[cardiacRN2006]

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.

[traumaRUs]

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.

[pinoyNP]

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.

[llg]

Originally Posted by 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.

[traumaRUs]

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]

Originally Posted by traumaRUs

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!

I agree. The ambiguity is what has harmed the CNS role more than anything else. People don't see it as a distinct role and "lump it in" with other mid-level providers. Then, they have to require special licensure to allow those people to make medical diagnoses, prescriptions for meds, etc. -- which eliminates all those CNS's who wanted to be a "traditional CNS" the way the role was originally conceived, as a leader of and resource for staff nurses. It also suggests (wrongly) that anyone with a Master's (e.g. NP) can be a CNS and provide that leadership in an inpatient setting even though most NP programs do not include the necessary content in education, management, etc.

Then, they start eliminating CNS tracks in graduate programs -- mergining them with their NP tracks because they don't recognize that the roles are different. Then, they start requiring that all faculty members be NP's since all their graduate programs are focusing on the NP role more than any others. Some markets become flooded with NP graduates and their salaries fall as new NP grads have harder and harder times finding good jobs. Traditional CNS's who want to advance their careers start looking at alternatives -- PhD faculty positions, staff development position, administration positions, etc.

Finally, they realize that hospitals need people with Master's Degrees who can function in the original CNS role -- but that no one in their job market is educated to fill that role because all of the MSN programs focus on the NP functions and not on the old CNS functions. So, what do they do? They start creating new roles, new titles, and new degrees (such as Clinical Nurse Leader) to fill in the gap that was left when all the old CNS's went away. That leads to further confusion and ambiguity -- and further disenfranchizes groups of nurses whose credentials were obtained more than 5 years ago because their degrees and certifications don't use the same wording.

That's the story of the CNS role in America over the last 25 years. It's the story of most of the CNS's of my generation. It's broken my heart to see the nursing profession mess up this fine role.

[traumaRUs]

llg - I agree too. In my area, the college of nursing where I got my CNS (as a post-MSN certificate) now has the CNL (clinical nurse leader). However, when I ask what the difference between the CNS and CNL, I don't get a consistent answer. In fact few people (especially those doing the hiring) seem to know the difference between the CNS and CNL.

There are too many MSN degrees IMHO. We can barely sort thru what already exists let alone bring in more degree programs. We as nurses, are not doing our profession any favors.

[MommyandRN]

It seems that the CNS role needs to be more defined. In my experiences the CNSs that I have worked with are sort of assistant Nurse Managers. They are supposed to educate the RNs on the unit, are there as a resource person to go to for information or help. More available in the unit than the Nurse Manager but not really one of the RNs. They work on the RNs' schedules, interview new employees, and work regular hours. Not much patient contact that I have seen.

[Satori77]

When I first started researching nursing programs in Colorado (over a year ago) I was amazed. I never knew they had masters=level, and even doctorate programs! It drew me to nursing even more, since I have always wanted an advanced degree. This thread has helped a lot, thank you. I am years from pursuing this, and right now am leaning towards CNS, but I still have much to think about. At the U of Colorado, they offer both an Adult CNS, and about 7 different NP tracks (plus several that seem to be neither). There definitely seems to be a push towards the NP programs. But I like the variety of options. Plus they have a DNP and a PhD in Nursing. And this is only one college!

[brizzo]

Here is a different role for a CNS. I have been working in the area of medical advertising for the past 9 years. Before this job I was employed by an academic medical center and ran an osteoporosis prevention program, as well as developed a women's health clinic (my area of specialization is women's health). In my role in medical advertising I have been able to teach and interpret medical conditions and treatments to non-medical teams of creative and account services people so they can understand the areas in which they are trying to influence with products and services. In order for them to create effective advertising for physicians/non-physician prescribers/patients they must first understand the condition they are treating, and the other options that might be considered. They need to understand the dynamics of decision making for thier product or the decision not to use thier product. Understanding these dynamics has been able to inform the team and resulted in better advertising.

Another aspect of my role is to monitor the work to make sure that the advertising is accurate and responsible. This has been a great career move and has been very rewarding. Consider this as a possible career option that is a great fit for a CNS.