CNS! Is this a Dying Specialty!?

irish_rainbow, BSN, MSN, DNP, NP · May 26, 2011

Hello,

I found this thread when I searched for NP vs. CNS. I have to say that you guys have brought up some really awesome points and I'm so glad that I am able to learn from and communicate with people who really know nursing and their profession.

I took the MAT today and made a 423. The director of the MSN Peds program at my school of choice advised that I should be able to get into the program with no problem since the base MAT score needed is 400. I already have my BSN and will have been working in a Level 3 NICU for a year in October. I am a little bummed that Arkansas does not have a Neonatal graduate program, however I think I want to become RNC-NIC certified and do Peds as my graduate coursework. I may decide in 5 or 10 years that I really want to work with another age group besides neonates. I don't really see that happening, but the Neonatal role seems limiting, plus I can't afford to move or go to school out of state. I would like to start graduate school this coming Spring 2012 if everything works out for me appropriately.

My problem (and why I'm posting here) is that I am having a huge personal struggle with choosing a track. I really, really like the idea of fulfilling the original CNS role as an educator, clinical practice expert, cost cutter, and working with nurses, staff, and patients as a whole to improve patient outcomes. However, I am also interested (and maybe a bit intimidated) by the NP role simply because I feel like I see more NP's and they seem more "marketable." I could be wrong about this, but that is just what I've noticed here in Arkansas. I was reading the Advanced Practice section of the Arkansas nursing board's website and it seems like Advanced Practice Nurses have 4 categories: ANP, CNS, CNM, and CRNA. CNS's are eligible for prescriptive authority, but I don't think they are eligible to sit for the ANP registry exam.

So my main dilemma is what track to choose based on my interests. I also thought about doing the Masters of Science in Nursing Education with an emphasis on Peds, but I'm not sure if I would be able to sit for any exams with that title. I wouldn't mind being useful in an educator role to nursing students, but that is not my main goal. I am really just terrified and frightened right now at choosing the wrong track since graduate school takes so much time and effort.

Any opinions would be greatly appreciated,

Elizabeth

enoRN · May 26, 2011

To reply Irish rainbow I would simply tell you that there is no focus that is WRONG TRACK, search your mind very well and decide on what you want to do and be informed. ....and I personally dont think there is a perfect track that fulfills your dream as a nurse especially as all roles are not well defined right now(interms of job responsibilities). Goodluck in your advancement.

Trauma Columnist · May 26, 2011

I think that the wrong track is something where you end up being unhappy.

I will reiterate though that as an APN, you can work as an educator, manager, change agent, etc.. However, if you stick to the "true" CNS role, crossing over to being an APN is not possible.

In order to give yourself the best chance at a better job, choose the widest scope track possible.

Can you shadow some CNS's to see what they do? Maybe shadow someone like llg who has a more traditional CNS role and then choose someone else who does the APN role?

elkpark · May 26, 2011

However, if you stick to the "true" CNS role, crossing over to being an APN is not possible.

I don't understand what you mean by this, trauma -- in every state I've been in over the years, CNSs have been considered advanced practice nurses (although there was some variation in whether Rx authority was available to them or not), and I've spent most of my CNS career delivering direct client care as a (child) psych CNS. Usually, the position(s) included spending some time in the other aspects of the CNS role, but I've always been predominantly a "hands-on" clinician in an advanced role (and that's what I was hired for).

I understand that there are some states that don't formally differentiate CNSs from generalist RNs for licensure or practice purposes, but, AFAIK, it's not enough states to justify a blanket statement like your comment above ... Can you explain further what you meant? (Thanks.)

Trauma Columnist · May 26, 2011

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.

irish_rainbow, BSN, MSN, DNP, NP · May 26, 2011

Thanks so much for your replies. Everyone here has been so nice and given really good information and feedback.

I did a Google search and found a chart that kind of breaks down the differences between the ANP and CNS role: http://resources.css.edu/academics/nsg/grad/docs/advancedpracticenursingrolescnsvsnp.pdf

Would you guys agree with this chart or not? It seems that based on this chart a lot of the job duties can overlap between an ANP and CNS as long as they are both working in a inpatient hospital setting. What is the general consensus on this?

I am still considering and thinking of what track to pick... I believe that whatever track I do pick I will definitely do the education track at the program I'm looking into... it's like a minor and is only 12 extra hours. But as far as CNS and ANP I am still torn on what I want to do.

tyloo · May 26, 2011

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!

Whispera, MSN, RN · May 26, 2011

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...

Advanced Practice Columnist / Guide · May 26, 2011

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.

Trauma Columnist · May 26, 2011

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.

Whispera, MSN, RN · May 26, 2011

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.

Trauma Columnist · May 26, 2011

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.