21 N.C. Admin. Code 36.0228 : — Occupational Licensing Boards and CommissionsBOARD OF NURSING — CLINICAL NURSE SPECIALIST PRACTICE

(a) Only a registered nurse who meets the qualifications outlined in Paragraph (b) of this Rule shall be approved by the Board as a clinical nurse specialist to perform advanced practice registered nursing activities listed in Paragraph (f) of this Rule.
(b) The Board shall approve an applicant who:
(1) has an active, unencumbered license to practice as a registered nurse in North Carolina or a state that has adopted the Nurse Licensure Compact;
(2) has an unrestricted previous approval, registration, or license as a clinical nurse specialist if previously approved, registered, or licensed as a clinical nurse specialist in another state, territory, or possession of the United States;
(3) has successfully completed a master's or higher level degree program that is accredited by a nursing accrediting body approved by the United States Secretary of Education or the Council for Higher Education Accreditation and meets the qualifications for clinical nurse specialist certification by an approved national credentialing body under Part (b)(4)(A) of this Rule; and
(4) either:
(A) has current certification as a clinical nurse specialist from a national credentialing body approved by the Board, as defined in Paragraph (h) of this Rule and 21 NCAC 36 .0120(26); or
(B) meets requirements that are equivalent to national certification if no clinical nurse specialist certification is available in the specialty. The Board shall determine equivalence based on consideration of an official transcript and course descriptions validating Subparagraph (b)(3) of this Rule, a current curriculum vitae, work history, professional recommendations indicating evidence of at least 1,000 hours of clinical nurse specialist practice, and documentation of certificates indicating 75 contact hours of continuing education applicable to clinical nurse specialist practice during the previous five years.
(c) An applicant certified as a clinical nurse specialist by a national credentialing body prior to January 1, 2007, and who has maintained that certification and active clinical nurse specialist practice and holds a master's or higher degree in nursing or a related field shall be approved by the Board as a clinical nurse specialist.
(d) New graduates seeking first-time clinical nurse specialist approval in North Carolina shall hold a master's or doctoral degree or a post-master's certificate from a clinical nurse specialist program accredited by a nursing accrediting body approved by the U.S. Secretary of Education or the Council for Higher Education Accreditation and shall meet all requirements in Subparagraph (b)(1) and Part (g)(3)(A) of this Rule.
(e) A clinical nurse specialist seeking Board approval who has never practiced as a clinical nurse specialist or has not practiced in more than two years shall complete a clinical nurse specialist refresher course approved by the Board in accordance with 21 NCAC 36 .0220(o) and (p), consisting of common conditions and their management related to the clinical nurse specialist's area of education and certification. A clinical nurse specialist refresher course participant shall be granted limited clinical nurse specialist recognition that is specific to clinical activities taught in the refresher course.
(f) The scope of practice of a clinical nurse specialist shall incorporate the basic components of nursing practice as defined in Rule .0224 of this Section as well as the understanding and application of nursing principles at an advanced practice registered nurse level in the area of clinical nursing specialization in which the clinical nurse specialist is educationally prepared and for which competency is maintained, including:
(1) assessing clients' health status, synthesizing and analyzing multiple sources of data, and identifying alternative possibilities as to the nature of a healthcare problem;
(2) diagnosing and managing clients' acute and chronic health problems within an advanced practice nursing framework;
(3) assessing for and monitoring the usage and effect of pharmacologic agents within an advanced practice nursing framework;
(4) formulating strategies to promote wellness and prevent illness;
(5) prescribing and implementing therapeutic and corrective non-pharmacologic nursing interventions;
(6) planning for situations beyond the clinical nurse specialist's expertise and consulting with or referring clients to other health care providers as appropriate;
(7) promoting and practicing in collegial and collaborative relationships with clients, families, other health care professionals, and individuals whose decisions influence the health of individual clients, families, and communities;
(8) initiating, establishing, and using measures to evaluate health care outcomes and modify nursing practice decisions;
(9) assuming leadership for the application of research findings for the improvement of health care outcomes; and
(10) integrating education, consultation, management, leadership, and research into the clinical nurse specialist role.
(g) A registered nurse seeking approval by the Board as a clinical nurse specialist shall:
(1) complete the appropriate application that includes the following:
(A) evidence of a master's or doctoral degree or a post-master's certificate, as set out in Subparagraph (b)(3) or Paragraph (d) of this Rule; and either
(B) evidence of current certification in a clinical nursing specialty from a national credentialing body, set out in Part (b)(4)(A) of this Rule; or
(C) meet requirements set out in Part (b)(4)(B) of this Rule;
(2) renew the approval every two years at the time of registered nurse renewal; and
(3) either:
(A) submit evidence of initial certification and re-certification by a national credentialing body at the time such occurs in order to maintain Board recognition, consistent with Paragraphs (b) and (h) of this Rule; or
(B) if subject to Part (b)(4)(B) of this Rule, submit evidence of at least 1,000 hours of practice and 75 contact hours of continuing education every five years.
(h) The Board shall approve those national credentialing bodies offering certification and recertification in a clinical nursing specialty that have established the following minimum requirements:
(1) active unencumbered licensure as a registered nurse; and
(2) certification as a clinical nurse specialist that is limited to applicant prepared with a master's or doctoral degree or a post-master's certificate.

21 N.C. Admin. Code 36 .0228

Authority G.S. 90-171.20(4); 90-171.20(7); 90-171.21(d)(4); 90-171.23(b); 90-171.27(b); 90-171.42(b);
Eff. April 1, 1996;
Amended Eff. April 1, 2008; January 1, 2007; November 1, 2005; August 1, 2005; April 1, 2003.
Amended by North Carolina Register Volume 29, Issue 15, February 2, 2015 effective 1/1/2015.
Readopted by North Carolina Register Volume 33, Issue 15, February 1, 2019 effective 1/1/2019.
Amended by North Carolina Register Volume 35, Issue 11, December 1, 2020 effective 11/1/2020.