Different roles for CNS's??? Come on guys share what you do!

llg, PhD, RN · Sep 29, 2007

The question is, if I do CNS, will it be a guarantee that I can practice both worlds, as an educator and as an advanced clinical practitioner like the NPs? I have browsed a lot of CNS curricula, and when I compared it w/ that of the NPs, the latter have more of the sciences: anatomy, physio, patho, pharma, assessments, etc, that makes them look more competent as an advanced clinical practitioners. The nursing admin and NP curriculum for me are both on extremely opposite poles, while that of the CNS is a hybrid and can be found in the middle, same for the nurse educator at some degree, only that the educator is leaning more towards the admin side.

There are no guarantees. Individual employers can structure roles as they please as long as they stay within the Nurse Practice Act and employers can require whatever education, certifications, etc. they want. Similarly, schools change curricula every few years -- adding and deleting courses and/or modifying them to suit the current conditions.

The best you can do is get the education that seems to be the best fit for your interests and future plans at the time -- and then be prepared to get additional education as the world keeps turning and conditions change.

... and try to enjoy yourself and help some people along the way.

Trauma Columnist · Sep 30, 2007

llg has excellent commentary as usual! TY.

It is always important to ensure that what education you get will allow you to do what you want. And you must also factor in your state's practice act as well as what the job market is. And, then if there is a chance that you might practice in another state, that too must be factored in.

My current job as a CNS is definitely an APN - I see pts, manage their dialysis, BP, diabetes and pretty much any other problem they have. I prescribe meds, order and interpret test and refer to other providers for things I can't handle or don't have the expertise. I am fortunate that in IL, the CNS role is that of an APN - in fact we just got prescriptive authority for class II narcotics which is really helpful in my dialysis pts who also have chronic pain.

In my new job, I will be back in the hospital and will have pretty much the same role - that of caring for patients.

KristinaAZ · Oct 4, 2007

Good point. ... And that's actually the beauty of the CNS education and role. The original conception of the CNS role was that CNS's are prepared at the Master's level to be expert at "traditional" nursing roles -- doing the types of things that all nurses are legally allowed to do, but with the knowledge and experience to do them at an expert level. That's why NO states required special licensure for CNS's in the beginning. The role was not created to have prescription authority, etc. so no special license was needed.
Later ... some CNS's wanted to expand the role to include some "physician externder" functions similar to those priveleges that NP's have. That required special licensure and some states (but not all, by any means) have gone that route to allow that.
As one of the earlier CNS's, I always viewed my role as being a nurse with expertise in my chosen specialty (neonatal) whose function was to support the neonatal nurses I worked with and to help them provide the best nursing care possible. If that meant teaching them something, I taught them. If that meant doing a research project to develop some knowledge, I did research. If that meant designing or managing a new program, I did that. etc. etc. etc. I had a general education at the MSN level that prepared me to help the staff nurses with whatever they needed.
I always loved the flexibility of the role and the fact that from one year to the next, my job would include a wide variety of activities to keep me stimulated and growing.

Thank you so much for posting this! You've described what I am interested in: remaining a bedside nurse, but at an expert level. I'm in an RN-MSN program now and am trying to decide which path to take. I would like to eventually practice more of an APN role, but not yet. Would you say that it is still possible to remain at the bedside with a CNS education?

RNAnnjeh, MSN, CNS · Oct 18, 2007

Things are so much different here in Canada.CNS and NP are the only 2 recognized APN roles, and only NPs have prescriptive abilities.My role as a CNS centers around patients and families of children with chronic illnesses. I am a case manager, health care navigator, advocate, sounding board, team player, researcher, educator, problem-solver, community liaison....the list goes on. It's all very family specific. Some days I'm even a s*!@ disturber. Whatever is needed. The most amazing thing about being a CNS is that you truly do get the best of both worlds....still providing patient care, but in a bigger, broader way and still having contact with nursing staff in a supportive, meaningful way.I'd post a link to the Canadian Nurses Association framework for advanced practice, but it is just being revised. Once it's approved, I'll post a link.Thanks for sharing :)

Melissa94RN, BSN, MSN, NP · Oct 24, 2007

Some great news in PA, I was just looking at the SBON site and 7/20/2007 Governor Ed Rendell signed into law Act 49 of 2007 and this will provide official recognition for the CNS. Right now I cannot see what the scope of practice will as the BON has given themselves 18 months to develop the regulations and so on for the CNS. This is a step in the right direction. I myself have been researching all of the different programs and still am not 100% sure which role I am going to take but this gives me another great option.

llg, PhD, RN · Oct 24, 2007

Some great news in PA, I was just looking at the SBON site and 7/20/2007 Governor Ed Rendell signed into law Act 49 of 2007 and this will provide official recognition for the CNS. Right now I cannot see what the scope of practice will as the BON has given themselves 18 months to develop the regulations and so on for the CNS. This is a step in the right direction. I myself have been researching all of the different programs and still am not 100% sure which role I am going to take but this gives me another great option.

Now ... you see ... I don't see that as great news. I see that as bad news to anyone who already has an MSN and who has been practicing in an advanced role quite well without special licensure. It will add requirements and credentials that will be difficult to get and expensive to maintain, thus hindering the practice of many fine current advanced practice nurses.

Virginia used to requirement for special licensure for CNS's -- but it didn't work out well so they got rid of it -- or at least changed the requirements so much that it doesn't matter any more. Thank goodness.

llg, PhD, RN

Trauma Columnist · Oct 24, 2007

Personally, I like the way IL has done it: NPs, CNSs, CNMs, CRNAs are all together considered APNs.

cardiacRN2006, ADN, RN · Oct 31, 2007

I've known that I'd like to go the ANP route, but didn't ever like the NP/CRNA job description-it just never seemed like a good fit...

So I didn't know quite what to do. I really like the idea of being a bedside clinical expert in my chosen field...

How do I find out the scope of the CNS in my state? I looked at the BON website, and it's not user friendly to say the least...

Advanced Practice Columnist / Guide · Nov 1, 2007

I think the best way to go about finding that information is to ask any of the CNS who work in your hospital. Also try searching through the National Association of Clinical Nurse Specialists website (www.nacns.org). The website appears to have an on-line forum.

If your home state is like mine, it is not that clinical nurse specialists are not recognized statewide because there are many hospitals and other facilities that continue to recognize the contributions of the roster of CNS' on their staff. It's just that the state BON does not have clear cut criteria of what qualifies a nurse to be a CNS and have no title protection for that role. Because of that, many master's prepared RN's function as CNS' and are addressed as such even without the formal training or national certification. However, as llg pointed out, this is not such a bad thing as many have been doing an excellent job with this role for many years without having gone through the formal training and certification.

By the way, there was a big issue about the merging of the CNS and NP role at one time by calling it with the collective title of APN. I wonder if this is still being talked about in nursing circles. I suspect some states (like IL as traumaRUs pointed out) adhered to this point of view by blurring the distinction between NP and CNS. It even seemed like ANA was supportive of this merger as ANCC certification uses the title APRN,BC for the credentials of both NP's and CNS' who pass their certification. I tend to assume that with so many issues facing the APN arena such as the practice doctorate, many past issues were just being left unresolved.

Trauma Columnist · Nov 2, 2007

PinoyNP - you are so right about the blurring of roles. I actually belong to the CNS list.serv but so many of the those nurse have the title CNS but few have a MSN and are certified as a CNS. Some hospitals/states seem to like the title CNS but freely give it out without any consistency as to education/certification. Sure doesn't do much for bringing the CNS role to the APN.

RNAnnjeh, MSN, CNS · Nov 6, 2007

Personally, I like the way IL has done it: NPs, CNSs, CNMs, CRNAs are all together considered APNs.

I have a feeling that this is the way that things are moving in Canada, too.

llg, PhD, RN · Nov 6, 2007

BTW ...

I do strongly support the idea that a CNS should have a Master's Degree in nursing -- and would support any state that wanted to restrict the use of that title to only those nures with MSN's. What I don't approve of is the placing of so many restrictions on the title that it prevents people with MSN's from using the title just because their particular MSN program was not called a "CNS track" or something similar. For example, someone with an MSN in Maternal-Child Nursing should be able to call herself a Pediatric CNS or a Maternity CNS or a Neonatal CNS if she has experience (and maybe certification) in that specific field. That fact that her MSN does not exactly match her job title should not matter. As I have worked in several different states, I have learned that we need some flexibility in titles to allow people to move around the country a bit and have their credentials recognized.

I also don't think that CNS's should be required to be educated for prescriptive authority and/or for other services outside the "usual" scope of nursing practice. When people were trying to blend the NP and CNS roles, the merged role excluded MSN's who were unprepared for and had no desire to be prepared for that type of "physician extender" function. For example, my clinical specialty is neonatal ICU. The role of the NNP includes 'physician extender functions" such as basic medical management (medical diagnosis and treatments such as intubation, the writing of medical orders for ventilation, nutrition, meds, etc.). Those medical functions make the NNP role totally different from that of a neonatal CNS who can provide expert "traditional nursing" care, do staff develoment, research, consultation, etc. In a field like neonatal ICU, the 2 roles are quite distinct and should be allowed to remain so. States that insist that the CNS's have the same education and certifications as NP's aren't taking fields like neonatology into consideration adequately.

That's why I have fought the merging of the roles all these years. But I do support requiring a Master's Degree (in nursing) for use of the CNS title.