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OREGON STATE BOARD OF NURSING

 

DIVISION 54

CLINICAL NURSE SPECIALISTS

851-054-0010

Purposes and Definitions

(1) Purposes of these rules:

(a) To implement the provisions of ORS 678.370 to 678.372 governing the state certification of Clinical Nurse Specialists (CNS) by the Oregon State Board of Nursing (the Board).

(b) To define the scope of practice of the CNS.

(c) To establish standards for safe practice for the CNS.

(d) To serve as a guide for the Board to evaluate CNS practice.

(e) To establish standards for the initial and ongoing approval of CNS education programs operating in the state of Oregon; and

(f) To establish educational standards for state certification of applicants completing CNS education programs operating outside of the state of Oregon.

(2) Definitions as used in these rules:

(a) “Assessment” means a process of collecting information regarding a client's health status using tools, techniques, and methodologies based on nursing theory and research. The skills employed during the assessment process include collecting, analyzing and evaluating data in order to diagnose symptoms, functional problems, risk behaviors and health status, and to develop interventions and plans of care.

(b) “Asynchronous learning” means learning experiences usually delivered through online technology where the interactions between the faculty and students are not constrained by time or place.

(c) “Client” means the recipient of CNS services for whom the CNS has established a provider relationship. A provider relationship is established through assessment and planning for the recipient.

(d) “Clinical Nurse Specialist” (CNS) is a registered nurse who has been approved and certified by the Board to provide health care in an expanded specialty role.

(e) “Clinical Nurse Specialist Educator” refers to a licensed CNS faculty member approved by the Board who has responsibility for input into the ongoing development, evaluation and revision of the CNS program curriculum. CNS Educators are responsible for student advising, supervision, evaluation, mentoring and collaborating with clinical preceptors and other health care professionals.

(f) “Clinical Nurse Specialist Program Administrator” refers to a licensed CNS approved by the Board and appointed by the Dean or Director of the Nursing school who is assigned the responsibility and accountability for the CNS education program within an accredited academic institution, including those functions aligned with program and curricular design and resource acquisition and allocation.

(g) “Clinical Practice Experience” means the supervised provision of care in a clinical setting that complements CNS course work and ensures acquisition of advanced practice nursing skills.

(h) “Clinical Preceptor” means a licensed independent health care provider qualified by education and clinical competency to provide direct supervision of the clinical practice experience of students in a CNS program under CNS educator direction.

(i) “Collaboration” is a process involving the CNS and one or more members of the health care team working together to achieve common goals, each responsible for their particular area of expertise.

(j) “Consultation” means interaction between the CNS and the consultee for the purpose of transmitting or obtaining information or advice.

(k) “Continuing Education hours” are contact hours of education. One contact hour is equal to 60 minutes of instruction. Ten contact hours are equal to one Continuing Education Unit (CEU).

(l) “Core Competencies” means the knowledge, skills and abilities required for performance in a CNS role identified and nationally validated by the nursing profession.

(m) “Diagnosis” means identification of actual or potential health problems or need for intervention, based on analysis of the data collected.

(n) “Direct supervision” means the clinical preceptor or faculty member is physically present at the practice site; retains the responsibility for CNS practice; oversees the student; and, if necessary, redirects or intervenes in CNS practice as well as being able to intervene if necessary.

(o) “Distance learning” means using multiple media for students to access the curriculum without the need to be physically present at the education site.

(p) “Interprofessional educator” means a professional faculty member licensed, certified, or otherwise recognized in a field other than nursing.

(q) “Major curriculum change” means a change that results in a refocus of purpose and objectives; or a substantive change in program structure, method of clinical or instructional delivery, or clinical hours and content.

(r) “Medical equipment” means medical supplies and durable or disposable equipment ordered by the CNS which are related to or required for self-care, or the plan of care.

(s) “National Certification” means a certificate of recognition in a specialty area issued by a national nursing organization.

(t) “Non-Oregon Based Graduate Program” means an academic program accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation that offers a graduate degree or graduate level certificate to qualified students for licensure as an advanced practice registered nurse (Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Nurse Practitioner) and does not have a physical location in Oregon.

(u) “Order” means written or verbal directives by the CNS to other members of the health care team.

(v) “Oregon Based Clinical Nurse Specialist Program” means a Board approved academic program meeting CNS licensing criteria that is physically located in Oregon and accredited by a nursing organization recognized by the United States Department of Education or the Council of Higher Education Accreditation which offers a graduate degree or graduate level certificate to qualified students.

(w) “Organization” means a system or network that provides patient care.

(x) “Population” means the collection of individuals in a community or a group of individuals defined by age, health status, lifestyle, disease and/or geographic location.

(y) “Prescribe” means written, verbal, or electronic legal directive to procure or designate for use legend drugs or controlled substances.

(z) “State Certification” means certification to practice advanced nursing as authorized by the Oregon State Board of Nursing.

(aa) “Three spheres of influence” means domains that denote the scope or breadth of practice activities and the target outcomes associated with a particular sphere (patient/population, nursing practice or health care system).

Stat. Auth.: ORS 678.150
Stats. Implemented: ORS 678.370 & 678.372
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 14-2010, f. & cert. ef. 9-30-10; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0015

Use of the Clinical Nurse Specialist Title

As of 10-01-2001 an individual shall meet the requirements and receive state certification as a Clinical Nurse Specialist in order to use the title Clinical Nurse Specialist or CNS. Pursuant to ORS 678.370, no person shall hold themselves out to the public as a Clinical Nurse Specialist or CNS without recognition and certification from the Oregon State Board of Nursing.

Stat. Auth.: ORS 678.370, ORS 678.372 & ORS 678.150
Stats. Implemented: ORS 678.370, ORS 678.372 & 678.150
Hist.: BN 4-2001, f. & cert. ef. 2-21-01

851-054-0020

Clinical Nurse Specialist Scope of Practice

The Clinical Nurse Specialist (CNS) independently provides evidence-based advanced nursing care to clients, and facilitates attainment of health goals. Within the practice of advanced nursing, the CNS provides innovation in nursing practice, based upon clinical expertise, evidence-based decision making, and leadership skills. The CNS practices within three spheres of influence. These three spheres are: individual clients and populations; nurses and other multidisciplinary team members; and organizations. Practice may target one or more spheres of influence.

(1) The CNS may practice with individual clients and populations of clients.

(a) Individual client care includes, but is not limited to:

(A) Assessing the client using tools, techniques, and methodologies based on theory and research;

(B) Diagnosing symptoms, functional problems, risk behaviors, and health status of the client;

(C) Developing a mutually derived therapeutic plan of care with the client;

(D) Designing, implementing, and evaluating nursing interventions by using data, research, and theoretical knowledge;

(E) Selecting, recommending, and ordering medical equipment, laboratory and screening or diagnostic tests for the client;

(F) Selecting, recommending and ordering prescription medications and devices as authorized per division 56 consistent with specialty and scope of practice;

(G) Establishing standing orders, protocols, algorithms, or electronic order sets related to nursing interventions and specific plans of care;

(H) Encouraging disease prevention, health promotion and health maintenance;

(I) Referring the client to other health care services or providers as indicated.

(b) Population care includes, but is not limited to:

(A) Planning, implementing and evaluating data collection;

(B) Selecting, ordering, and recommending screening and diagnostic tests for individuals within the population;

(C) Interpreting and analyzing population data to formulate diagnoses in the area of needs, functional problems, risks, and health issues;

(D) Reviewing and revising diagnoses based on subsequent data collection;

(E) Innovating, implementing, guiding, evaluating, and revising population-focused plans and programs;

(F) Encouraging disease prevention, health promotion and health maintenance;

(G) Establishing criteria for referral within a population;

(H) Establishing algorithms, standing orders, or practice guidelines related to specific populations;

(I) Informing the population about its health and promoting other community systems that influence health;

(J) Assessing need for and participating in activities to change health and social policies that affect the health of the community.

(2) The CNS may practice with nurses and other members of the multidisciplinary care team to advance the practice of nursing and improve client care. This practice includes, but is not limited to:

(a) Consulting and collaborating to identify and manage health care issues;

(b) Providing leadership in the utilization of research in practice;

(c) Coaching nursing staff in clinical practice development;

(d) Identifying knowledge deficits of target groups providing health care;

(e) Developing, providing and evaluating educational and other programs that enhance the practice of nursing personnel and/or other members of the health care team.

(3) The CNS may practice with organizations to provide clinical expertise and guidance. This practice includes, but is not limited to:

(a) Using system-wide change strategies based on an assessment of the needs and strengths of the organization;

(b) Initiating collaborative relationships among teams to facilitate interdisciplinary practice;

(c) Collaboratively developing and evaluating research-based and client-driven systems and processes;

(d) Creating, advising, and influencing system-level policy that affects programs of care;

(e) Evaluating and recommending equipment and products being used in patient care for efficacy, efficiency, cost-effectiveness, and client/consumer satisfaction.

(4) The CNS may provide expertise that includes, but is not limited to:

(a) Summarizing, interpreting, and applying research results;

(b) Teaching, coaching, and mentoring health care members in the evaluation and use of research;

(c) Providing leadership through practice in a CNS Program as a CNS Program Administrator, CNS Educator, or CNS Clinical Preceptor with CNS students;

(d) Planning, directing, and evaluating multidisciplinary programs of care for clients;

(e) Evaluating client outcomes and cost effectiveness of care to identify needs for practice improvement;

(f) Conducting and participating in research and research protocols;

(g) Designing and establishing standing orders related to nursing interventions.

(5) The CNS scope of practice may include:

(a) Prescribing, ordering, administering and dispensing medications per division 56 regulations and requirements.

(b) Receiving and distributing drug samples.

(c) Obtaining DEA registration for controlled substances in Schedule II-V.

Stat. Auth.: ORS 678.150
Stats. Implemented: ORS 678.370, 678.372
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0021

Standards for Clinical Nurse Specialist Scope of Practice

The Clinical Nurse Specialist (CNS), shall meet the standards for Registered Nurse practice, and shall also meet the practice standards of advanced practice, including but not limited to:

(1) Recognizing and practicing within the limits of knowledge and experience of the individual CNS, and consulting with or referring clients to other health care providers when indicated;

(2) Providing and documenting nursing services within the scope of practice and specialty for which the individual CNS is educationally prepared, and for which competency has been established and maintained. Educational preparation includes academic coursework, workshops or seminars, or other supervised, planned learning, provided both theory and clinical experience are included.

(3) Teaching, coaching, mentoring and providing leadership using professional standards of CNS practice.

Stat. Auth.: ORS 678.370, 678.372 & 678.150
Stats. Implemented: ORS 678.370, 678.372 & 678.150
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0030

Standards for Clinical Nurse Specialist Programs

The Board's standards for all Clinical Nurse Specialist programs for initial applicants are as follows:

(1) The CNS program shall be a minimum of 30 semester hours or 45 quarter hours in length. Post graduate advanced practice registered nurse applicants who obtained CNS preparation in a different role or population focus may complete less than 30 semester hours or 45 quarter hours with documentation of the following:

(a) Completion of directly supervised clinical hours in the applicable CNS role;

(A) 500 minimum supervised clinical (clock) hours of clinical experience for master’s and post-graduate preparation if completed after January 1, 2007; or

(B) 1,000 minimum supervised clinical (clock) hours for post-baccalaureate practice doctorate preparation.

(b) Completion of curriculum requirements in place for the CNS program at the time of matriculation with evidence of any advanced placement or credit for prior learning; and

(c) Specialty and population specific competencies as required for practice in the CNS role and three spheres of influence.

(2) CNS Educators who teach within the CNS program shall be educationally and clinically prepared in the same population focus and clinical areas they teach and shall include state certified advanced practice registered nurses.

(3) The curriculum content shall contain theory and clinical experience in the CNS population focus for which application is being made, preparing the graduate to meet all core competencies within the CNS scope including the three spheres of influence. Graduates as of June 30, 2015 need to demonstrate successful completion of discrete graduate level courses in advanced level physical assessment, pharmacology, and pathophysiology.

(4) The clinical experience must consist of full scope preparation in the CNS population focus for which application is being made as well as the three spheres of influence.

(5) In the event of program revision, programs must maintain and provide upon request documentation that students met the program’s curriculum requirements at the time of enrollment and matriculation into the program. Any discrepancies must be justified.

(6) Written program materials shall accurately reflect the mission, philosophy, purposes, and objectives of the program.

(7) Programs shall demonstrate appropriate course sequencing and requirements for matriculation into the program, including completion of all pre-licensure nursing curriculum requirements before advancement into CNS clinical coursework.

(8) Clinical preceptors shall meet clinical and licensure qualifications for the state in which they practice.

(9) Distance and asynchronous learning programs shall meet all standards of OAR 851-054-0030.

(10) Clinical Nurse Specialist programs outside of the United States shall meet all standards of OAR 851-054-0030. Such programs shall be determined by Board approved or directed credentials review to be equivalent to graduate nursing programs offered in the United States that prepare the graduate for practice within the CNS scope. Nationally recognized nursing accreditation standards or guidelines may be applied by the Board at the Board’s discretion, in accordance with the Oregon Office of Degree Authorization regulations.

Stat. Auth.: ORS 678.050, 678.150, 678.370, 678.372
Stats. Implemented: ORS 678.050, 678.150, 678.370, 678.372
Hist.: BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0035

Standards for Approval of Oregon Based Programs

The Board of Nursing holds the Dean or Director of the School of Nursing accountable for identification and appointment of qualified nurse administrators, educators and preceptors. The Dean or Director shall ensure that programs which prepare CNSs in one or more programs/tracks have CNS program administrators with defined position responsibility for budget and resource preparation, curricular design and implementation, and program evaluation.

(1) CNS Program Administrators:

(a) Qualifications: A CNS program administrator who has overall responsibility for one or more CNS tracks shall meet the following requirements:

(A) An active unencumbered Oregon CNS state certificate;

(B) National certification as a CNS in at least one population focus area or specialty is preferred;

(C) A doctoral degree in an education or health-related field;

(D) Educational preparation or experience in teaching and learning principles for adult education, including curriculum development and administration and at least two years (2,080 hours) of CNS practice which meets Oregon’s requirements;

(E) In a multi-track program, where only one program administrator is appointed by the Dean or Director of the school, there must be evidence of additional program administrators or lead CNS faculty to provide oversight for student supervision who are qualified in that specific program’s population focus and spheres of influence.

(b) Responsibilities: The principle responsibilities of the CNS program administrator shall be:

(A) Ensuring appropriate student faculty ratios to meet program goals and objectives;

(B) Providing leadership and accountability for the administration, planning, implementation and evaluation of the program;

(C) Preparing and administering the program budget;

(D) Facilitating faculty recruitment, development, performance review, promotion and retention;

(E) Confirming that cooperative agreements with clinical practice sites are current.

(c) CNS program administrator responsibilities may include functioning as program faculty with appropriate workload assignment to fulfill administrative duties and responsibilities.

(2) CNS Educators:

(a) Qualifications: The CNS Educator shall meet the following requirements:

(A) An active unencumbered Oregon CNS state certificate; and

(B) A minimum of a masters degree in nursing with at least 2,080 hours of prior CNS practice which meets Oregon’s requirements;

(C) National certification as a CNS in at least one population focus area or specialty is preferred;

(D) In a doctoral program, a majority (greater than 50%) of CNS educators must be doctorally prepared;

(E) Current knowledge and competence as a CNS in the population focus area and the spheres of influence consistent with teaching responsibilities;

(F) Adjunct clinical faculty employed solely to supervise clinical nursing experiences of students shall meet all the faculty requirements;

(G) Inter-professional educators who teach non-clinical nursing courses shall have advanced preparation appropriate to the area of content.

(b) Responsibilities: The principle responsibilities of the CNS Educator shall be to:

(A) Enable each student to meet faculty developed objectives and competencies by:

(i) Verifying and approving arrangements with a clinical agency for each student’s clinical practicum consistent with their learning objectives;

(ii) Coordinating preceptor selection and orientation(s); and

(iii) Providing and verifying direct student supervision;

(B) Monitor clinical practice experiences, make periodic site visits to the clinical practice location, evaluate students’ performance on a regular basis with input from the student and preceptor;

(C) Provide direct student supervision of clinical experiences as required for patient safety and student skill attainment;

(D) Assure appropriate use of preceptors for clinical instruction by verifying that:

(i) The student to preceptor ratio is appropriate to the accomplishment of learning objectives, to provide for patient safety, and to the complexity of the clinical situation;

(ii) Oregon licensure or certification is current and appropriate to the health professional’s area of practice;

(iii) Functions and responsibilities for the preceptor are clearly documented in a written agreement between the agency, the preceptor, and the clinical program;

(iv) Initial experiences in the clinical practicum and a majority of the clinical experiences shall be under the supervision of clinical preceptors who are state certified CNSs.

(3) CNS Clinical Preceptors: The CNS clinical preceptor shall meet the following standards:

(a) Licensure as an independent health care provider qualified by education and clinical competency to provide direct supervision of the clinical practice experience of students in a CNS program;

(b) Clinical preceptors may be used to enhance, but not replace, faculty-directed clinical learning experiences.

(4) Program accreditation requirements and Board notification process:

(a) Currently accredited programs that prepare Clinical Nurse Specialists for state certification under these rules and requirements shall submit to the Board:

(A) A copy of their most recent program self-evaluation reports;

(B) Current accreditation and survey reports from all nursing accrediting agencies; and

(C) Interim reports submitted to the nursing accreditation agency.

(D) These documents must be submitted to the Board upon receipt to or release from the accrediting agency or no later than 90 days from enactment of these rules.

(b) Programs which prepare Clinical Nurse Specialists for state certification under development or pre-accreditation review shall submit the following for review by the Board:

(A) Copies of the curricula within 30 days of sending the information to the accrediting agency;

(B) Copies of self-evaluation reports and any interim reports provided to all national nursing accreditation agencies at the time of notification from the accrediting agency that the program has not been fully accredited;

(C) Verification of accreditation from all accrediting agencies within 30 days of receipt by the program;

(D) Annual reports which enable the monitoring of continued compliance with Board requirements.

(5) Approval of a New Oregon Based Clinical Nurse Specialist Educational Program

(a) Any university or college wishing to establish a Clinical Nurse Specialist education program must make application to the Board no later than one year before proposed enrollment of students.

(b) The following information must be included with the initial application along with supporting documentation:

(A) Purpose for establishing the nursing education program;

(B) Community needs and studies made as the basis for establishing a nursing education program;

(C) Type of program including clear identification of proposed licensure role and population foci for graduates including eligibility for national certification as indicated;

(D) Accreditation status, relationship of educational program to parent institution;

(E) Financial provision for the educational program;

(F) Potential student enrollment;

(G) Provision for qualified faculty;

(H) Proposed clinical facilities and other physical facilities;

(I) Proposed time schedule for initiating the program. If initial approval is denied, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

(6) Survey of Oregon Based Clinical Nurse Specialist Educational Programs

(a) Board representatives will conduct in person visits to nursing programs for the following purposes:

(A) Review of application for initial program approval;

(B) Initial and continuing full approval of an educational program;

(C) Receipt by the Board of cause for review including but not limited to:

(i) Significant curricular change which includes addition of a new state certification recognized population focus or role;

(ii) Evidence that graduates fail to meet national certification eligibility criteria, if applicable;

(iii) Violation of Board standards.

(D) If approval is denied or withdrawn, the applicant may request a hearing before the Board and the provisions of the Administrative Procedures Act shall apply.

(b) Board representatives will contact nursing programs to schedule site visits:

(A) Within 60 days of receipt of an application for initial program approval;

(B) Upon receipt of national accreditation report for existing programs; one year after implementation of new programs; every 3-5 years for continuing approval;

(C) Within 30 days of receipt of a complaint.

(D) For purposes of reviewing a major curriculum change.

Stat. Auth.: ORS 678.050, 678.150, 678.370, 678.372
Stats. Implemented: ORS 678.050, 678.150, 678.370, 678.372
Hist.: BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0040

Eligibility for Initial State Certification

(1) An applicant for certification as a Clinical Nurse Specialist (CNS) shall:

(a) Hold or obtain an active unencumbered registered nurse license in Oregon;

(b) Hold a graduate degree in nursing, or a post-masters certificate with evidence of CNS theory and clinical concentration. The program shall meet the following educational standards:

(A) The program shall be at least one academic year in length;

(B) There shall be faculty and/or clinical instructors who are academically and experientially qualified in nursing, and who maintain expertise within the CNS scope of practice;

(C) Accreditation of the graduate nursing degree by a national nursing organization recognized by the US Department of Education or documentation of a Board approved or directed credentials evaluation for graduates of programs outside of the U.S. which demonstrates education equivalency to a graduate degree in nursing accredited by the national nursing organization recognized by the US Department of Education.

(D) Applicants who graduate or obtain a post-masters CNS certificate on or after January 1, 2007 shall have completed 500 hours of clinical practice within the program.

(c) Meet the practice requirement through verification of:

(A) Graduation from a CNS educational program which meets the requirements of OAR 851-054-0030 within the past one year; or

(B) Practice of at least 192 hours in the two years following graduation from a CNS program; or

(C) Practice within the CNS scope of practice for at least 960 hours within the five years preceding the application. Verification of practice hours is subject to random audit.

(2) If an applicant does not meet the practice requirement in 851-054-0040(1)(c), the applicant shall:

(a) Obtain a limited license as a registered nurse in the State of Oregon; or hold an active Oregon registered nurse license;

(b) Submit for Board approval, a detailed plan for precepted practice that includes: a plan for demonstrating core, population, and specialty competencies that support the CNS role; names and qualifications of all CNS preceptor(s) at least one of whom must be an Oregon state certified CNS skilled in the population focus or specialty care; and a description of the nature of the proposed unpaid, voluntary, precepted clinical experience.

(A) If the applicant has practiced at least 960 hours within the six years prior to the date of application, the practice plan shall provide for 250 hours of preceptorship. Documented practice hours within the CNS scope for the past two years may be recognized and may reduce the required hours, except that, in no case shall the precepted practice be less than 120 hours.

(B) If the applicant has practiced at least 960 hours within the CNS scope for the ten years prior to the date of application, the practice plan shall provide for 400 hours.

(C) If the applicant has not practiced at least 960 hours within the CNS scope for the last ten years, the re-entry requirement shall be met through:

(i) Successful completion of a CNS post masters certificate program which meets the requirements of OAR 851-054-0030, or;

(ii) A comprehensive series of CNS courses within a US Department of Education recognized nationally accredited CNS program in the population or specialty sought.

(iii) The plan of study shall be submitted in advance for Board approval before enrollment. The plan of study shall cover the entire scope of the population or specialty area under which the applicant was previously state certified, and must include both clinical and didactic hours. The program of study shall include advanced pharmacology, pathophysiology, physical assessment, and theory and clinical experience in the CNS population focus for which renewal is being made, preparing the applicant to meet all core competencies within the CNS scope including the three CNS spheres of influence in order to meet the requirements of OAR 851-054-0030.

(iv) The institution shall provide documentation which demonstrates previous credits, courses, or competency testing applied to meet final completion. Proof of completion of this plan of study shall be provided to the Board in the form of official transcripts documenting completion of all required coursework.

(c) Obtain a limited CNS state certification for precepted practice. The limited state certification shall be issued only upon receipt of a completed CNS application, application for limited state certification, Board approval of the plan for supervised practice, and payment of all applicable fees. The limited state certification is valid only for precepted practice that has been approved in advance by the Board, and will be valid for one year from the date of issue. One extension of the limited state certificate may be granted upon approval and payment of fee, provided there is a current valid application for state certification on file and no disciplinary action has been taken against the applicant. This extension will be valid for one year from date of approval.

(d) Successfully complete the precepted hours of practice supervised by the CNS preceptor. Successful completion shall be verified by a final evaluation submitted by the supervising CNS to the Board to verify that the applicant is competent to practice in the CNS scope at a safe and acceptable level, and that the number of required hours of precepted practice was completed.

(e) Submit evidence of continuing education related to the CNS role to total 20 contact hours for each year out of practice with no less than 50% obtained from accredited providers of continuing nursing education (CNE), continuing medical education (CME), or continuing pharmacology education (CPE). Continuing education taken concurrent with the reentry plan may be applied towards the total continuing education requirement, provided all hours are complete by the end of the preceptorship.

(3) The applicant shall submit all fees required by the Board with the application. The fees are not refundable. An application that remains incomplete after one year shall be considered void.

(4) Clinical Nurse Specialists seeking prescriptive authority will need to meet all additional requirements in Division 56. These requirements may be obtained as part of a re-entry program plan approved by the Board.

(5) Grounds for denial of graduate Clinical Nurse Specialist applicants for initial state certification include failure of CNS program to:

(A) Maintain accreditation status through a US Department of Education recognized national nursing accrediting body;

(B) Submit curricula, self-evaluation reports, interim reports or notice of accreditation reports as required by the Board until such reports are received and reviewed by the Board;

(6) Students who graduate from a program which was accredited at the time of their completion shall be considered to have graduated from an accredited program regardless of the current program status for the purpose of licensure.

Stat. Auth: ORS 678.050, 678.370 & 678.372
Stats. Implemented: ORS 678.050, 678.370 & 678.372
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 10-2001, f. & cert. ef. 7-9-01; BN 6-2006, f. & cert. ef. 5-8-06; BN 11-2006, f. & cert. ef. 10-5-06; BN 3-2007, f. & cert. ef. 3-13-07; BN 14-2010, f. & cert. ef. 9-30-10; BN 8-2013, f. 5-6-13, cert. ef. 6-1-13; BN 11-2013, f. 12-3-13, cert. ef. 1-1-14

851-054-0050

Renewal of Clinical Nurse Specialist Certification

Renewal of the Clinical Nurse Specialist (CNS) certification shall be on the same schedule as the renewal of the registered nurse license. The requirements for renewal are:

(1) Active license as a registered nurse in Oregon; and

(2) Practice as a CNS for no less than 960 hours within the five years prior to renewal or have completed a preceptorship as established in OAR 851-054-0040(2); and

(3) Forty contact hours of continuing education accumulated during the current certification period. At least 50% shall consist of formal academic or structured continuing education obtained from the following continuing education accrediting bodies: American Nurses Credentialing Center (ANCC), Accreditation Council for Continuing Medical Education (ACCME), American Academy of Continuing Medical Education (AAOCME), Accreditation Council for Pharmacy Education (ACPE), state boards of nursing and state nursing associations.

(4) Proof of national board certification as a CNS in a specialty may be used to meet structured continuing education requirements for the current renewal cycle for up to 50% of the total continuing education requirement.

(5) A CNS with prescriptive authority must meet additional CE requirements as specified in Division 56.

(6) The CNS shall affirm and document completion of the continuing education and practice hours on the application renewal or delinquent renewal form. Verification of all hours and credits is subject to random audits by the Board. Falsification of continuing education or practice hours is grounds for disciplinary action.

(7) The CNS shall maintain accurate records of any claimed CE hours and practice hours for no less than five years from date of submission to the Board.

(8) An applicant for renewal who has graduated from the CNS program less than two years prior to the first renewal will not be required to document the full 40 contact hours of continuing education. Continuing education will be prorated on a monthly basis based on the length of time between graduation and the date of the first renewal.

(9) The applicant shall submit the required fees with the application. Fees are not refundable. An application shall be void if not completed during the current biennial renewal cycle.

(10) An applicant for renewal up to 60 days past the expiration date shall meet all requirements for renewal and pay a delinquent fee.

(11) Any individual whose state CNS certification is delinquent may not practice as a CNS until certification is complete, subject to civil penalty.

Stat. Auth.: ORS 678.101, 678.370 & 678.372
Stats. Implemented: ORS 678.372
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 14-2010, f. & cert. ef. 9-30-10; BN 8-2013, f. 5-6-13, cert. ef. 6-1-13

851-054-0060

Clinical Practicum in Oregon for Clinical Nurse Specialist Students Enrolled in a Non-Oregon Based Graduate Program

(1) A clinical nurse specialist student enrolled in a Non-Oregon Based Graduate Program may not participate in a clinical practicum in Oregon without prior Board authorization.

(2) Prior authorization will be predicated upon approval of the following:

(a) A completed registration form;

(b) Verification of a current, unencumbered registered nurse license in Oregon;

(c) Verification of enrollment in a graduate program accredited by a United States Department of Education or the Council of Higher Education Accreditation approved national accrediting body;

(d) Verification of regional accreditation and/or Board of Nursing approval from the state in which the program originates;

(e) Proof of approval by the Office of Degree Authorization of the Non-Oregon Based Graduate Program;

(f) Submission of a written signed agreement between the Non-Oregon Based Graduate Program responsible for the student and the Oregon licensed preceptor;

(g) Identification of the faculty advisor accountable for general supervision from the Non-Oregon Based Graduate Program; and

(h) Identification of the Oregon licensed clinical nurse specialist faculty providing direct clinical evaluation of the clinical nurse specialist student.

(3) Oregon licensed preceptors are responsible for validating that the student has registered and received Board authorization prior to participating in a clinical practicum in Oregon.

(4) A clinical nurse specialist student shall practice under the direct supervision of an approved Oregon licensed clinical nurse specialist, nurse practitioner, medical physician, or doctor of osteopathy who agrees to serve as preceptor, and general supervision of a faculty member as approved in the clinical practicum registration.

(5) Oregon faculty will be approved by the Board based on congruence of clinical scope and expertise to the student’s clinical placement.

(6) The student’s assigned preceptor may not simultaneously serve as their designated faculty of record. The faculty of record must provide on-site evaluation of both the student and the preceptor.

Stat. Auth.: ORS 678.150
Stats. Implemented: ORS 678.150
Hist.: BN 8-2012, f. 5-7-12, cert. ef. 6-1-12; BN 16-2012(Temp), f. & cert. ef. 11-15-12 thru 5-1-13; BN 5-2013, f. 2-28-13, cert. ef. 4-1-13

851-054-0100

Disciplinary Action on Clinical Nurse Specialist Certification

(1) The Board may deny, suspend or revoke the authority of a Clinical Nurse Specialist (CNS) to practice under a limited or full certificate for the causes identified in ORS 678.111(1).

(2) Revocation, suspension, or any other encumbrance of a registered nurse license, or any special authority to practice as a CNS, in another state, territory of the United States, or any foreign jurisdiction may be grounds for denial of Clinical Nurse Specialist certification in Oregon.

(3) It shall be conduct derogatory to nursing standards for the CNS to:

(a) Charge the client or any third-party payer in a grossly negligent manner;

(b) Use ordering or prescriptive authority without sufficiently documented evidence of advanced nursing assessment and establishment of the client/provider relationship;

(c) Prescribe or dispense medications without specific authority under state or federal law;

(d) Practice as a CNS in a specialty area or scope of practice not supported by the licensee's clinical and didactic training.

Stat. Auth.: ORS 678.150
Stats. Implemented: ORS 678.150, 678.370, 678.372, 678.385 & 678.390
Hist.: BN 4-2001, f. & cert. ef. 2-21-01; BN 11-2006, f. & cert. ef. 10-5-06; BN 16-2012(Temp), f. & cert. ef. 11-15-12 thru 5-1-13; BN 5-2013, f. 2-28-13, cert. ef. 4-1-13

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