The current definitions of professional nursing (RN) and clinical nurse specialist (CNS) are non-descriptive.They lack distinctive specificity and allow wide variation in the interpretation of what constitutes nursing practice, jeopardizing the integrity of professional nursing practice in the Commonwealth of Virginia. These definitions do not acknowledge nursing as a professional discipline that 1) uses a methodical process, long-described in the literature as the nursing process; 2) generates nursing diagnoses on which professional nurses act; and 3) intervenes with patients, families and communities using independent, dependent and interdependent nursing actions. At present, the definitions of both RN and CNS practice permit the archaic ascription of nursing practice to handmaiden status.  

Additionally, the 2016 designation within the Code of Virginia that CNSs are advanced practice registered nurses (APRN) requires that CNS practice be adequately described. At present, CNS practice is not differentiated from RN practice which is an injustice to those prepared to intervene at this level, and a disservice to the public who needs to the services these professionals are prepared to provide. The educational preparation of the CNS develops a depth of knowledge and breadth of skill in specialty nursing practice that permits provision of advanced practice nursing services as validated by specialty certification. The National Council of State Boards of Nursing (NCSBN) laid the foundation for appropriate regulatory language in their 2008 document for all APRNs, including CNSs. The Commonwealth of Virginia needs to move forward in implementing this initiative for the CNS community as it 1) is consistent with the Institute of Medicine’s Future of Nursing recommendations regarding employing the full skill set of professional nurses; and 2) brings a much-needed healthcare provider to address some of the common and costly chronic health conditions plaguing Virginians.