[dianacs]

Originally Posted by 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.

That sounds really interesting. How did you initially come into the position?

[traumaRUs]

brizzo - what a unique role! I was a broadcast journalist for 10 years before becoming a nurse.

[brizzo]

I got in to the role of medical advertising by getting a call from a recruiter. I have an Entrepreneurial spirit, the role was not defined, I could make it what I wanted. I was the first health care provider hired in the company. I took a chance and it has worked out well. Since then I have found that there are alot of advanced practice nurses in this field, or in the field of medical writing. It is a great career opportunity. Many work from home and are self employed. Google medical writing and there is a professional organization that gives you even more information.

[traumaRUs]

Thanks much for the info and for sharing. Sounds very interesting.

[KelRN24]

Originally Posted by llg

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.

You have written many valid points. I am very fortunate that I attend a school where the NP and CNS programs are separate and distinct. We may share some core MSN courses, but that is the extent of it.

The nursing industry in general has experienced issues of role confusion and education levels; it appears that it is no different for advanced practice nursing. When examining the history of nursing the problem of turf wars and roles among various levels of nurse has always casused confusion and aminosity.

As I work on my last year of the Acute Care CNS program, I realize that my role and responsibilites are going to be partly what I make of them. I work in a community hospital that has never had a CNS and I stand a good chance of metamorphising into that role, especially in the Critical Care areas. However, as you and others have pointed out, despite the national CNS organization, there still seems to be a lack of clarity as to where the CNS fits into the acute care matrix. I personally chose the CNS track due to the role varibility and functioning. I like the idea of teaching patients, families and staff, being a collaborative member of the patient/physician care team as well as staff development. A lot of preparation and hard work go into the making of a CNS (as I am finding out!) we need to ensure our place in the nursing profession.

I appreciate the wisdom of those of you that have completed advanced degrees...it is hard to find a balance of career, personal life and education.

Question...Anyone a CNS in SC? It appears that the scope of practice is pretty open. Also, does anyone have experience in the ED/ICU as a CNS? Any comments or suggestions?

Thanks,

~KelRN24

Life is better at the beach!

[hudson_rn]

Hi All !! I've been an RN for 27 years now and went back to school for CNS back in 1992. I graduated with my Critical Care CNS in 1993 from Univ. Texas - Houston Health Sciences Center (fast track program). I came back to Michigan and worked in the hospital setting for about a year as a critical care float nurse until an opportunity came along at another hospital across town. I took on a role implementing, integrating, and then administrating an APACHE III Critical Care Outcomes database system (now owned by Cerner), was the chief statistician for the critical care nursing division, the high risk cardiac case manager, and the acting trauma coordinator. I LOVED it - the variety was just to die for. I did that gig until 1999 when I unexplicably anaphylaxed to latex at work one day, which promptly ended my hospital career. I worked an NIH research gig for a while, went back to school for my MS in public health, and then ended up at my county health department where I was an epidemiologist and the emergency preparedness coordinator for about 4 years. I was promoted 2 years ago to supervisor of the communicable disease control programs, where I get to use all my skills (except trench work). I'm working on getting my NP license and who knows where I'll end up next! I think the AP CNS role is what you make it, and that's a beautiful thang!!
hudson_rn, RN, MSN, MS

[traumaRUs]

Wow Hudson - what a wonderful career! Sounds like you are very happy! May I ask why you are going for the NP when a CNS is an APN? Or does the CNS not allow you to practice as an APN in your state?

[hudson_rn]

Hi Trauma,

In Michigan, CNS is not yet licensed as an ANP, only the NP role is. Several of my CNS buddies have gone on and taken the NP exam for that reason. The CNS group in Michigan has been working for some time to move CNS as licensed ANP role, but the lack of a nationally recognized certification exam seems to be the paper jam in that effort. I noticed the AACN exam site has a place for the national CNS exam, do you (or anyone else on this list) know the status of that?

[hudson_rn]

....and yes, I'm quite happy. I owe it to a couple of great mentors, one of whom held my feet to the fire with a threat of an incomplete grade if I didn't step out of my comfort zone. She always told us that we couldn't be great "Change Agents" if we were "afraid of change ourselves", and I've tried to live up to those expectations to the best of my abilities ever since graduating. I think that's one of the reasons that the CNS program at the University of Texas SON remains one of the topped ranked programs to this day.

Once completing the core advanced nursing courses (i.e. phys/pathophys, assessment, pharm, etc.), we had to have additional clinical/work experiences that were not based in our core set which for me was cardiac critical care/some trauma. I tell you all that the first step I was forced to take out of my comfort zone was one of the hardest ever, but once I got used to it, I rarely looked back and wouldn't trade any of those experiences for the world (well, maybe one of them I would consider trading...LOL). I ended up with clinical experiences that back in '92-'93 were considered cutting edge (i.e. portable ECHMO; artifical heart, balloon, and CAD pumps; rehab w/motorized artificial limbs; new human skin burn grafts; and highly specialized cancer treatments to name a few). We also were at hospitals that were fully electronic in all aspects of clinical documentation, and, we had Email which was a huge thing back then because there were no GUI's yet (i.e. Yahoo!, AOL, Netscape, etc.). I suffered huge computer world shock when I returned home to Michigan in '93 to hospitals that were just starting EMR's or that still used paper kardex and med card systems (Old Timers know just what I'm talking about so you Newbies be quiet!!). I ended up with work experiences that were way out of my comfort zone because I had never had the opportunity or thought about developing them as a skill set (i.e. legal/Risk Management; financial/budgeting; unit design & layout; clinical research; translating research that I had actually participated in to clinical practice; and actually monitoring clinical studies that were in progress). I also received some of the best trauma training (and certification) available at the time in the USA at Ben Taub Hospital (only the LA General and Baltimore programs were comparable at that time). In fact, I was trained on the trauma "Golden Hour" method which was being researched at Ben Taub by Dr's Pepe & Maddox during my time there. All those experiences made me realize that it's fine to have core expertise, but that you also need to have experience in the non-clinical facets of practice to be truly able to create, promote, and sustain needed change (especially in todays business driven world).

Anyhoo, thank you all for letting me type your eyes off and for the opportunity to share a small portion of my training with you! After being a nurse for so long, I have lots to tell and am willing to share whenever asked, ok?

[hudson_rn]

WOW brizzo - that is a great role. If I may ask, what have been some of your greatest challenges and successes?