Subchapter H. CLINICAL NURSE SPECIALISTS
GENERAL PROVISIONS Sec.
21.801. Definitions.
21.802. Scope.
21.803. Applicability of rules relating to professional nurses.
21.804. Approved educational programs.
21.805. Fees.
CERTIFICATION REQUIREMENTS
21.811. Qualifications for initial certification.
21.812. Qualifications for certification by endorsement; additional certification.
21.813. Application for certification.
MAINTENANCE OF CERTIFICATION
21.821. CNS standards of conduct.
21.822. Biennial renewal of certification.
21.823. CNS-level continuing education; waiver; sanctions.
21.824. Inactive status and reactivation.
21.825. Sources of continuing education.
21.826. Requirements for continuing education courses.
21.827. Continuing education course approval.
21.828. CNS responsibilities.
PENALTIES FOR VIOLATION
21.831. Penalties for violations.
Authority The provisions of this Subchapter H issued under The Professional Nursing Law (63 P.S. § § 211—225.5), unless otherwise noted.
Source The provisions of this Subchapter H adopted July 16, 2010, effective July 17, 2010, 40 Pa.B. 3944, unless otherwise noted.
GENERAL PROVISIONS
§ 21.801. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the content clearly indicates otherwise:
Act—The Professional Nursing Law (63 P.S. § § 211—225.5), which provides for the certification of CNSs.
Approved—Approved by the Board.
Approved program—Those educational programs accredited by the NLNAC or CCNE for preparing a professional nurse to practice as a CNS.
Board—The State Board of Nursing of the Commonwealth.
Board-designated specialty—One of six patient populations, including neonatal, pediatrics, family/across the lifespan, adult/gerontology, women’s health/gender-related and psychiatric/mental health.
Board-recognized—The Board has determined that an entity meets the Board’s quality standards to conduct an activity and has named the entity on the Board’s web site.
Certification—Certification as a CNS issued by the Board.
CCNE—Commission on Collegiate Nursing Education—The organization recognized by the United States Secretary of Education as a National accreditation agency that provides a nongovernmental peer review process in accordance with Nationally recognized standards established for the practice of accreditation in the United States.
CNS—Clinical nurse specialist—An individual licensed in this Commonwealth to practice professional nursing who meets the educational and examination or equivalency requirements of the act and who is certified by the Board as a clinical nurse specialist.
NLNAC—National League for Nursing Accrediting Commission—The organization that is recognized as the accrediting body for all types of nursing education programs by the United States Department of Education and that is responsible for the specialized accreditation of nursing education programs, both postsecondary and higher degrees.
National certification—The credential awarded by a Board-recognized organization evidencing that an individual has passed a National certification examination and has maintained current National certification in a specialty as specified by the organization.
National certification organization—An organization recognized by the Board and maintained on the approved list on the Board’s website that has as one of its purposes the examination of individuals who will practice as CNSs.§ 21.802. Scope.
In this subchapter, the Board:
(1) Provides for certification of CNSs who meet the qualifications set forth in the act.
(2) Administers the act by providing rules and regulations relating to the issuance and renewal of CNS certification.
(3) Provides rules and regulations for the conduct of CNSs.
(4) Regulates the practice of CNSs.
§ 21.803. Applicability of rules relating to professional nurses.
Sections 21.1—21.4a, 21.6 and 21.11—21.18a apply to nurses certified under this subchapter.
§ 21.804. Approved educational programs.
(a) The Board will approve educational programs as set forth in section 6.2(c) of the act (63 P.S. § 216.2(c)).
(b) The Board will maintain a list of approved educational programs on its web site as set forth in section 6.2(c)(2) of the act.
(c) Educational programs that prepare nurses to practice as CNSs created after March 20, 2008, shall submit evidence that the program meets the criteria in section 6.2(c)(1) of the act to the Board for inclusion on the list of approved programs.
§ 21.805. Fees.
(a) The following application fees are charged by the Board:
Certification as a CNS… $115
Biennial renewal fee… $56
Restoration of certificate after suspension or revocation… $60
Reactivation of inactive or lapsed certificate (5 years or longer)… $50
Verification of certification … $45
Verification of certification with history… $50
Approval of each hour of CNS continuing education activity by sources not listed in § 21.825(a) (relating to sources of continuing education)… $115
Renewal of approval of CNS continuing education activity by sources not listed in § 21.825(a) … $35
(b) In addition to the application fee prescribed in subsection (a), which is payable directly to the Board, a candidate for National certification will also pay an additional fee to the certifying organization. A candidate may contact the certifying organization for more information regarding the National certification examination and examination fee.
Authority The provisions of this § 21.805 amended under section 11.2(a) and (b) of The Professional Nursing Law (63 P.S. § 221.2(a) and (b)); section 17.5(a) and (b) of the Practical Nurse Law (63 P.S. § 667.5(a) and (b)); and section 810(a)(3) and (7) of The Administrative Code of 1929 (71 P.S. § 279.1(a)(3) and (7)).
Source The provisions of this § 21.805 amended July 26, 2019, effective July 27, 2019, 49 Pa.B. 3891. Immediately preceding text appears at serial pages (385261) to (385262).
Cross References This section cited in 49 Pa. Code § 21.811 (relating to qualifications for initial certification); 49 Pa. Code § 21.813 (relating to application for certification); 49 Pa. Code § 21.822 (relating to biennial renewal of certification); 49 Pa. Code § 21.825 (relating to sources of continuing education); and 49 Pa. Code § 21.827 (relating to continuing education course approval).
CERTIFICATION REQUIREMENTS
§ 21.811. Qualifications for initial certification.
The Board may certify an applicant for initial certification who files an application on a form provided by the Board and pays the application fee in § 21.805 (relating to fees), in accordance with the following:
(1) RN license. The Board may certify an applicant who has a current, unrestricted license to practice professional nursing in this Commonwealth.
(2) Education. The Board may certify an applicant who has a master’s degree, doctoral degree or post-master’s degree or certificate in nursing from an educational program that meets the requirements of section 6.2(c)(1) of the act (63 P.S. § 216.2(c)(1)).
(3) Alternative education. An applicant for initial certification who completed an educational program in a related discipline previously recognized for National certification as a CNS may be granted certification from the Board in the area of the applicant’s current National certification from the American Nurses Association or the American Nurses Credentialing Center.
(4) National certification or equivalence.
(i) The Board may grant initial certification in a Board-designated specialty or other pertinent specialty to an applicant who demonstrates current National certification by examination.
(ii) The Board may grant initial certification without specialty to applicants who demonstrate that their educational program does not make them eligible to take a National certification examination and who demonstrate equivalence. For purposes of this section, the Board will determine equivalence on a case-by-case basis after considering the information submitted by the applicant that may include an official transcript, course descriptions, current curriculum vitae, work history in the CNS role, professional recommendations and additional advanced nursing education and certification examinations.
(5) Mandatory training in child abuse recognition and reporting. An applicant for initial certification shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
Authority The provisions of this § 21.811 amended under section 2.1(k) of The Professional Nursing Law (63 P.S. § 222.1(k)); section 17.6 of the Practical Nurse Law (63 P.S. § 667.6); and 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 21.811 amended March 25, 2022, effective March 26, 2022, 52 Pa.B. 1916. Immediately preceding text appears at serial pages (396914) and (385263).
Cross References This section cited in 49 Pa. Code § 21.813 (relating to application for certification).
§ 21.812. Qualifications for certification by endorsement; additional certification.
(a) Certification by endorsement. An applicant for certification by the Board who holds an unrestricted license, certificate or authorization to practice as a CNS from another state, territory or possession of the United States or a foreign country, who met initial certification requirements equivalent to the Board’s certification requirements and a current RN license in this Commonwealth may be granted certification by endorsement. An applicant for initial certification by endorsement shall have completed at least 3 hours of approved training in child abuse recognition and reporting in accordance with § 21.508(a) (relating to child abuse recognition and reporting—mandatory training requirement).
(b) Additional certification. A CNS who is already certified by the Board may apply for an additional certification. To be granted an additional certification, the CNS shall meet the educational and National certification requirements for the additional certification.
Authority The provisions of this § 21.812 amended under section 2.1(k) of The Professional Nursing Law (63 P.S. § 222.1(k)); section 17.6 of the Practical Nurse Law (63 P.S. § 667.6); and 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 21.812 amended March 25, 2022, effective March 26, 2022, 52 Pa.B. 1916. Immediately preceding text appears at serial page (385263).
Cross References This section cited in 49 Pa. Code § 21.813 (relating to application for certification).
§ 21.813. Application for certification.
(a) An applicant for certification shall submit an application form provided by the Board to the Board for its review and approval.
(b) An applicant for initial certification shall include documentation satisfactory to the Board that the applicant meets the qualifications in § 21.811 (relating to qualifications for initial certification).
(c) In addition to the documentation in subsections (a) and (b), an applicant for certification by endorsement shall include documentation satisfactory to the Board that the applicant meets the educational qualifications in § 21.812(a) (relating to qualifications for certification by endorsement; additional certification) and the following:
(1) Verification of unrestricted licensure, certification or authority to practice as a professional nurse and CNS issued by the proper licensing authority of another state, territory or possession of the United States or a foreign country.
(2) A written statement from the out-of State licensing, credentialing or authorizing entity setting forth the licensure, certification or authorization to practice requirements at the time the applicant was first licensed, certified or authorized to practice by that entity.
(d) An applicant who holds certification from the Board who is applying for an additional certification under § 21.812(b) shall submit, in addition to the documentation required under subsections (a) and (b), documentation of the following:
(1) Official transcript from the applicant’s CNS program and any additional educational programs, including degree awarded, demonstrating a concentration in the specialty in which the applicant is seeking certification.
(2) Proof of current National certification as a CNS.
(e) An applicant shall remit the certification fee in § 21.805 (relating to fees).
(f) An applicant shall verify compliance with section 8.5(e) of the act (63 P.S. § 218.5(e)) on the application for certification.
(g) An applicant shall submit additional information as identified on the application or as requested in writing by the Board. If supporting material is not provided within 12 months of the date of application, the applicant will be required to file a new application and remit the certification fee.
MAINTENANCE OF CERTIFICATION
§ 21.821. CNS standards of conduct.
(a) In addition to the standards of conduct for a professional nurse set forth in § 21.18 (relating to standards of nursing conduct), a CNS shall perform only those services that comprise the practice of professional nursing as defined in section 2(1) of the act (63 P.S. § 212(1)).
(b) A CNS practicing in this Commonwealth shall maintain a level of professional liability coverage as set forth in section 8.5(e) of the act (63 P.S. § 218.5(e)).
§ 21.822. Biennial renewal of certification.
(a) The certification of a CNS will expire at the same time as the CNS’s professional nursing license as provided in § 21.29 (relating to expiration and renewal of license).
(b) Notice of application for renewal will be forwarded biennially to each active CNS at the CNS’s address of record with the Board prior to the expiration date of the current biennial period.
(c) As a condition of biennial renewal, a CNS shall hold a valid, unexpired and unrestricted professional nursing license.
(d) As a condition of biennial renewal, a CNS shall complete a minimum of 30 hours of Board-approved continuing education, in the 2 years prior to renewal as required under section 8.5(c)(2) of the act (63 P.S. § 218.5(c)(2)), unless the requirement is waived by the Board under § 21.823(b) (relating to CNS-level continuing education; waiver; sanctions) or the CNS’s certification is on inactive status. At least 2 of the required 30 hours must be completed in approved training in child abuse recognition and reporting in accordance with § 21.508(b) (relating to child abuse recognition and reporting—mandatory training requirement).
(e) The applicant shall remit the required renewal fee in § 21.805 (relating to fees) with the applicant’s renewal application forms. Upon approval of the renewal application, the CNS will receive a certification for the current renewal period.
Authority The provisions of this § 21.822 amended under section 2.1(k) of The Professional Nursing Law (63 P.S. § 222.1(k)); section 17.6 of the Practical Nurse Law (63 P.S. § 667.6); and 23 Pa.C.S. § 6383(b)(2).
Source The provisions of this § 21.822 amended March 25, 2022, effective March 26, 2022, 52 Pa.B. 1916. Immediately preceding text appears at serial pages (385264) and (396915).
§ 21.823. CNS-level continuing education; waiver; sanctions.
(a) In lieu of meeting the RN continuing education requirements of section 12.1(b) of the act (63 P.S. § 222(b)), a CNS may submit proof of completion of the CNS continuing education requirement set forth in section 8.5(c)(2) of the act (63 P.S. § 218.5(c)(2)).
(b) The Board may waive the requirements of continuing education in cases of illness or undue hardship. It is the duty of each licensee who seeks a waiver to notify the Board in writing and request the waiver at least 90 days prior to the end of the renewal period. The Board will grant, deny or grant in part the request for waiver.
(c) An individual failing to meet the continuing education requirements for a biennial period will be sanctioned in accordance with § 43b.18a (related to schedule of civil penalties for nurses).
Cross References This section cited in 49 Pa. Code § 21.822 (relating to biennial renewal of certification).
§ 21.824. Inactive status and reactivation.
A CNS who places the CNS’s certification on inactive status is not required to meet the continuing education requirements in section 8.5(c)(2) of the act (63 P.S. § 218.5(c)(2)) during the period the certification is on inactive status. Upon application for reactivation of certification, the CNS shall provide the documentation in § 21.828(b) (relating to CNS responsibilities) to demonstrate that the CNS has met the continuing education requirements for the biennial period immediately preceding the request for reactivation.
§ 21.825. Sources of continuing education.
(a) The following providers of continuing education and credentialing organizations have currently met the standards for course approval for continuing education and, provided that these providers and credentialing organizations comply with § § 21.826 and 21.827 (relating to requirements for continuing education courses; and continuing education course approval), they are preapproved to offer creditable continuing education, subject to reevaluation as set forth in subsection (b):
(1) Board-approved CNS educational programs and CNS educational programs approved by other state boards of nursing or that hold current accreditation issued by a National nursing accreditation organization.
(2) National and international nursing organizations and their state and local affiliates.
(3) National and international medical and osteopathic organizations and their state and local affiliates.
(4) National pharmaceutical organizations and their state and local affiliates.
(5) National nursing specialty organizations and programs accredited by National nursing accrediting associations.
(6) Continuing education programs approved by other state boards of nursing for advanced practice nurses or CNSs.
(b) The approval given to the providers and credentialing organizations in subsection (a) is subject to reevaluation. A rescission of provider or credentialing organization approval will be made in accordance with 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure) or by amendment of this section.
(c) CNSs may obtain credit for continuing education offered by providers not indicated in subsection (a) if the provider obtains Board approval of the continuing education prior to its implementation, or the CNS obtains Board approval of the continuing education prior to attending the continuing education. A continuing education provider or CNS may obtain Board approval of continuing education by submitting an application for approval, the fee in § 21.805 (relating to fees) and the supporting documentation in § 21.827(b) at least 90 days prior to the course.
(d) CNSs may obtain credit for correspondence courses, taped study courses, and other independent or online study courses if the course is approved under subsection (c).
(e) Up to 4 hours may be approved under subsection (c) for service as a teacher in a nursing education program, preceptor providing direct clinical supervision in a specialty area, lecturer or speaker and for publication in a refereed journal or other scholarly publication relating to the CNS’s area of practice.
(f) An hour for the purposes of CNS continuing education is 50 minutes.
(g) The Board will apply § 21.132(b) (relating to continuing education hours) to determine the number of hours awarded for academic coursework.
Cross References This section cited in 49 Pa. Code § 21.805 (relating to fees); 49 Pa. Code § 21.827 (relating to continuing education course approval); and 49 Pa. Code § 21.828 (relating to CNS responsibilities).
§ 21.826. Requirements for continuing education courses.
Each course must have:
(1) An established mechanism to measure its quality, established criteria for selecting and evaluating faculty, and established criteria for the evaluation of each participant who completes the course.
(2) An adequate physical facility and appropriate instructional materials to carry out the continuing education course.
(3) An instructor whose area of expertise is in the subject matter being taught.
Cross References This section cited in 49 Pa. Code § 21.825 (relating to sources of continuing education).
§ 21.827. Continuing education course approval.
(a) As a condition of approval, providers and credentialing organizations are required to provide CNSs who complete continuing education courses with a certificate of completion which contains the information in § 21.828(a) (relating to CNS responsibilities).
(b) Providers or CNSs requesting Board approval for continuing education as set forth in § 21.825(c) (relating to sources of continuing education) shall pay the fee in § 21.805 (relating to fees) and submit the following information to the Board:
(1) The full name and address of the provider.
(2) The title of the program.
(3) The dates and location of the program.
(4) The faculty names, titles, affiliations, degrees and areas of expertise.
(5) The schedule of the program—title of subject, lecturer and time allocated.
(6) The total number of hours requested.
(7) The method of certifying and assuring attendance, and draft of certificate of attendance to be provided to course participants.
(8) The course objectives.
(9) The target audience.
(10) The core subjects.
(11) The instruction and evaluation methods.
(c) Providers shall submit other information requested by the Board.
(d) The provider shall provide CNSs who successfully complete a course with a certificate of attendance.
(e) A separate application shall be submitted whenever a change is made to any information submitted under subsection (b), except for information related to a change in date or location, or both.
Cross References This section cited in 49 Pa. Code § 21.825 (relating to sources of continuing education).
§ 21.828. CNS responsibilities.
(a) A CNS is required to maintain documentation of completion of continuing education, including:
(1) CNS’s name.
(2) Dates attended.
(3) Continuing education hours.
(4) Title of course.
(5) Course provider.
(6) Location of course.
(b) Primary responsibility for documenting completion of the continuing education requirements rests with the CNS. A CNS seeking to renew certification shall verify compliance with continuing education requirements. Certificates of attendance and other documentation of completion of continuing education requirements must be maintained for 5 years. The Board approval letter sent to the applicant will be considered acceptable documentation of hours obtained through § 21.825(c) or (e) (relating to sources of continuing education).
(c) Falsification of information required under this section or failure to complete the continuing education requirements by those who continue to practice as CNSs may result in the institution of formal disciplinary action under section 14(a)(3) of the act (63 P.S. § 221(a)(3)) and § 21.831(3) (relating to penalties for violations).
Cross References This section cited in 49 Pa.B. § 21.824 (relating to inactive status and reactivation); and 49 Pa.B. § 21.827 (relating to continuing education course approval).
PENALTIES FOR VIOLATION
§ 21.831. Penalties for violations.
Certification as a CNS may be suspended, revoked or otherwise restricted, and the Board may order remedial measures when, after notice and opportunity to be heard, the Board finds that:
(1) The CNS has engaged in medical diagnosis or the prescription of medical therapeutic or corrective measures prohibited under section 8.6(a) of the act (63 P.S. § 218.6(a)).
(2) The CNS has performed a service beyond the scope of practice of professional nursing as defined in section 2(1) of the act (63 P.S. § 212(1)).
(3) The CNS has violated the act or this subchapter, or engaged in any conduct prohibited for professional nurses.
Cross References This section cited in 49 Pa.B. § 21.828 (relating to CNS responsibilities).
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