In this chapter, the following terms have the meanings indicated. Terms Defined. “Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as: A certified nurse midwife (CNM); A certified registered nurse anesthetist (CRNA); A certified nurse practitioner (CRNP); or A clinical nurse specialist (CNS). “Board” means the Board of Nursing. “Certification” means the permission to practice as a clinical nurse specialist granted by the Board to a registered nurse who: Met all the specified requirements of a national certifying body recognized by the Board; and Complied with the requirements of this chapter. “Clinical nurse specialist” means an advanced practice registered nurse certified by the Board to practice as a clinical nurse specialist in this State. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “Registered nurse (RN)” means an individual who: Is licensed by the Board to practice registered nursing; or Has a multistate licensure privilege to practice registered nursing. “Standard of care” means the practice of clinical nurse specialist in accordance with the core competencies and behaviors specified by the National Association of Clinical Nurse Specialists (NACNS), American Nurse Credentialing Center (ANCC), American Association of Critical Care Nurses (AACN), or other national certifying body recognized by the Board. “System” means the setting within which the clinical nurse specialist is practicing. An applicant for certification as a clinical nurse specialist shall: Hold a current Maryland license in good standing to practice registered nursing or a multistate licensure privilege to practice registered; Have graduated from a Board-approved graduate level education program for a clinical nurse specialist at the master’s level or higher that is accredited by; The National League for Nursing Accreditation Commission (NLNAC); The Commission on Nursing Education (CCNE); or Any other accrediting body recognized by the Board; Successfully complete a national certifying exam recognized by the Board for national certification as a clinical nurse specialist in the applicant’s area of practice; Hold a current national certification as a clinical nurse specialist from a national certifying body recognized by the Board; Submit to the Board a completed application for certification as a clinical nurse specialist on a form required by the Board; Comply with all requirements set forth in COMAR 10.27.01.04; Demonstrate oral and written competency in the English language; and Pay all fees. Beginning on October 1, 2012, as long as the applicant remains certified and in good standing, the Board shall deem that an applicant meets the qualifications to be certified as a clinical nurse specialist if the applicant has: Been licensed as a registered nurse in Maryland or has a multistate privilege to practice registered nursing; Obtained a master’s degree or higher in Nursing; Practiced as a clinical nurse specialist; and One of the following: An active certification as a clinical nurse specialist from a national certification body recognized by the Board; An active national certification at the highest level in the applicant’s area of practice; or A national certification at the highest level in the applicant’s area of subspecialty. Certification as a clinical nurse specialist expires at the same time as the clinical nurse specialist’s registered nursing license. Before a clinical nurse specialist’s certification expires, the clinical nurse specialist may renew the certification biennially if the clinical nurse specialist: Is otherwise entitled to be certified; Submits to the Board: A completed renewal application for clinical nurse specialists on a form that the Board requires; and Documentation of current national certification as a clinical nurse specialist from a national certifying body recognized by the Board; and Pays all fees. Clinical nurse specialists renewal applicants who are authorized to practice registered nursing in this State under a multistate licensure privilege shall be periodically required to submit to a criminal history records check in accordance with the schedule and requirements set forth in COMAR 10.27.01.13J — N. The clinical nurse specialist shall ensure that the Board has a record of the renewed national certification if the national certification expires before the registered nurse license renewal date. Certification as a clinical nurse specialist shall be deemed to have lapsed if the Board does not have a record of a current active national certification. Practicing on an expired national certification is prohibited and is subject to discipline under Health Occupations Article, §8-316(a), Annotated Code of Maryland. The unique role of the clinical nurse specialist is to: Integrate care across the continuum and through three spheres of impact: The patient; The nurse; and The system; and Ranges from: Wellness to illness; and Acute to chronic care. The clinical nurse specialist provides direct care to patients with complex needs, acts as a consultant, conducts research, and provides education and guidance for staff nurses. The practice of the clinical nurse specialist encompasses the continuous improvement of patient outcomes and nursing care. The clinical nurse specialist shall adhere to standards of clinical practice, scope of practice, and the standards of professional performance in accordance with this chapter. The scope of practice of the clinical nurse specialist includes, but is not limited to: Practicing with individual clients, families, groups, and populations of clients; Performing a comprehensive physical assessment of patients; Establishing medical diagnosis for common short-term and chronic stable health problems; Diagnosing, treating, and managing patients with acute and chronic illness or disease, or both; Ordering, performing, and interpreting laboratory tests; Ordering diagnostic tests and using the findings or results in the care of patients Initiating, monitoring, and altering appropriate therapies or treatments; Providing primary health care, including health promotion and disease prevention by assessing, educating, and providing referrals for the patient, family, and caregiver; Providing emergency care; Referring patients to appropriate licensed physicians or other health care providers as needed; Consulting or collaborating with a licensed physician or other health care provider as needed; and Creating therapeutic environments through mentoring and system changes to: Develop caring, evidence-based practices; Facilitate ethical decision making; Respond to diversity; and Alleviate patient distress. A registered nurse who has completed the education requirements for the advanced practice of a clinical nurse specialist and has registered for a national certifying exam recognized by the Board may practice in this State as a clinical nurse specialist graduate if the registered nurse has: A current license to practice registered nursing in this State or holds a multistate licensure privilege to practice registered nursing; Submitted a completed application for certification as a clinical nurse specialist graduate; and Submitted satisfactory evidence that the applicant has applied to take a national certifying exam recognized by the Board and has been accepted as a candidate for the exam. A clinical nurse specialist graduate shall practice under the direct supervision of a certified clinical nurse specialist. A clinical nurse specialist graduate shall cease practice immediately if the clinical nurse specialist graduate fails the required national certification exam as required in Regulation .02A(3) of this chapter. A clinical nurse specialist graduate who fails the national certification exam may continue to work as a registered nurse until the clinical nurse specialist graduate passes a national certifying exam for clinical nurse specialist. Unless authorized to practice under this chapter, an individual may not use the following words or abbreviations: Certified clinical nurse specialist; Clinical nurse specialist (CNS); Clinical Registered Nurse Specialist (CRNS); Clinical nurse specialist graduate; or Nurse specialist graduate. An individual certified under this chapter shall be subject to disciplinary prohibitions and sanctions set forth under Health Occupations Article, §§8-316 and 8-701 — 8-703, Annotated Code of Maryland. Health Occupations Article, §§8-205(a)(1), (2), (4), and (5) and 8-302(b)(1)(iii) and (2)(ii), Annotated Code of Maryland Effective date: October 1, 2012 (39:19 Md. R. 1236) Regulation .02D amended as an emergency provision effective September 1, 2014 (41:19 Md. R. 1074); emergency status expired effective February 27, 2015 Regulation .02C, D repealed effective April 13, 2015 (42:7 Md. R. 569) Chapter revised effective July 2, 2018 (45:13 Md. R. 667) Regulation .01B amended effective November 14, 2022 (49:23 Md. R. 996) Regulation .04 amended effective November 14, 2022 (49:23 Md. R. 996)