CNS vs NP?

CraigB-RN, MSN, RN · Mar 12, 2009

I've been filling a CNS position. I dont' wory about it. I try not to get into explaining much. Everyone knows I'm the one doing the research on how to best provide nursing care in an evolving specialty and they know that magicallly I can do some skills they can't.

Sigh. we can all dream of a perfect world can't we.

Trauma Columnist · Mar 12, 2009

Amen to that sentiment Craig!

CraigB-RN, MSN, RN · Mar 17, 2009

Question for you non NP CNS's out there.

Do you feel that a sig percentage of nurses go into NP program, even though they don't plan on working as an NP becasue they percieve that it will be easier and they wont have to listen to as much of the nursing theory stuff?

Trauma Columnist · Mar 18, 2009

Hmmm good question Craig. Personally, I did my adult health CNS as a post-MSN certificate so I only did the advanced pharm, advanced assessment, advanced pathophys so I didn't do any theory classes. For that, I was fortunate.

Nursing theory is not relevant (IMHO of course) to what we do as APNs. So, to spend time, in essence to waste our time in theory, it is much better to spend more time in clinicals.

Joe NightingMale, MSN, RN · Mar 19, 2009

Not sure I agree with the purported uselessness of nursing theory.

Theories can help with understanding patients, their decisions, and their communities. Which helps you treat them.

After all, if they won't/can't get treatment or meds, then all your diagnosis is in vain

Trauma Columnist · Mar 19, 2009

I guess I have to respectfully disagree Joe. When I see my chronic pts (who know and trust me), I think more along the medical diagnosis - I don't even consider nursing diagnosis. When I work in the acute setting (either in the ICU with my full time job or in the ER with my part time job), again, nursing theory doesn't play into my medical diagnosis.

Personally, I would have appreciated another 200 or so hours of clinical time, with more time focused on procedures.

llg, PhD, RN · Mar 19, 2009

I guess I have to respectfully disagree Joe. When I see my chronic pts (who know and trust me), I think more along the medical diagnosis - I don't even consider nursing diagnosis. When I work in the acute setting (either in the ICU with my full time job or in the ER with my part time job), again, nursing theory doesn't play into my medical diagnosis.
Personally, I would have appreciated another 200 or so hours of clinical time, with more time focused on procedures.

I am going to say something here that may offend some people -- in order to "spark a little debate" here. In doing so, I am assuming (hoping?) that traumaRUs will keep in mind that I am a friend. We have had many discussions over the years and I don't want this one to damage that friendship. I am playing "Devil's Advocate" here on purpose.

OK, traumaRUs ... old buddy ... old pal?

Joe NightingMale has also been involved in several pleasant discussions with us.

My reaction to reading your post quoted above traumaRUs is: If you are only thinking in terms of medical diagnosis and not practicing from a nursing-based perspective, then you are NOT practicing as an "advanced nurse." You are practicing instead as a "junior physician."

What can and should make advanced-practice nursing "Nursing" is that the practitioner incorporates the medical knowledge and skills into his/her practitioner while still retaining a foundation of knowledge and philosophical perspective of a nurse. If you have truly abandoned that nursing perspective, then you can no longer claim to be practicing as a nurse -- because it is the nursing disciplinary perspective that makes in "Nursing" as opposed to "Physician's Assistant."

Joe NightingMale, MSN, RN · Mar 19, 2009

While I wouldn't go as far as llg, I am worried that the APN roles are not clearly defined...that they're hard to tell apart from medical roles.

Though it could probably be argued that nursing in general, at this point in time, is also hard to define and in flux.

CraigB-RN, MSN, RN · Mar 19, 2009

To me that was the difference between the CNS role and the NP role.

This is an oversimplification, but as a CNS I directed nursing care of the patient. Despite arguments to the contrary, the NP's diagnose and treat, wich to me has always sounded like practicing medicine. The patient has a sorethoat, you do a rapisd strep and give the Bicillin.

Becasue non of my proffesors could give me a specific answer to how the nursing model was different from the medical model when running a cardiac arrest, or treating a Gi bleed or, whatever, is one of the primary reasons I dropped out of the NP program i was in to pursue the CNS role. I'm a better educator than provider anyway.

llg, PhD, RN · Mar 19, 2009

I have been involved in this "discussion" within the nursing profession for many years -- even being involved in some of the national organizations that helped define some of these roles back when they were first formalized.

What "we old-timers" tried to establish as a basis was pretty much what I said in my previous post. NP's were still practicing nursing because their fundamental way of thinking about a patient retained a nursing philosophical and theoretical foundation even as they incorporated medical knowledge and skills into their practice. If people wanted to abandon their nursing foundation and function 100% from a medical perspective, then they should go to medical school or PA school. That's why NP programs have been MSN programs and have required that students take the same core MSN classes (research, theory, etc.) that other MSN students take.

Throughout academia, the thing that distinguishes one discipline from another is its foundation of knowledge, philosophical perspectives, theory, customary practices, traditions, etc. The "set" of these things is different for anthropology compared to sociology, for example. The "set" is different for biology and chemistry. etc.

A similarly unique "set" should distinguish nursing from other health care disciplines such as medicine, respiratory therapy, nutrition, etc. even though there is some overlap in our subject areas. Without some "walls" or "lines" to mark those differences, chaos ensues. Turf wars develop. Confusion over proper credentials creates messy political fights, etc.

Nursing has struggled over the years to define its "set" clearly -- and to convince its members to "stay within the line" as nurses have not been academically inclined and so many nurses remain uneducated about the nature of knowledge, philosophy, etc. Few nurses study these types of issues or ask these types of questions. They focus on the practice arena only and do whatever tasks they can do that seems to be needed. While that "roll up the sleaves and dig in" mentality has its value -- it has created a mess of roles, definitions, and functions that don't always make sense when you try to organize it into a health care system that everyone can understand.

This mish-mash of make-shift roles and attitudes is part of the reason we have struggled for respect and compensation as a profession. We have not successfully laid claim to a "set" of knowledge, skills, philosophical perspectives, methodologies, traditions, etc. to which we committ ourselves and all identify as "Nursing."

It is a shame that the educators who have taught in some of the NP programs have not conveyed the importance of a nursing identity (perspective) in their teaching. Instead of teaching their students how to enrich their nursing practice by incorporating medical knowledge and skills ... they have apparently led them to abandon their nursing heritage and to therefore leave nursing. That weakens the profession.

I've worked with NP's who have retained their nursing identity. So, I know it can be done.

CraigB-RN, MSN, RN · Mar 19, 2009

Identity is one thing, and I also have seen providers who have never given up their identity as a nurse. CRNA and NP. But that had nothing to do with any theoretical foundation, at least they never verbalized anything and in most cases denied any belief in any of the theories they were taught.

Practice on the other had, at least by my definition is the same. You treat the sore throat, the MI, the GI bleed the same, no matter what. The patient in front of you attached to the level one infuser, isn't' in a potentially hypoperfusing secondary to decreased fluid intake, they are bleeding to death from th huge bullet hole in their gut. yes these are meant to be an examples and not specifics, don't go off on my choice of nursing diagnosis or anything.

Without mentioned any of that philosophical or theoretical framework, explain to me the difference, because after 33 years, I can't tell the difference, and I've watched lots of NP' PA and MD's work. Give me specifics, because, I don't get it. Unfortunately I've not had any professors who have been able to explain it either, they kept going of on that theoretical stuff. With the exception of Brenner, (my pet theory) who's theory has been around since before Christ, they are all theories, no facts.

Now here is my perspective as a professional educator. Things like nursing diagnosis, nursing theory, and even care plans can be effective tools to help nurses developer a way of thinking, but it's just that, it's a way of learning how to think. It's a method, just like the Socratic method is used in law schools.

CraigB-RN, MSN, RN · Mar 19, 2009

oops hit the submit to fast.

Help me to understand. As a new CNS and as an educator, I need to be educated. It's hard to be one of the unified voices in the wilderness when you don't know what to say.