Advanced Practice

xxiv IntroductionIn addition, the implementation of the Consensus Model may affect nurse anesthesia practicefor new graduates in some states by not allowing them to be granted a temporary licenseto practice and by not allowing new graduates to practice prior to receiving certification.Certification and RecertificationThe National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA)consists of two councils—the Council on Certification of Nurse Anesthetists (CCNA) and theCouncil on Recertification of Nurse Anesthetists (COR); each council has autonomousauthority to carry out its credentialing functions. The CCNA and the COR requirements arerecognized in nurse practice acts in all states as well as by individual employers. This nationalrecognition attests to the value of the CRNA credential and strengthens the nurse anesthesiaprofession. The NBCRNA credentialing programs are accredited by the National Commissionfor Certifying Agencies and the American Board of Nursing Specialties.To ensure continued national recognition, several key issues facing the certification andrecertification of CRNAs will need to be addressed. These will likely include:n Devising and implementing methodologies to ensure continued competencyn Incorporating new technology in assessment methods (for example, simulation andonline educational offerings)n Changing trends in recertification, such as requiring re-examination via simulation orcomputerized testingThe implementation of the Consensus Model may also affect certification and recertification.For example, specialty certification in areas such as pediatrics, pain management,and obstetrics is not required at this time; however, specialty certification is consideredhighly desirable by some members of the CRNA profession. In the future, the CCNA mayneed to certify and the COR to recertify not only in the general CRNA role but also inspecific specialties.Clinical Nurse Specialists: What Does The Future Hold?Kelly A. Goudreau, DSN, RN, ACNS-BCDesignated Learning/Education Officer, Portland VA Medical CenterPast President, National Association of Clinical Nurse SpecialistsThe role of the clinical nurse specialist (CNS) has undergone some significant changes over thelast 50 years. The role, initially conceived in psychiatric nursing practice, has grown andexpanded to include almost every area in which nursing is a key component of the healthcaresystem. The most rapid change has occurred during the past 15 years. In the 1990s, the costto-valueratio of the CNS was questioned, but more recently the CNS role has been recognizedand affirmed for the intrinsic and versatile skills it brings in a time of needed change. The skillsof a CNS include working within three spheres of influence: patient, nursing and healthcareworker, and systems. 7 These three areas of practice continue to have clear and broad applicationacross healthcare settings. Some individuals would say that the skills of the CNS are neededmore now than at any other time in the evolution of health care. As the IOM 2,3,8 and the Institutefor Healthcare Improvement (IHI) 9,10 describe, there are gaps in the current healthcare system.The CNS is uniquely prepared to be the trans-professional collaborator, agent of change,integrator of evidence-based practice, and driver of patient/client outcomes that are needed, nowmore than ever before, to ensure the safety and quality of care for patients.The release and subsequent implementation of the Consensus Model for APRN Regulation:Licensure, Accreditation, Certification and Education 1 will assist in recognizing the CNSand the role the CNS plays in health care. Additionally, the emphasis on healthcare reform bythe Obama administration will provide further, as yet undefined, opportunities for the CNSand advanced practice skills.