The plight of the psychiatric clinical nurse specialist: the dismantling of the advanced practice nursing archetype.

If there were an endangered species list for nursing practice, the psychiatric-mental health clinical nurse specialist (PMHCNS) would surely now be at the very top. Changes in the delivery of mental healthcare over the past 2 decades have clouded the value of the traditional PMHCNS role and pushed this specialist to the brink of extinction. The latest assault was the announcement by the American Nurses Credentialing Center (ANCC) in November 2011 that it was retiring the Adult and Child/ Adolescent Psychiatric Clinical Nurse Specialist examinations as well as the Adult Psychiatric and Mental Health Nurse Practitioner examination by 2014. Currently certified PMHCNSs can renew their credentials using clinical practice hours and professional development activities. American Nurses Credentialing Center is making these changes to the certification examinations as part of the implementation of the new Consensus Model for APRN (advanced practice registered nurse) Regulation: Licensure, Accreditation, Certification & Education, also known as the LACE or the APRN Consensus Model (www.nurse credentialing.org). After that date, any nurse wanting to pursue practice in advanced psychiatric nursing will have only 1 optionVthe Family Psychiatric Nurse Practitioner (across the life span) certification. With this announcement, we fear that the remaining PMHCNS programs will transition to nurse practitioner (NP) programs, leaving those of us who proudly hold the CNS credential to join the ranks of the endangered species. This would be particularly troublesome for child and adolescent psychiatric CNSs whose patient population lacks an adequate number of providers. Many CNSs are now asking how this could happen to the first and historically one of the most influential nursing specialty groups, is it inevitable, and what can we do about it?