As a Clinical Nurse Specialist (CNS) in Virginia who has practiced for over 25 years , I am in support of changes petitioned to the Board of Nursing to recognize CNSs as Advanced Practice Registered Nurses (ARRN) in Virginia and grant licensure rather than registration. Recognition of the CNS as an APRN is consitstent with the American Nurses Credentialing Center's (ANCC) support of the position. CNS practice in Virginia is inconsistent with other states across the nation. The Institute of Medicine (IOM) report: The Future of Nursing: Leading Change, Advancing Health supports APRNs nationwide to practice to the fullest extent of their education, which is not currently happening in Virginia. As health care reform becomes a reality, rapid change will need to take place, this is one of those changes required.