CNS-Critical Care, online programs? (APN/CNS/NP confusion!)

Annaiya, NP · Nov 6, 2010

I think I can answer at least some of your questions. You may want to consider doing some research to see how APNs are being utilized at the hospitals near you, because there are regional differences. I'm in TX and everyone around here seems to have AC NPs, not CNSs. I know the popularity of CNSs has diminished in preference to NPs. This is partly due to the fact that NPs can bill directly for reimbursement, whereas CNSs are an expense to the hospital just like staff nurses. Scope of practice may differ among states, but CNSs generally focus more on education and care coordination. Whereas NPs function very similarly as residents. Where I work the ACPNPs can intubate, put in CVLs, art lines, chest tubes, run codes, and generally field all of the questions/concerns regarding patients from the nursing staff. Generally CNSs in TX don't have prescriptive authority, whereas NPs can prescribe anything within their scope of practice other than Schedule II drugs. So depending on what you want to do and what jobs there are in your area should lean you toward either CNS or ACNP. I'm not aware of any dual degree programs.

As for what school you go to, that has been asked on this forum a lot and the answer is always that it doesn't really matter where you go to school in terms of getting jobs afterward. I would recommend comparing the curriculum of the different schools you are interested in and pick the one that seems the best. There is a lot of variation between schools. I chose to go to an online school (UAB), because their curriculum was much better than the school that is here locally. I had also heard very good things about their program, and so far have not been disappointed. I wouldn't discount a school just because it offers an online program.

Be thankful that you did well in your prior schooling, so you should be able to get in. Every school I have talked to has said they've seen a dramatic increase in the number of applications recently. I work with several nurses who have applied and not gotten into grad school and there are lots of people on these boards who haven't been able to get in. I haven't heard of any programs being "easy" to get into lately. At least not the NP programs. Good luck with your search!

Walden-Puddle, RN · Nov 8, 2010

Thanks for the reply and details. From your description....it looks like I fall right between the cracks!

I want to practice at a higher level in critical care myself (I like bedside nursing), but at the same time I really want to do education, EBP and care coordination as people move from ED/ICU/PACU/Stepdown to Telemetry and medsurge floors.

Sometimes just giving the nurses on these floors a little more information about the plan of care and things they can watch out for on individual patients can be helpful (I'm learning this myself.) It's one thing for me to get report from the outgoing nurse. But my patients usually get MUCH better care if I'm lucky enough to get 5 minutes with the attending or the doctor who admitted the patient when they occasionally come to follow up. YES...I carefully read the h&p's, progress notes etc.....but even then...it's sometimes doesn't quite paint the full picture and often a few tiny details here and there escape. That's where I think an APN can make a difference in coordinating care as well as practicing care. I also want to help shape policy concerning these transfers of care. Basically...it strikes me as a game of "telephone" where the clarity of the original message USUALLY gets at least slightly dminished each time information is handed over. I'd love to develop formats that help preserve as much as possible.

I'm in California and have seen a fair amount of postings for both CNS and NP's in my hospital chain...so I know they are both being utilized (which is good when it comes to preceptorship opportunities) So I guess the next step is to reach out to some of them and ask them about their roles / scope of practice etc.

Some questions? Since the grad school admission process can be long (which is why I'm starting now) I was wondering whether I should get my CCRN in the interim...or whether it's unecessary if I'm simply going to do what is (essentially) a masters in critical care nursing (NP and CNS both receive an MSN? or no? Am I mistaken about that?)

Would the CCRN be a good trial run for the masters program (and/or help me get more out of the program)....or is it really unecessary at that point?

Thanks again!

IckuRN, RN · Dec 9, 2010

I've been pondering my future education as well....

The CCRN is just proof that you know what you're doing. I don't think much matters if your GPA smokes everyone else's, but having the CCRN is certainly not going to hurt your application.

NP and CNS both fall under the MSN category. So far in my research, the cost and credit hour requirement has been the same for both program tracks. CA sounds a lot like MD, where every ICU has a CNS, or two...but the roles can vary vastly by facility, so I'm sure by state as well. The same can be said for NP's and PA's.

Perhaps researching the career's future growth/demand in your area may help you make your decision?