Practice - Basic Guidelines for Development of a Course in Diagnosis and Management of Problems in the Clinical Specialty Area for Clinical Nurse Specialists

Rule 222.1(6) defines a diagnosis and management course as:

A course offering both didactic and clinical content in clinical decision-making and aspects of medical diagnosis and medical management of diseases and conditions. Supervised clinical practice must include the opportunity to provide pharmacological and non-pharmacologic management of diseases and problems considered within the scope of practice of the advanced practice nurse’s specialty and role.

This definition must serve as the foundation for development of the course. The course must prepare the clinical nurse specialist to make medical diagnoses and medically manage individuals within the specialty area rather than aggregates. Although the course must be at least 45 clock hours (three semester credit hours) in length, it may be necessary for the course to be longer than 45 clock hours in order to include all appropriate content in a particular specialty area. Likewise, depending on the specialty area, more than one course may be necessary to ensure that content is addressed in appropriate detail.

Course Content:

• The focus of the course must be on the development of medical diagnoses rather than nursing diagnoses. The student must learn to formulate a differential diagnosis and develop an appropriate plan for management of the patient
• The course must include content covering the full scope of both acute and chronic diseases and conditions within the designated specialty area for which authorization is sought (e.g. medical-surgical, pediatric).
• The student must be prepared to treat individual patients rather than aggregates.
• The content must focus on the defined patient population that is appropriate to the authorized specialty area (e.g. pediatrics, adults, oncology)
• A minimum of 45 clock hours of content must focus on medical diagnosis and management of diseases and conditions. Content such as ICD-9 Coding, reimbursement, and marketing cannot be included as part of the minimum 45 clock hours
• Course content must be reviewed and reevaluated on an ongoing basis in order to verify that medical diagnosis and management content reflects the current standard of care. As standards of care change, course content must be updated to reflect these changes.

Course Materials:

• The required texts must include medical management texts appropriate for the specialty area. Texts must be reevaluated on an ongoing basis for currency.

Clinical Experiences:

• Clinical experiences should provide the student with an opportunity to make medical diagnoses and manage diseases and conditions within the full scope of the authorized specialty area (e.g. a clinical nurse specialist in pediatric nursing should not be limited to settings with only adolescent patients).
• Clinical nurse specialists who are functioning as clinical instructors must have limited prescriptive authority.

Faculty:

• Clinical nurse specialist faculty members whose teaching responsibilities include coordinating or teaching the diagnosis and management course(s) must have limited prescriptive authority.
• The course coordinator must be qualified to make medical diagnoses and medically manage diseases and conditions within the full scope of the clinical specialty area.
• Faculty members who are not clinical nurse specialists must be authorized to practice in a clinical specialty area that is appropriate for the content they are assigned to teach.

Adopted by the Texas Board of Nursing on January 24, 2003.

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