DOI: 10.1097/NUR.0b013e3181e3626a

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PMID: 20526123

Issn Print: 0887-6274

Publication Date: 2010/07/01


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A Journey Toward Clinical Nurse Specialist Recognition by Medicare: Benefits of Core Clinical Nurse Specialist Certification

JEFFREY ALBAUGH

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Excerpt

Clinical nurse specialists (CNSs) face challenges in terms of certification because there are so many different nursing specialties, and developing and maintaining certification examinations are expensive. Certification may be necessary for licensure in some states and also is necessary for recognition as a Medicare provider. The core examination tests competencies expected and required for the role of the CNS across the life span regardless of specialty. This examination does not replace specialty examinations such as the one I took in urology, but may be used in addition to a specialty examination for further recognition through various agencies such as Medicare. This article describes my journey toward Medicare recognition, which involved developing and implementing a core CNS examination.
I began my career in nursing almost 25 years ago and started that journey as a spinal-cord nurse working in a 5-bed intensive care unit and 14-bed step-down unit. Many of our spine-injured patients had issues with bowel, bladder, and sexual function. Oftentimes, a cystometrogram would be performed on patients at the bedside to determine bladder capacity and function. A urology nurse would come in and fill that bladder while noting any sensations to urinate and monitoring bladder pressure to determine if the bladder contracted when filled to capacity. I would assist the nurse and found this testing very interesting. Several years later, after I was working in ambulatory surgery, the urology nurse in charge of bladder testing decided to take a job in another institution. In about 1993, I was approached by a urologist who asked me if I had any interest in coming to work in urology. I told him I would be willing to give it a try, and that began my love affair with urology nursing. In 2002, I completed my master's degree and took the urology certification examination to become a board-certified urology clinical nurse specialist (CNS). The examination was through the Certification Board of Urology Nurses and Associates. I passed the examination and began working as an outpatient urology CNS.
My role in urology was to perform urodynamic testing of the bladder, oversee bladder training and biofeedback, evaluate and manage urinary incontinence, and to evaluate and manage sexual dysfunction. I have had full prescriptive privileges in Illinois and also a drug enforcement agency number because testosterone is a controlled substance and may be part of the treatment regimen for sexual dysfunction. Although I worked primarily with outpatients, I was employed by the hospital, and all my billing was done through the hospital. I did not need my own Medicare provider number at that time.
My role changed and evolved as I continued to work with men with sexual dysfunction to include evaluation and management of female sexual dysfunction as well. The sexual health clinic expanded to serve more women in addition to the many men with sexual dysfunction. After discussion with multiple stakeholders in the institution, it was decided that my sexual health clinic would be best positioned in the wellness institute rather than in urology, so that my female patients would feel more comfortable coming to the clinic.
At that point, I began working in an outpatient clinic, and I needed to bill for my services as an independent practitioner. I have licensure as a urology CNS in the state of Illinois, yet when I went to apply for my Medicare provider number, I was told that my certification in urology was not recognized or accepted, and I was denied a provider number. When I called to inquire about this, I was told I would need to take one of the accepted certification examinations.
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