Different roles for CNS's??? Come on guys share what you do! - page 5

Good evening everyone! Those of us that are CNS's have a great variety of roles/jobs and I am curious just what everyone else does. I graduated in May with a post-MSN adult CNS. Currently, I work in... Read More

  1. Visit  Melissa94RN} profile page
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    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.
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  3. Visit  llg} profile page
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    Quote from Melissa94RN
    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
  4. Visit  traumaRUs} profile page
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    Personally, I like the way IL has done it: NPs, CNSs, CNMs, CRNAs are all together considered APNs.
  5. Visit  cardiacRN2006} profile page
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    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...
  6. Visit  juan de la cruz} profile page
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    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.
  7. Visit  traumaRUs} profile page
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    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.
  8. Visit  RNAnnjeh} profile page
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    Quote from traumaRUs
    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.
  9. Visit  llg} profile page
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    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.
    Last edit by llg on Nov 6, '07
  10. Visit  cardiacRN2006} profile page
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    I was really suprised how many nurses didn't know what a CNS was... I told everybody at work that I was going to start working toward that goal and they had no idea what I was talking about.
  11. Visit  traumaRUs} profile page
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    And I'll be honest, in many states a CNS isn't an advanced practice nurse and in some states, its not a protected title. What this means is that anyone can call themselves a CNS and its okay.
  12. Visit  juan de la cruz} profile page
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    Having gone through graduate courses on APN issues, I was taught (and actually having the textbook reference to back it up) that clinical nurse specialists have historically been the first APN group to establish master's degree preparation early on for entry into the role. That is why it surprises me that there are nurses (apparently, in other states) who are addressed as CNS without having obtained a graduate degree. I also strongly believe that master's degree preparation is important to CNS practice.

    It is also unfortunate that CNS education has not quite moved forward as fast as NP training has gone. Since there are limited options for CNS educational tracks and certification examinations, I can see how a neonatal ICU nurse who wants to advance as a CNS in that field will have trouble deciding on what program or certification to choose.

    In regards to the blending of the CNS and NP role, I think the idea seems logical if we are thinking about marketability as an advanced practice nurse. However, I think it would be hard to see this as a reality in actual clinical practice. As an NP, my focus is on the mid-level provider role more than being an educational resource for clinical nursing issues. I honestly have no time left to devote to nursing staff development and nursing in-services with my busy schedule. That is the reason why we still need to have CNS' who function in their traditional role. The bottom line to me is that we need both CNS' and NP's in the clinical setting and one has to choose which role they prefer to belong to.
    VentNut_RN and jpRN84 like this.
  13. Visit  llg} profile page
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    Quote from pinoyNP
    The bottom line to me is that we need both CNS' and NP's in the clinical setting and one has to choose which role they prefer to belong to.

    I agree completely. They are both good roles and should be respected equally. It's a shame that the politics of advanced practice has hindered the further development of the CNS role. Getting tangled up with NP's did not help us as that movement for merging the roles failed to grasp that the roles are different in many of the clinical specialties.
    jpRN84 likes this.
  14. Visit  traumaRUs} profile page
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    PinoyNP and llg - you both bring up very valid points. BTW I wish I had taken some APN issues classes. I am pretty active in my state's APN organization and am surprized at the ambiguity of CNS practice in IL. I am in a practice with 18 MDs, 3 PAs, 1 ACNP, 3 FNPs and me (adult health CNS). All of the mid-levels do the same exact job: mid-level provider! This is all allowed by our various practice acts. However, this hasn't help delineate the difference between CNS and NP. For me, I do absolutely no staff education nor am I involved in change as to nursing procedures. I am strictly a hands-on provider. This may not be good for the future of CNS's in IL!
    llg likes this.


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