Success Story: The CNS As Credentialed Provider
A guest post by the National Association of Clinical Nurse Specialists (NACNS).
The University of Virginia Health (UVA Health), serving the Greater Charlottesville/Albemarle region of Virginia, took the important step this month to validate its 14 clinical nurse specialists (CNSs) as “credentialed providers.” This step formally recognizes CNSs as Advanced Practice Registered Nurses (APRN). UVA Health System includes a 631-bed hospital, level I trauma center, nationally recognized cancer and heart centers, and primary and specialty clinics throughout Central Virginia.
The entire credentialing approval process took four months and, today, CNSs at UVA Health can practice with full practice authority, ordering many services for patients based on their own professional assessment rather than relying exclusively on physician approval.
Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN, lead clinical nurse specialist of UVA Health, coordinated the credentialing effort. According to Elgin, the other three APRN roles (nurse practitioners, nurse midwives, and nurse anesthetists) were already bundled underneath the credentialed provider structure and there was a growing need to recognize CNSs and align their level of responsibility and scope of practice with that of their APRN counterparts.
Beyond the interest in improving patients’ experiences, the ascension of CNSs to the status of credentialed providers means that UVA Health is in line with the CNS professional standards of practice. The change also will provide mechanisms for third-party billing of services provided by a CNS. At the same time, there is legislation in the Virginia General Assembly to elevate the scope of practice of the CNS to allow for prescriptive authority.
“There was a real need for credentialing CNSs,” said Elgin. “The fluidity of the CNS role is important, but it could lead to role confusion for colleagues. After centralizing the CNS team, I performed a systematic gap analysis, comparing our practice to the National Association of Clinical Nurse Specialists (NACNS) core competencies. Being able to validate our CNSs were ‘aligning with and meeting national standards’ is actionable language that is meaningful and powerful to an organization.”
NACNS core competencies can be found here. They include competencies in Direct Care, Consultation, Systems Leadership, Collaboration, Coaching, Research and Ethical Decision-Making, Moral Agency, and Advocacy.
The Benefits of Credentialing the CNS
As a credentialed provider, CNSs’ validation as an APRN by the UVA Health nursing body and interdisciplinary colleagues is helping to build the structures and processes that are necessary to facilitate reimbursement practices. Another significant improvement will be CNSs’ ability to formally consult other interdisciplinary clinicians without a physician co-signature. This efficient approach to patient care leverages the CNSs’ ability to generate revenue for the organization for the work they perform. Finally, and most importantly, validating a CNS as a credentialed provider creates an opportunity to rethink processes and structures around interprofessional practice and develop different and more efficient methods to work together in a healthcare setting.