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

ROLO · Dec 17, 2009

Re: Different roles for CNS's??? Come on guys share what you do!

"I am a CNS and most physicians I know look as CNS as an educator or researcher. I work for a doctor and function as an NP (diagnosis, prescribe, bill etc). The doctor who hired me knew that I was an ANP and did not care what if I was a CNS, NP, or PA...as long as I know my stuff and able to bill..I was happy that she gave me that chance and prove myself. It's sad to say but I had a hard time with fellow NP at the hospital who feels that I needed to go back to the NP program to do what I'm doing now. I remember hearing comments that "she's not an NP, she's a CNS"...(a lot of hosp staff has a habit or thinks I'm an NP so they will say I am an NP and that when the other NP hears this...They would correct them and made it known that I was a CNS. Which I do introduce myself as an APN/CNS...but still they see me as an NP. It is getting better that the NP are not "making side remarks"...I do my job and take care of my patients and I enjoy what I do. Any CNS who function as an NP out their with similar experience? Where I work there is only 2 others who function like the NP as a CNS."

Sorry about the failure to recognize the CNS (we need to change that!), but I think it is cool that your physician has voiced his expectations of you as an MSN, has certain expectations of you, and is assisting you in your growth --very cool!

ROLO · Dec 17, 2009

So, what advice do you have on creating a position as an ED CNS? I've been an ED staff nurse for most of my 18 years, plus I am a paramedic, so I think it is fair to say that I am pretty well-rounded in emergency care. I am entering my last year of school (adult/geri CNS). I work and live in "Mayberry" (as in the "Andy Griffith Show"), a small town, where I am known as the "male nurse," and there are almost NO APNs in the area (there's a couple of FNPs, and NO CNSs that I know of). HOW DO I CREATE MY PRACTICE?! I know what I want to do: I want to see ED pts as needed; but, if it is "slow," then the docs can do their thing (seeing pts), and I can work on some education, or research, or whatever. Then, as it gets busy, and pt flow is interrupted, I can make my way back into the ED clinical area, doing whatever needs to be done, so that pts are seen quickly and safely.

Any feedback? That was just a quick summary, and I didn't mean to minimize any CNS importance.

Trauma Columnist · Dec 17, 2009

Hi Rolo - as an APN, its all about billing. If your hospital credentials you to see pts without a physician going behind you to see the pt, then you are a viable entity. If however, the MD has to repeat everything you do, you are not viable or billable.

While I agree the flow of the ER is very important, improving the flow can be managed by an RN, don't need an APN.

ROLO · Dec 22, 2009

traumaRUs, I just wanted to thank you for all your kind words & support! I could have sent you a private message, but I wanted to post for the benefit of others. I checked in with our state board again, via phone, as I like to do from time to time, eventhough I have read through the guidelines --it is sometimes nice talking to someone from there and getting that verbal interpretation of what everything means. I wish I had gotten the young lady's name, cause she was very nice & helpful, and seemed very knowledgeable about APN practice in Indiana.

She told me what I had gathered from my previous conversations: APNs "are not licensed" in Indiana, but work "as an extension of their RN license;" there is no differentiation in NP and CNS practice; CNSs may prescribe, but, of course, that is after a pharmacology course, proper application, etc.; the determining factor of practice is one's collaborative agreement.

She said that she, too, has read some of the nursing web sites, and is also surprised by the various types of APN practice and how they vary from state to state --nevertheless, she seems to know Indiana practice, and she made sure that I understood by listening to me repeat what she had said & making that verifcation.

It is funny: I had accessed the guidelines of CNS and NP practice via the internet. THEY WERE EXACTLY THE SAME at one time. Then, they were updated, and the CNS guidelines were changed in some areas --I'm talking the old text was lined-through, and then new text was written in, so that one could see old AND new guidelines. When I read through the new, they were basically saying the same thing they did before, only kind of re-worded.... That's what facilitated my calling the Indiana BON the first time, cause I was thinking, "AREN'T THEY SAYING THE SAME THING?!"

So, with that being said, I stayed up way too late last night, reading the DNP boards... WOW! I don't want to comment too much on those boards, but there are some heated discussions there! It is amazing with the current state of healthcare that many healthcare professionals are still very territorial...that it is getting more difficult to practice (lots of classes & lots of clinicals, for one thing)...and limitations on practice that some states have imposed on certain APNs (failure to acknowledge, can't prescribe, etc.). Point of bringing all of this up? I kept thinking, as I was reading those boards, is it worth it to complete my MSN?! ...cause I have no idea where healthcare is headed.

Thanks traumaRUs, whispera, and others for your time!

Trauma Columnist · Dec 22, 2009

Thanks for the kind words!

I think pursuing an MSN is never wasted - no matter what track you choose. By doing your homework, hopefully you will avoid the issues I've had because I didn't do my homework.

Take care.

allsmiles2008 · Dec 27, 2009

TraumaRUs... thanks for a great and very informative thread!!

enoRN · Jan 10, 2010

That really sounds like a lot of responsibility. I am planning becoming a CNS soon.

kinlabelle · Jan 21, 2010

I live in Knoxville, TN. I'm planning to start my MSN in this coming Fall. My goal is to become Geriatric NP but where I will be going to school they just have a CNS program. I was not familiar with the program, since that I applied over there, I have been doing a lot of research about CNS. The school told me that I can still become a GNP by taking and passing the ANCC and take some post-graduated classes. Is anybody has an advice or suggestions?

Thanks!

Trauma Columnist · Jan 22, 2010

Personally, I think if you wan the GNP, I would go to that program. If, however, the dual program would fit the bill, then okay.

rnphd2b · Jan 22, 2010

I live in Colorado and I am the Critical Clinical Nurse Specialist for a 200 bed hospital. I LOVE my job my areas of responsibility are ICU (20 bed mixed unit), Telemetry, Cath Lab, PCU and ED.

I do some education but mostly I guide practice by implementing evidence based practice, revising and constructing policy and protocol, I gather, evaluate and report data on patient outcomes, I head up the resusitation committee and the critical care council. I also round in the ICU, work one on one with the RN's , patients and families around the plan of care, outcomes and revisions.

It is a great job and I am very lucky to have it. :):):)

kinlabelle · Jan 22, 2010

Thanks for your comments! I'm getting the good understandings of the CNS program.

mfRN0206 · Apr 9, 2010

Hi, I'm an RN with a bachelors degree interested in continuing my education. I want to go back to school for a masters but am having difficulty finding information on my specific interests. Ideally, I'd like to have a neuroendocrine focus. But I don't know if that is better suited by becoming an NP or CNS. Any suggestions or recommendations? Also, I'm not sure which specialty I should choose for my masters ... adult/family/acute? My guess is that the adult specialty would most accomodate me after I graduate and start looking for neuroendocrine-related positions. I'd like to be a researcher and clinician. So what education path should I choose?