Clinical Nurse Specialist

llg, PhD, RN · Aug 30, 2006

The CNS role is somewhat of a "catch all " role in many institutions in that the CNS supports and promotes nursing practice by performing a variety of different functions -- such as teaching, research, developing programs and policies, providing some direct patient care, role modeling, etc. Different environments and different situations call for different actions and the CNS is often expected to adjust his/her practice to meet the needs of the unit and/or patient population that is the focus of his/her practice. So, it's hard to pinpoint the role or describe it simply.

I spent many years as a CNS and am now in a position similar to a CNS that my hospital calls a "Clinical Practice & Education Specialist." Over the years, I have occupied roles called CNS in several different hospitals and none of them was exactly the same as the others -- except that in each one, my job was to support the practice of nursing in my unit and within the hospital as a whole. In some jobs, the role included a lot of staff development activities. In another job, it included a lot of direct patient care. In yet another, I did a lot of discharge planning. In yet another job, I had the opportunity to do some original research.

I suspect you'll see some of that role variability in the responses you get within this thread. That may seem confusing -- but it can be a wonderful thing. If you can tolerate the variability and the ambiguity of having a role that requires flexibility, a CNS role can be great in that it provides a way to improve nursing care for a whole population of patients and improve the practice (and working conditions) of a whole group of nurses. The variability can also help prevent burn-out and keep you motivated and "fresh" on the job.

To learn more about the CNS role, you should probably browse through the CNS journal. Take a look at several issues published over several years and see how the role is always evolving and get a sense of the types of things that CNS's do. It might take a trip to nursing library (or good hospital library) if you can't browse it online -- but it would be a trip well worth making before you invest in becoming a CNS yourself.

Good luck. The world needs more CNS's. My hospital is always looking for MSN's who have taken CNS tracks in school and can't find enough of them to hire.

llg

ERNP · Sep 6, 2006

Thank you llg.

I actually finished a dual FNP/CNS program. I never pursued any CNS opportunity because I could never figure out exactly what it was and no one could provide me with a concrete answer.

Now I know why.

Trauma Columnist · Sep 6, 2006

Hi there - I'm a CNS in a large nephrology practice. There are three NPs and me and 11 MD's and 5 PA's. The APN's handle the medical management of the chronic dialysis patients in multiple units. It is very interesting as I had little knowledge of dialysis and the special needs of this population.

My role is exactly like the NP's: I see patients, write scripts, give orders for med changes, order tests, x-rays, examine and assess. I have a collaborative agreement and prescriptive authority.

I did interview for a strictly CNS role at another hospital prior to accepting this position and that job involved being the bedside educator on two floors. However, I would have no collaborative agreement nor any prescriptive authority and that wasn't the role that I wanted.

As llg stated, though, there are many, many roles.

ERNP · Sep 6, 2006

TraumaRUs.. that is very interesting too. I didn't know that a CNS could function exactly as an NP does. I wonder why then we need 2 separate titles?

llg, PhD, RN · Sep 6, 2006

TraumaRUs.. that is very interesting too. I didn't know that a CNS could function exactly as an NP does. I wonder why then we need 2 separate titles?

Many CNS's don't want to focus on the "medical" management of the patient, write prescriptions, etc. Many CNS programs don't include those functions and I'm not sure if all states even allow that.

Master's programs can't include everything. If you have a program that includes medical management, etc. then there won't be time to include the indepth study of other aspects of the CNS role, such as traditional nursing functions, staff development, program development, management, research, etc.

Some people want more of a Nurse Practitioner role and some people want their expertise to be in those other areas. That's why the 2 different paths (NP and CNS) were developed in the first place. I can understand that some people want a combined role, but I can only support that if both the CNS and the NP aspects are given equal time and focus within the educational program. Combined educational programs and blended roles have been tried -- and have been successful sometimes. However, there have also been some problems and issues with combining the 2 roles. They are just fundamentally different in focus at their foundation -- the NP designed more to provide "physician extender care" and the CNS developmed for supporting and enhancing traditional nursing practice. Those are both fine things, but they are not the same thing.

llg

ERNP · Sep 6, 2006

That also makes sense llg. My dual role program actually did take twice the time as it would have for NP alone. I didn't know in the beginning that it was a dual role program until one day I questioned why we had so much stuff that wasn't in other NP programs. That was when we were informed that they had switched to a dual role program and we would all be eligible to sit for the CNS exam, in addition to the NP exam, upon graduation.

It turns out 2 of the professors had written an article on the blended role education. So surprise, we were the first year where I went to school.

We had CNS clinical hours, we had NP clinical hours. We had CNS projects, and more NP clnical hours. I will say the CNS portion of the degree probably caused more growth in me as a professional. It required that I do alot of things I would probably never have done otherwise.

llg, PhD, RN · Sep 6, 2006

That also makes sense llg. My dual role program actually did take twice the time as it would have for NP alone. I didn't know in the beginning that it was a dual role program until one day I questioned why we had so much stuff that wasn't in other NP programs. That was when we were informed that they had switched to a dual role program and we would all be eligible to sit for the CNS exam, in addition to the NP exam, upon graduation.
It turns out 2 of the professors had written an article on the blended role education. So surprise, we were the first year where I went to school.
We had CNS clinical hours, we had NP clinical hours. We had CNS projects, and more NP clnical hours. I will say the CNS portion of the degree probably caused more growth in me as a professional. It required that I do alot of things I would probably never have done otherwise.

I LOVED your post, ERNP. I am so glad that you understood what I was trying to say. I have no objection to the blended role -- IF -- both dimensions are well-covered in the educational program. The problem I have seen is that some NP's get a few hours of CNS-type classes and think they have all the qualifications it takes to be a CNS. They may be great NP's, but they haven't studied or acquired the CNS skills. At my hospital, we get applicants all the time for our CNS/Staff Development positions who are NP's by education and who know next to nothing about the job functions. They don't understand why we don't hire them for our CNS/staff development roles.

As someone who became a CNS back in 1981, it's sad to see the role still so misunderstood.

llg

MSNpsychnurse · Sep 12, 2006

Ilg: Where do you live? In northwestern PA, there is not a good understanding of what a CNS is ... and unfortunately is viewed from a budgetary perspective as an "expensive", thus expendable RN

AngelsRN · Sep 12, 2006

Thanks for the information -- I still dont know what direction to go it, but I have a base to start with as far as the CNS role

Trauma Columnist · Sep 12, 2006

I also need to state that I did my CNS as a post-MSN program. My MSN is in management and leadership and I had several education courses, many management and leaderhip and change agent courses.

My post- MSN CNS only required that I do adult chronic care, adult acute care and geriatric care which also encompassed advanced pathophys, advanced pharm and advanced assessment. I did 700 hours of clinical time also.

I do know that I wanted the more medical modality and if circumstances had been different would have probably chosen the Acute Care Nurse Practitioner. That is more the role that I identify with personally. Professionally, I ensured that I received a thorough clinical experience and intentionally chose clinical experiences where I felt that I was weak.

I truly respect llg's opinion and have always respected her experience and insight. Thanks.

llg, PhD, RN · Sep 12, 2006

I also need to state that I did my CNS as a post-MSN program. My MSN is in management and leadership and I had several education courses, many management and leaderhip and change agent courses.
My post- MSN CNS only required that I do adult chronic care, adult acute care and geriatric care which also encompassed advanced pathophys, advanced pharm and advanced assessment. I did 700 hours of clinical time also.
I do know that I wanted the more medical modality and if circumstances had been different would have probably chosen the Acute Care Nurse Practitioner. That is more the role that I identify with personally. Professionally, I ensured that I received a thorough clinical experience and intentionally chose clinical experiences where I felt that I was weak.
I truly respect llg's opinion and have always respected her experience and insight. Thanks.

Aw, shucks! Thank you, TraumaRUs. I think it is important that people figure out where their interests and talents lie (and their weaknesses) and then plan to educate themselves accordingly. I see too many people on this site who are investing their time and money in education that they don't really know much about. They are just going to school to go to school and hope they will find a decent career waiting for them when they are done. Some of them should just slow down and get to know themselves (and nursing) first -- before they invest their time and money in graduate school.

I wish them well ... but think they are going about it the wrong way.

llg