[elkpark]

Originally Posted by llg

I think it is sad that we have screwed up this very fine role. The old CSN role was/is a valuable one and we should have protected it better as a separate entity.

I could not agree more. It is very sad, and, I think, a real loss for nursing.

[pinoyNP]

Just a question, do you think that one of the reasons why some CNS' sought prescriptive authority was because by adding this responsibility, they felt that it legitimized their advanced practice standing as nurses? I wonder because although I completely agree and believe in the benefits of keeping traditional CNS in all health care settings, the roles of a traditional CNS are still within the scope of professional nursing practice leaving one to question whether this is really advanced practice at all.

[elkpark]

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.

[traumaRUs]

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.

[llg]

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.

[traumaRUs]

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.

[llg]

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.

[traumaRUs]

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!!!

[llg]

Originally Posted by traumaRUs

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.

[elkpark]

Originally Posted by llg

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!