(919) 781-9461
8 a.m.-5 p.m., Mon-Fri
North Carolina Board of Nursing