CNS vs NP?

I am a psych CNS. Everyone at the clinic where I work at calls me an NP. All the other NPs who work there are FNPs or Adult NPs. We all prescibe medications. I have extensive training in psychotherapy as well as the medications. It has been my unfortunate realization that I cannot make very much money doing therapy. I wish I could. I am burnt out on prescribing after 5 years. Every day is a fight with people who are drug addicts or just plain misinformed. They also come in for prescriptions because thier insurance will not pay for therapy, and they need something to help them. This was not what my program trained me to do. I would not mind doing research either, if I knew where to get a job doing such work. Each clinic I go to seems to get worse. As a psych CNS we are a highly sought after commodity. There are really high turn over rates because we have people wooing us every day. Right now for stability, my children, and my duty to my clients I stay put. This is my first post hope it helps.

Tammy - thanks for sharing. You sound like you are quite stressed at your job. I'm sorry.

What an informative thread! I am in the process of deciding which school to attend and am very confused by the difference of the roles between CNS,NP and CNL in California. I have 14 years exerience as a Physical therapist assistant and would like to merge my current knowledge with a nursing education and profession. I like the concept of CNS. The program I have been accepted at offers CNL or FNP. If CNL is replacing CNS, but CNL is not an APN, and not considered a nurse manager, then I am really confused. I understand the CNL role to include, expert clinician, researcher, change agent, collaborater of all disciplines and someone who has the ability to change care plans. I have read all the othe CNL threads and many other articles about CNL and I am still confused. Can anybody shed some light on all this?

Sorry to expand this thread to CNL. I am having a really hard time deciding which path to take and which school I should attend.

Just a newb.. but would like to thank those who contributed to the thread. It makes it much clearer.

Question though.. is there a perioperative CNS? I have heard of NP's doing the RNFA role, and of course there is the CRNA. I'm assuming both of these (NPs and CRNAs) are characterized as APNs right? Is there a CNS/APN in the perioperative area besides these two possibilities?

Definitely pursue the FNP, because everyone knows what it is and you can always bill for your services. The last thing you want is to be in a position where you have to EXPLAIN your role to an employer. If there's any confusion, then the job will go to the FNP.

Think of the CNL (Clinical Nurse Leader) as a micro-systems leader (a single unit, one clinic, a public health department). The CNL is a generalist nurse, with more education/attention towards team leadership, outcomes management, problem-solving. The CNL is not a nurse manager --- the CNL does not oversee budgets, hiring, firing, and the multitude of other administrative/personnel issues that a manager is tasked to do. The CNL can "free up" the manager by focusing the CNL's attention on making care better.

The CNS is a systems leader (vertical leadership) and can respond to issues/problems through the health system. The CNS also has most specialty training about his/her area: oncology, burn, trauma, critical care, psychiatric illnesses, community health, etc). The CNS also is the point-person for educating RN staff about responses and changes to care. In our health system, the Digestive Health CNS primarily works in the digestive health unit, but also floats throughout the hospital to consult on digestive issues and patients that are in other units.

My School prepares CNLs, CNSs, and NPs. I see people who love patient care (and do not want to leave the bedside) as happy CNLs. They are still patient-care focused, and use their additional skills to helop make care better, more effective, and more efficient.

As I travel the country, I encounter many people who do not know what they want to specialize in, and view the FNP as a 'generic MSN'. The FNP is not a catch-all role --- it is a primary care provider. More and more State Boards of Nursing and Nurse Practice Acts are prohibiting the FNP from working in in-patient areas (other than ER/EDs). I have seen FNPs work in inpatient areas (but in staff nurse roles and wages because they are not permitted to bill as a NP except in primary care/outpatient areas).

I think it's great that the CNS has Rx authority in other states, but here in my state the CNS doesn't, and is just getting title recognition now. I live in Pennsylvania. I want to go back for my MSN as a Psychiatric CNS, but I dont know if it will be worth it job wise, as most employers seem to be looking for Psych NP as they have prescriptive authority.

That is a huge issue for many of us. I live and practice in IL where we have the same nurse practice act as NPs, CNMs, and CRNAs.

Not necesarily true. Go the way that helps fullfill what YOU want in life. I choose the CNS route after a couple of semesters of FNP. You see I found out I don't care about pelvic floor disfunction in elderly females. I do care about teaching, both staff and patients. So for me the CNS route is a better fit. If that changes, there is always post grad certificate. (for now at least)

Agree that you should follow your heart Craig. However, its a real drag for people (both pts and peers) to be forever asking you "and what does a CNS do?"