title: The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.
abstract: OBJECTIVE
  The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007.
  
  
  METHODS
  The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes.
  
  
  RESULTS
  On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses.
  
  
  CONCLUSIONS
  Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.
authors.affiliation: Author Affiliations: Customer Success ClinOps Specialist, Health Catalyst, Salt Lake City, Utah; Director of Nursing Projects, PeaceHealth, Vancouver, Washington; and Pro tem, Nursing Quality Assurance Commission, Washington State Department of Health, Tumwater.
authors.forename: Heather
authors.initials: H
authors.lastname: Schoonover
mesh_terms: D049674:History, 21st Century; D006801:Humans; D008008:Licensure, Nursing / Q000266:history* / Q000331:legislation & jurisprudence*; D009720:Nurse Clinicians / Q000331:legislation & jurisprudence*; D014861:Washington