CNS vs NP?

Specialties CNS

Published

Just wondering if anyone knows what the difference is between CNS vs NP. I'm looking more into the CNS program b/c I've heard there's more patient interaction than with a NP. I was told NP are for more diagnostic purposes. Is any of this true. I want to do something that allows me to stay with my patients. Anything helps.

Again, I can only speak to psych CNS nursing practice, since that's the only area I'm really familiar with. Psych CNS MSN programs have always focused on education/preparation as a psychotherapist (with some consultation/leadership/etc. in the "core" courses), which is very definitely outside the scope of practice of generalist RNs. So the "advanced practice" aspect has always been quite clear in the case of psych CNSs.

You make a good point, though.

Specializes in Nephrology, Cardiology, ER, ICU.

I live in a state where CNS's are considered APNs and by that, they mean we have prescriptive authority and ability to bill Medicare/Medicaid. I knew this when I went into it and this is what I wanted. To be honest, I wouldn't have considered the CNS unless it had prescriptive authority and the ability to order tests, interpret the results, diagnose and treat.

I appreciate the info in the way things were originally.

Specializes in Nursing Professional Development.

As a CNS, I have never had prescriptive authority and never wanted it. Nor did I ever want to make medical diagnoses, do primary care, etc. I was educated as a traditional CNS and never wanted anything else. I have never held advanced licensure in any state.

I think that traditional CNS role is advanced practiced... it's just not expanded practice beyond the scope of practice covered by the basic nurse practice act. Think of it as moving up the ladder vertically rather than expanding the role horizontally. The traditional CNS role takes basic nursing practice to higher levels (advanced) of sophistication. The NP role expands the role (horizontally) to include other domains of patient care. Both are "higher levels" of practice than the basic staff nurse role ... but only one type of practice should require different licensure.

Does that make sense?

BTW: I always thought that if CNS's wanted prescriptive authority, they should be able to get it by taking a course, doing a practicum, and passing a test for some "added certification" to give them that privlege. But all CNS's shouldn't be forced to add a "physician extender" component to their if they didn't want to. We should be able to be "advanced nurses" without it.

I also hope you guys are not offended by use of the expression "physician extender." I just don't know what else to call those functions that involve medical diagnosis, prescriptive authority, etc.

Specializes in Nephrology, Cardiology, ER, ICU.

llg - I value your opinion very much and really appreciate your take on this. I know (now) that I would have been happier in the NP role. Fortunately, in my state that is really the role that I have. Since I did my CNS as a post-MSN certificate, my classes consisted of advanced A&P, Advanced patho, advanced assessment and clinicals. I had no theory courses as the differences of a CNS and NP.

Many of my colleagues have elected not to take the CNS test at all and function at the MSN level of education in either education and/or change agent and/or clinical expert. When I have discussed this with them, they have said that they don't want the responsibility and/or ability to prescribe, dx and tx.

That is one of the cool things with nursing - we do have choices. And the term "physician extender" isn't offensive. My role is to see the more simple issues and problems, thus freeing the MD up for the more complex.

Specializes in Nursing Professional Development.

I always that some of the core courses would be the same for the 2 roles ... things like theory, research, nursing issues, etc. Then the NP and CNS students would split for courses (and practicums) related to their role foci. If a CNS wanted an NP certification, she would then take those role-specific courses and practicum. Similarly, if an NP wanted a CNS certification, she would take the CNS-specific courses and practicum.

That seemed pretty clear and easy-to-understand to me. ... But the nursing profession took a more convoluted path, with each individual school, employer, and state board bending to the local political pressures to do a "patch-work" system that varies from town to town. As one might expect, they made a mess of it.

Specializes in Nephrology, Cardiology, ER, ICU.

I agree with you llg - the roles are so blurred now that no one has a clue who does what or with what education. And...now we also have the CNL and DNP and DNSc degrees to wonder. I always wonder if I don't know what the heck the difference is, how do my patients or colleagues know the difference!!!

Specializes in Nursing Professional Development.
I agree with you llg - the roles are so blurred now that no one has a clue who does what or with what education. And...now we also have the CNL and DNP and DNSc degrees to wonder. I always wonder if I don't know what the heck the difference is, how do my patients or colleagues know the difference!!!

I agree completely. I've been intersted in these issues and following the developments within the advanced practice roles since the 1970's, and I get confused. I feel sorry for young nurses today trying to decide on a career path for themselves. They have too many choices and too many people in authority each trying to "sell" their particular program.

I agree completely. I've been intersted in these issues and following the developments within the advanced practice roles since the 1970's, and I get confused. I feel sorry for young nurses today trying to decide on a career path for themselves. They have too many choices and too many people in authority each trying to "sell" their particular program.

Agreed!

Specializes in Critical care.

I am in Texas where the CNS is an Advanced Practice Nurse. Along with NP, CRNA, and CNM, these are the 4 APN titles in TX. I am a CNS in Acute care, but have always been employed as Critical care CNS, but my title with the BON is CNS acute care. I chose to take the CCNS exam offered by AACN, which TX recognizes, mainly because al of my experience has been in ICU settings...My CNS program automatically included the classes that allowed me to apply for and obtain perscriptive authority, however I do not need it for my job. I keep the hours current so I can keep it. The program I graduated from has changed since then, not sure how or what, just know they made some changes in the program tracks they offer.

I like the CNS role, in my current role I use all that I learned in school. Not much staff education or research, but the other subroles of the CNS have been very useful to me.

Specializes in Nephrology, Cardiology, ER, ICU.

JWRN - thanks for the input.

This thread has been incredibly helpful. I have been entertaining the idea of going back to school for enough more eduaction so I can teach at the 4 year level (personal bias mostly because I never practiced at another level). After looking for online courses I thought the Nurse Educator Masters would be "the way to go".

and then I talked to a colleague that has her doctorate in Nursing and Chairs the dept at one of the Nursing schools in the area. She explained that the Nurse Educator Master's is good for teaching LPN or ADN courses pretty much anywhere, but is not really respected enough to teach at the 4 yr schools. she did not have a good reason why, just that is the trend the convuluted picture that has been painted (see prior posts- and thanks for that info that I did not have before.)

I do not want any part of management and a leadership Masters does not capture my interest at all.

After a lot of discussion with this colleague- she picks up patient care shifts with us in the summers to keep up her skills- I have figured out that the CSN is likely the right fit for me. and fortunately this thread also reinforces that plan.

It also means that I cannot do the curriculum online as there are clinicals and things- if I am wrong about that-please let me know. the timing now is such that I will not be starting school until 2010 when my son finishes high school because the schools are too far, and I work 0.8 now. just too much.

anyway the real point is that the mess we have created with wanting to go beyond a BSN is that it is very difficult to know what degree is needed for the goal a nurse has in mind. and then trying to choose a program- it is not an easy path, and we really do not have very good guides.

so again thank you for this thread. :yeah: I have copied parts of it into the file I keep to help me make decisions about all of this.

She also explains that I would need to plan on working on my doctorate within a short time of being hired to teach. hopefully by that time there will be some financial incentive for all of that.

K

Specializes in Nephrology, Cardiology, ER, ICU.

Glad this was helpful for you. Another thing to consider is that in some states (IL is one of them) in order to teach you must have an MSN, not an MS in Education. I have a good friend who didn't check into things thoroughly and ended up a with an MS in Education but can't teach!

Myself, I did the MSN in admin and leadership and then realized I wanted a clinical focus so did a post-MSN adult health CNS>

Good luck with your decision.

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