CNS! Is this a Dying Specialty!? - page 4

by Visuals

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Okay guys, What's the deal with this specialty? 1) Is there a demand? 2) Anybody currently practicing wished they had done NP instead? 3) Anybody currently praciticing love they job? why?.....Hate it? why? 4) With... Read More


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    Here is my experience on deciding the right graduate tract. I applied to two NP programs and felt indifferent if I was accepted or not. I knew my indifference was stemmed from making a poor choice based on marketability. I was thinking to myself so what if it is more marketable will I look forward going to work or better yet would I even look forward going to clinicals in school? I changed my tract to CNS on my one application and sent out another application for CNS to a different school. I felt relieved when I changed my tract and HAPPY. I don't even know if I will be admitted but I am so happy to be at peace with my decision!
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    When I graduated with my MSN, we were told we were CNSs. If we took 3 more courses we'd be NPs. If we took a dreaded test, we'd be certifed CNSs (or, since I'm psych, at that particular time, if we had the right assessment course, we could choose to take the psych NP test and be certified psych NPs). I think it all depends on your specialty, your school, and your state...
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    Quote from traumaRUs
    Sure.

    I attended the same college of nursing for both my CNS post-MSN certificates so this is my only experience with this education. This is what I found:

    I was very, very surprized that fully 50% of their peds CNS graduates do not pursue any type of certification after school. This is because they wish to function in an MSN role versus APN role. Many of these (the 50% that don't take the exam) work in management, administration and/or Six Sigma (or other similar change agent).

    The true CNS role (with the spheres of influence) really is a change agent, educator, consultant, etc..

    The adult program that I did involved a lot of theory and ambiguous (at least to me who is a black and white person) and to me, at least, nonsense that had nothing to do with what I wanted from the program. The ANCC adult test that I took in 2006 was heavily focused on the spheres of influence, roles of the CNS (again heavy on the consultant role) and had few clinically relevant questions.

    When I took the peds CNS exam in March 2011, I found it to be much more clinically focused with few spheres of influence questions.

    I also want to point out that my program has now phased out the peds CNS program and has both an FNP and NNP program now in addition to an adult health CNS and CNL programs.

    I guess I also need to say that if you choose not to get certified or get certified and then practice in a nonclinical role, it makes it very hard to stay clinically focused and up to date.

    That is the real reason for my statement: that if you aren't in a job that is clinically focused and thus the APN role, then coming back to that role after a while (years or so), is very difficult.
    Sorry to get into the conversation but I think what Elkpark was trying to clarify (and she can confirm this if I'm wrong) is that though CNS's do not have prescriptive authority in a number of states and/or do not get a formal state-granted certification as a CNS, they still are true Advanced Practice Nurses and are viewed as such in healthcare settings that are located in states where they: (1) have no prescriptive authority, and/or (2) have no formal state-granted CNS certification.

    This is very true in the 2 states I've worked in. Michigan does not grant CNS's a special certification over and beyond their RN licenses but in almost every healthcare facility I've known there, CNS's are recognized for their graduate education, their expertise in specialty nursing care, and their contribution to nursing staff development and education among other things. It's not that they are not considered APN's, it's just that the state BON does not see the need to grant an additional layer of certification beyond the RN license because their role is still rooted exclusively in nursing.

    Though one can get a state-granted CNS certificate in California where I am now, CNS's here do not have prescriptive authority, however, that does not take away from the fact that they are true APN's and are recognized as such by the BON and most every healthcare facility in the state. I guess the bottomline is that it doesn't matter if in these states, CNS's do not have identical roles as NP's (and they really were meant to be distinct roles), they are still considered APN's for their advanced knowldege and higher level of contribution to nursing.
    eagle78, llg, and elkpark like this.
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    Thanks for the help Juan - I was at work when I wrote that rather long, pointless post - sorry!

    I have only practiced as an APN in IL and here, we are on par with the rest of the APNs: we have prescriptive authority, see pts, order tests, etc..

    There are CNS that I know who have chosen not to take the certification exam for a variety of reasons. In their jobs, though they are considered MSN-prepared, they are not considered APNs.

    I know that I am very biased as I am very unhappy with my educational choices which is no one's fault but my own.
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    I always thought of MSN-prepared nurses as being APNs, whether they were certified or not. In fact, I thought the point to the ANCC's APRN, BC credential was to designate those who were certified, from the APRN's (without BC) who weren't certified. I thought both APRNs and APRN, BCs were APNs. I thought anyone with a MSN was an APN.

    I feel I've lost my own train of thought here...duhh. Let me try again. We have several categories of Masters' degreed nurses. Some overlap, some don't. Some overlap some places but not others:
    MSN-prepared nurse
    CNS, certified or not
    NP
    APRN
    APRN, BC
    APN
    nurse anesthetist
    nurse midwife

    Then the states get involved and decide who can do what, and license or don't license what each can do.

    On a side note, when I was trying to get prescriptive authority as a CNS, which is legal in my home state, it was very difficult to get information. I even called the licensing agency in my state and at first was told my training doesn't exist! (bang head on wall here) I got the information I needed by writing to the licensing agency and doing lots of web searches. If the powers-that-be don't understand all the varieties of "us," it's logical we might not understand it either, totally.

    So, I advise figuring out what the degree you're considering means in your state, before you invest time and money in getting something that might not lead where you think it might lead. My school gave information that was totally untrue--I don't think faculty knew the answers we needed. Write to your state BON or licensing agency or talk to people who already have the degree.
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    I came back to basically apologize as I don't want this to come across as CNS-bashing.

    I had an MSN in management and leadership prior to going back for a post-MSN certificate.

    As an MSN prepared RN I was just that: an MSN prepared RN - certainly not an APN. Heck, I was still working 1500-0300 in an ER and I wasn't the only MSN-prepared RN there.

    Totally agree to get info BEFORE you commit to an education plan.

    When I started the adult CNS program, the hospital where I worked was paying for school and providing clinicals and a job. However, when I graduated, there was a hiring freeze on and so, I moved on. I did work as a staff nurse for over 3 months after I got my CNS - again no jobs.
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    Quote from llg
    I think it is a role "in trouble" because schools have not supported it lately. Many have switched their programs to prepare CNL's instead.

    I never wanted to be an NP and do "primary care" of patients. I always wanted to focus on supporting staff nurses through staff development and providing leadership to clinical projects designed to improve nursing practice. That made the traditional CNS role the best fit for me. NP's don't get the advanced education in staff development, project management, change theories, etc. that CNS's do. NP education is focused on the provision of primary care -- and mostly in an outpatient setting (though some APN progms do include in-patient care now.)

    As the traditional CNS role became muddled with attempts to combine it with the NP role and education, it became much less attractive to me. So I switched my focus to staff develoment, research, and evidence-based practice -- getting my PhD and certified in Nursing Professional Development. I work in a hospital doing stuff that is consistent with an advanced, but traditional, CNS role.
    This is a very good explanation of what a CNS is and does. I've never truly understood a CNS' role. I do now. THANK YOU. This thread is very interesting.
    traumaRUs likes this.
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    Quote from Whispera
    I always thought of MSN-prepared nurses as being APNs, whether they were certified or not. In fact, I thought the point to the ANCC's APRN, BC credential was to designate those who were certified, from the APRN's (without BC) who weren't certified. I thought both APRNs and APRN, BCs were APNs. I thought anyone with a MSN was an APN.
    The four advanced practice roles are clinical nurse specialist, nurse midwife, nurse practitioner, and nurse anesthetist. That's it for advanced practice. There are lots of other MSN concentrations "out there," and lots of individuals with MSNs (in those other concentrations) who aren't advanced practice nurses.
    traumaRUs likes this.
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    When I was in grad school (for an MSN) there were some specializing in Administration and a few other non-direct-contact specialties. Are those the ones not considered to be APNs? We were all told we would be CNSs on graduation, even them.

    I think I'm getting bogged down in details, actually. I know what I can do and that's enough for me.
  10. 1
    I have good news! After researching and talking with the director of the program I am interested in, I have learned some new information which I think will be helpful for me. The school I am interested in has "post-graduate" studies. So basically, if I decide to do the Pediatric CNS track, I can go back and do post grad studies to sit for my APN license if I want to. This makes me less fearful of choosing the wrong track since it's easily remedied should I change my mind at any time. The post grad studies can range from about 3-5 semesters, which isn't too bad considering you'd be getting a whole other certification. Also, there are only about 3 classes that are actually different between the Peds CNS and Peds PNP... now the Peds Acute NP is a little different between both, I believe.

    In all of my research, I have to say that it does seem the two titles have intertwined over the years and it can get extremely confusing when trying to define what exactly these specialities really are. I think a lot of it does depend upon the state in which you practice, the school you attended, and the facility in which you work. Where I work they are simply called Advanced Practice Partners and have a huge range of duties depending on what a particular unit has hired them for.

    I really appreciate everyone's help and discussion on this issue... you guys are so awesome and nice! :-)
    enoRN likes this.


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