Fate of the CNS degree

Jules A, MSN · Nov 7, 2015

If it survives, which I doubt, I don't think it will pay any more than academia. Not sure what the rates are at other places but the CNSs in my hospital, who are all older fwiw, make way less than what I make as a NP and they are relegated to social work tasks. In my experience and area, prescribing is where the money and opportunities are.

Trauma Columnist · Nov 7, 2015

Hi there. I can easily speak to this as I'm an adult health as well as peds CNS.

I practice in IL in an APRN role. In IL CNS=NP as to scope of practice. In school, we learned CNS is the "change agent." Well, at least from my perspective "change agents" is the first job cut from the fold.

I knew I wanted the APRN role, not a "change agent" or educator. If I had to do it all over I would have opted for the NP role. When I became an adult CNS (2006), there was no Consensus Model, no LACE (I believe that started in 2008). When I decided to go back for another post-MSN certification in order to see children, I chose the Peds CNS as it blended well with my adult health CNS.

The advantage to CNS is that per the Consensus Model you can work both in-pt and out-pt. The role I'm in now does both. FNP is supposedly only out-pt and primary care at that. However, I work with six APRNs: 3 FNPs, 3 CNSs (the other 2 CNSs are adult health).

A lot to think about before you make a decision.

Psychcns · Nov 7, 2015

I am a psych CNS. When i received my psych CNS there was no psych np. Now there is and psych np dominates as the psych advanced practice provider. There has been effort the last 10 years to standardize the CNS curriculum so all states will have the core competency courses to be eligible for prescriptive authority. The next step it would seem is for educators to look at both curriculums and role preparation. Is there a need for two advanced practice roles? How are they the same/different? How will health care change the next 10 years and is there a need for both roles? Will there eventually be a single payer system? Would that matter? More questions than answers but I am also interested in people's thoughts.

Jules A, MSN · Nov 7, 2015

Excellent points, I always forget that in other states CNSs' can prescribe.

Psychcns · Nov 7, 2015

CNS can prescribe in 36 states. The other thing I wonder about is whether there will be a conversation about the difference between psych PA and psych NP. I.e. Should they both come under medicine?? The original psych np was supposed to do physicals and then do a mental status and then diagnose and prescribe. Sounds like what the psych pa's say they do. It's all fluid and political.

Trauma Columnist · Nov 7, 2015

Yes, in IL I prescribe, have a DEA, NPI and bill just like all the NPs in my practice.

For me, moving is not an option (and I don't want to anyway), but when choosing an MSN program, portability is another factor. Since my husband is now retired from the USAF, we don't move but would have considered this if he was still active duty and/or in a mobile career.

Personally, I would have chosen ACNP and PACNP (adult and peds acute care NP) programs as I enjoy both in-pt and out-pt.

meanmaryjean, DNP, RN · Nov 7, 2015

I see tremendous value in the CNS role, unfortunately hospitals in my area do not. Case in point: less than two years ago, my large system employed nearly a dozen CNS, and they were specialized by population. (In Indiana, CNS do not have prescriptive authority)Our peds CNS went back and became an NP and now practices in the PICU.

We had a CNS intern and another peds RN both enrolled in CNS Peds program.

First, the hospital eliminated the position of CNS Director (our only PhD RN).

Then they told the two students that there were not positions for them upon graduation. So, no peds CNS at all.

Then the oncology CNS completed her PhD and left for a more suitable position in academia.

Then, the powers that be re-assigned all of the CNS to be basically The Bundle Police. In their infinite wisdom, the geriatric CNS was assigned the children's hospital.

Finally, three more have left for other positions and/or NP school. Our once vibrant nursing research department is in shambles, and nearly all of the others are either looking at retirement or other employment.

Once the bean counters can't see the value in a position, the position is in danger. I fear that is what will happen to the CNS role. Sadly.

ExploringNurse · Nov 7, 2015

All definitely great information, and I appreciate it immensely.

Trauma, I live in IL too, but plan on moving out in next 3 to 4 years.

What is the consensus model? I read about it here and there but can never find a good explanation in lame terms. Also, LACE? how do they two terms affect the practice e of an NP? I am not against the NP route, but do not want to be stuck in an urgent care clinic where all that matters is numbers. I get numbers being important, but most make it trump quality care. I would do agnp, because hours, holidays and weekends are important to me as well. I am also worried about the NP market to come. When I went to search for CNS programs near me, I found 2 or 3. When I searched NP programs, I found 10 to 15.

Maryjean, great post, and it is true for most positions that bean counters deem worthless.

Trauma Columnist · Nov 7, 2015

Here is the Consensus Model: APRN Consensus Model

And here is the LACE FAQs: login.icohere.com/public/topics.cfm?cseq=935

Jules A, MSN · Nov 7, 2015

CNS can prescribe in 36 states. The other thing I wonder about is whether there will be a conversation about the difference between psych PA and psych NP. I.e. Should they both come under medicine?? The original psych np was supposed to do physicals and then do a mental status and then diagnose and prescribe. Sounds like what the psych pa's say they do. It's all fluid and political.

In my state or at least in my experience I don't think PAs can't bill for psych. Or maybe they would need a psychiatrist co-signing which are strange bedfellows. I don't know any PAs who work in psych doing mental health prescribing. There are plenty who do the H&Ps which are almost never done by psychNPs. There is one dual certed FNP-psychNP I know who will fill in for H&Ps when the FNP isn't available but it isn't common so at least for now we don't have any competition with PAs.

I am not against the NP route, but do not want to be stuck in an urgent care clinic where all that matters is numbers. I get numbers being important, but most make it trump quality care. I would do agnp, because hours, holidays and weekends are important to me as well.

So good luck with that because I think the places that are not focused on the numbers are the jobs where NPs work like a chamber maid and don't make any money. Maybe consider a Masters in Social work? The only way I have found to truly make stellar money is to work exactly like a physician and that means quick, succinct diagnosing and prescribing only. If I'm wrong I'm sure others will write in and clarify.

sauce · Nov 8, 2015

pretty sure time doesn't make the only factor that depends on quality of care. I mean we are made to diagnose and treat. I mean yeah your patients have to like you but that doesn't mean you sit there and talk about their dog for an hour and/or explain to them for 20 minutes why one antibiotic is better than another for the cut on their toe.

Its all an inverse U shaped curve theory where too little or too much time is bad. Some times more time is needed but I mean we are here to make money too. But then again how many nurses know anything about business. Usually the 'quality of care' excuse is just so they can opt for more time drinking coffee and gossiping about some random chick they don't like thats hotter than they are instead of seeing more patients.

All in all it seems like most posts on this forum are pretty much indirect questions pretty much asking "how can i make the most bucks and not have to work for it"

I have your answer though. food stamps, not advanced practice nursing.

sigh

"ok mr bob, now that we have given you your toe medicine is there anything else you would like to discuss in your life? how is your cat doing? hows your cholesterol feel today? you didn't happen to drop one of your oxycodone down the sink this week did you, I would hate for you to go 4 hours with awful pain from when you dropped a ball of yarn on your toe 20 years ago."

-.-

Medicine is a service. Do your job, do it quickly, get paid. Holistic care? Holistic care shouldn't take any longer than ''regular care." But then again holistic care is just a tag-phrase made up by nurses to try to make what they do distinct from physicians.

Next time my wireless router breaks Ill ask for the holistic care package since God forbid they don't consider my sewer system when my internet isn't working.

end rant.