American Association of Critical Care Nurses

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American Association of Critical Care Nurses
AACN Certification Corporation

• Standards and Certification of the Clinical Nurse
  Specialist in Acute and Critical Care the
  Evolution of a Specialty

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Regulation

• Regulation of advanced practice nursing is
  accomplished through statutes, the rules and
  regulations of state nurse practice acts,
  certification, peer review and self-regulation.
  Nurse practice acts are administered under the
  authority of state governments to assure public
  safety.

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Educational Preparation

• Education of the CNS is at the graduate level in
  nursing. The education program assists the CNS to
  integrate the collaborative model of care into a
  coordinated patient management plan and develop
  competencies within each of the spheres of
  influence of the CNS. The curriculum requirements
  are delineated in The Essentials of Masters
  Education for Advanced Practice Nursing

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Educational Preparation

• The advanced practice nursing student prepared in
  a direct care provider role must receive
  sufficient clinical experience to provide depth
  and breadth in a given specialty or with
  designated populations. The acute and critical
  care CNS program should provide sufficient
  clinical experiences to prepare the graduate to
  provide for public safety.

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Educational Preparation

• When preparing a graduate who will provide direct
  client care, make diagnoses, prescribe, and
  assume accountability for clinical care, the
  educational program should provide the student
  with opportunity to master knowledge of
  healthcare problems and to apply these skills in
  extensive clinical practice. They should have a
  minimum of 500 hours in direct clinical practice
  during the educational program.

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Certification

• Certification of the CNS is recognition of
  competence made by the profession. One component
  of certification is eligibility, related to
  successful completion of the program of study,
  course content, and specified amount of
  supervised clinical practice. The other
  component of certification is knowledge
  determined by passing a written examination that
  tests the knowledge base for the selected area of
  advanced practice.

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Certification

• Through use of a consistent definition for the
  acute and critical care CNS, criteria to review
  and assess competence for CNS practice, and CNS
  educational requirements, certification will
  assure the public that the acute and critical
  care CNS meets consistent standards of quality.

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Licensure

• The CNS is licensed to practice as a registered
  nurse in the state in which the nurse practices
  and is subject to the states legal constraints
  and regulations. Many states have additional
  requirements that the CNS must satisfy to
  practice or be recognized.

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Advanced Practice Licensure

• State Boards of Nursing which utilize the CCNS
  examination as one criterion for advanced
  practice licensure or designation include
  Alabama, California, Connecticut, Idaho,
  Illinois, Iowa, Kentucky, Louisiana, Minnesota,
  Missouri, Montana, New Jersey, New Mexico, North
  Carolina, North Dakota, Ohio, Oklahoma, South
  Dakota, Texas, Utah, Virginia and Wisconsin.

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Specialization

• The acute and critical care CNS practices in any
  setting in which patient care requirements
  include complex monitoring and therapies,
  high-intensity nursing intervention, or
  continuous nursing vigilance within the full
  range of high acuity care.

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Prescriptive Authority

• The CNS provides direct patient care, such as
  assessing, diagnosing, planning and intervening,
  which includes prescribing pharmacologic as well
  as non-pharmacologic treatment of health
  problems.

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Nurse Competency CNS ACNP

• 22 45
• 7 5
• 11 10
• 14 13
• 8 6
• 4 4
• 13 7
• 21 10

• Clinical Judgment
• Advocacy/Moral Agency
• Caring Practices
• Collaboration
• Systems Thinking
• Response to Diversity
• Clinical Inquiry
• Facilitation of Learning

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Evolution of a Specialty

• Early 1960s - cardiac units open, patient
  outcomes improve
• Mid-1960s nurses take over care of critical
  patients
• 1969 American Association of Cardiovascular
  Nurses (AACN) formed
• 1971 name changed to American Association of
  Critical-Care Nurses

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Evolution of a Specialty

• 1975 AACN Certification Corporation is
  established
• 1976 First administration of the CCRN
  certification examination
• 1984 First role delineation study conducted by
  a nursing certification organization to validate
  CCRN exam
• 1989 - Competence Statements for Critical Care
  Clinical Nurse Specialists developed by AACN CNS
  special interest group and adopted by AACN Board
  of Directors

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Evolution of a Specialty

• 1993 AACN Synergy Model for Patient Care
  introduced
• 1995 - ACNP Scope and Standards jointly developed
  by AACN and ANA
• 1996 - Acute Care Nurse Practitioner
  certification examination jointly developed by
  AACN and ANCC

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Evolution of a Specialty

• 1997 CCRN job analysis indicates 40 of CCRNs
  are practicing outside of the traditional four
  walls of the ICU
• 1998 Job analysis conducted to study the role
  of the CNS in acute and critical care.
• 1999 AACN Certification Corporation launches
  Acute and Critical Care Clinical Nurse Specialist
  certification examination

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Evolution of a Specialty

• 2002 AACN publishes Scope of Practice and
  Standards of Professional Performance for the
  Acute and Critical Care Clinical Nurse Specialist
• 2003 Comprehensive study of critical care
  nursing practice compares CNS and ACNP practice,
  identifies entry-level critical care
  competencies, and defines nursing competencies
  for care of the progressive care patient

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Evolution of a Specialty

• 2004 Progressive Care generalist certification
  examination launched
• 2004 Job analyses begin on Cardiovascular and
  Cardiology subspecialty certification
  examinations
• 2005 Plan development of Nurse Practitioner
  certification examination and Interventional
  Cardiology subspecialty certification examination
• 2006 Plan development of Entry-level Critical
  Care certification examination.