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Implementing Autonomous Clinical Nurse Specialist Prescriptive Authority: A Competency-Based Transition Model

Klein, Tracy Ann PhD, FNP, FAANP

doi: 10.1097/NUR.0b013e318263d753
Feature Article

Purpose: The purpose of this study was to identify and implement a competency-based regulatory model that transitions clinical nurse specialists (CNSs) to autonomous prescriptive authority pursuant to change in state law.

Background/Rationale: Prescriptive authority for CNSs may be optional or restricted under current state law. Implementation of the APRN Consensus Model includes full prescriptive authority for all advanced practice registered nurses. Clinical nurse specialists face barriers to establishing their prescribing authority when laws or practice change. Identification of transition models will assist CNSs who need to add prescriptive authority to their scope of practice.

Description of Project: Identification and implementation of a competency-based transition model for expansion of CNS prescriptive authority.

Outcome: By January 1, 2012, 9 CNSs in the state exemplar have completed a practicum and been granted full prescriptive authority including scheduled drug prescribing. No complaints or board actions resulted from the transition to autonomous prescribing.

Conclusion: Transition to prescribing may be facilitated through competency-based outcomes including practicum hours as appropriate to the individual CNS nursing specialty.

Implications: Outcomes from this model can be used to develop and further validate educational and credentialing policies to reduce barriers for CNSs requiring prescriptive authority in other states.

Author Affiliation: Advanced Practice Consultant, Oregon State Board of Nursing, Portland.

The author reports no conflicts of interest.

Correspondence: Tracy Ann Klein, PhD, FNP, FAANP, Oregon State Board of Nursing, 17938 SW Upper Boones Ferry Rd, Portland, OR 97224-7012 (

© 2012 Lippincott Williams & Wilkins, Inc.