Non-Prescribing CNS-What's Your Role?

Trauma Columnist · May 10, 2017

I'm a CNS in IL and do have prescribing and more importantly BILLING ability. In this day of transitioning health care, IMHO being able to prescribe and bill for your services that is the key to an APNs success and employability.

Again, in my area, CNS are only employable if they are providers.

I have moved this to the CNS forum for other opinions.

core0 · May 10, 2017

So lately I've been curious about the role of the CNS. I don't plan on going back to school for 2-3 years at the least, however I'm interested in learning about other roles. I plan on reaching out to CNSs at my institution to hear more about what their roles are, but I also thought I'd start a thread here.
At first, CNS sounds perfect for me-I'm very interested in research/EBP, supporting clinical RNs with education and development, and being an "expert" in nursing care providing consultation.
In New York, CNS do not have prescribing authority, which is fine for me (although I have thought about NP and still open to that as an option, prescribing authority is not a deal-breaker for me). So, I'm wondering, for those CNSs without prescribing authority, what is your role like, especially if it involves patient care responsibilities.
CNS is attractive to me because with the degree and certification, you qualify for many roles, including Nurse Educator, management, quality, etc. On the other hand, I'm wondering if other degrees offer similar opportunities. For example, Educators at my hospital are involved in curriculum development and education, staff development, and sit on committees. Guess I'll have to just reach out to CNSs there to see what exactly they do and how it differs from the educators.
Anyway, just interested in the latest thoughts on whether it's worth it to be come a CNS, especially for those not necessarily interested in having prescribing authority!

I work in a large academic medical system. CNS have prescribing privileges here but in the hospital system are used in the traditional role. Almost every unit has one and some have 2. The CNS is the clinical lead for the program or area of defined nursing practice. Working with the unit director (who is the administrative lead) they evaluate and integrate new knowledge for the unit as well as make sure current knowledge is maintained. They don't go into staffing but instead are 100% leadership. They are also on most of the committees and are in charge of rolling out new initiatives.

We also have a unit nurse educator position which is a part time educator position assists the CNS in program work. They work with the CNS to make to educate the nurses on policy changes and help run skill fairs.

llg, PhD, RN · May 10, 2017

My hospital doesn't use the title of CNS because of licensing issues in our state. However, we have a role that combines the traditional non-prescribing CNS with Professional Development. Each unit has one -- a MSN-prepared nurse who leads clinical initiatives, quality improvement projects, develop policies, etc. and also oversees staff development (with the help of a BSN prepared educator).

MurseJJ · May 11, 2017

Thank you for sharing! Interestingly, at my hospital's Nurses Week poster parade, I ran into a CNS and was able to chat briefly. It was a very enlightening conversation, though I didn't really get into a lot. Her view is similar to what I read here, that the CNS became overshadowed by the NP, however she is of the opinion that the CNS, at least in our area (NYC metro area) is making a come-back. The local oncology specialty hospital (Memorial Sloan Kettering) apparently has a CNS for every unit (each unit at Sloan is focused on a specific type of cancer). I think she said there are around 40 CNSs there. Across the river in NJ, CNSs apparently have prescriptive authority. She also mentioned that she maintains a small outpatient practice, though I wasn't able to find out more about that (I'd be interested in what her practice is like without prescriptive/diagnostic capability in NY, though I'm assuming it would be along the lines of counseling? She's an oncology CNS I believe).

What resonated with me was how she appreciates the role of the CNS as an "expert" in not only nursing practice, but also in a specific disease/population focus. She said she's often asked to guest lecture at other institutions on her expertise. She also mentioned that she appreciates the CNS as being really 'advanced nursing", and that the NP role didn't appeal to her as sometimes they are relegated to doing what the physician doesn't want to do or maintains some relationship with a physician (I guess this depends on a lot of things, and presumably CNSs that practice similarly to NPs have the same collaborative relationship with a physician).

Anyway, I appreciated the conversation and hope to shadow a CNS to see what its really like. Thanks for the replies and definitely keep them coming!

llg, PhD, RN · May 11, 2017

I hope your friend was right about the traditional CNS role (non-prescribing) making a comeback. I always thought it was a great role the exemplified "advanced" nursing in that it required the highest level of clinical expertise without expanding the role into the realms of what is normally thought of as "medical" diagnosis and treatment.

I was a CNS back in the old days before it got muddled with the NP role. But as support for the role declined and the emphasis began to be placed on medical diagnosis and prescribing ... I moved over to Professional Development.

elkpark · May 11, 2017

A lot of us "old school" CNSs feel strongly that the CNS role is true "advanced practice nursing," and the other advanced practice roles are "medicine lite" -- which is fine, but it's not something that has ever interested me.

Trauma Columnist · May 11, 2017

Elkpark - I am not sure if I'm an old school CNS or just an old nurse but I've been a CNS for 11 years and in my area, we have to be able to bill for our services, otherwise the suit folks come along and chop at the budget and out go the nurses with masters degrees and doctorates that bring in the money.

I think you are lucky to work at an institution that values something other than the almighty dollar

MurseJJ · May 11, 2017

Elkpark - I am not sure if I'm an old school CNS or just an old nurse but I've been a CNS for 11 years and in my area, we have to be able to bill for our services, otherwise the suit folks come along and chop at the budget and out go the nurses with masters degrees and doctorates that bring in the money.
I think you are lucky to work at an institution that values something other than the almighty dollar

It's interesting, my hospital has a number of roles that I assume would fall into the traditional responsibilities of the CNS (correct me if I'm wrong):

-Wound/Ostomy/Continence Nurse

-Skin Care Resource Nurse

-Nurse Educator

-Clinical Coordinator

Curiously, at this week's Nursing Excellence Awards at my hospital, a Nurse Educator won the advanced practice award (even though, as great as she really is, Educators aren't APRNs, and she isn't an NP/CNS/CNM/CRNA).

MurseJJ · May 11, 2017

This is from the job description for a CNS position at our system's pediatric hospital:

The CNS demonstrates clinical expertise in the standards of the Emergency Nurses Association. The CNS guides and promotes the growth and development of evidence-based professional nursing practice through application of advanced nursing knowledge and skills with patients and families, nurses, and other health care providers. The CNS is responsible for consultation, clinical teaching, professional staff development, and nursing practice for a designated area.

Foster a culture of learning and guide the next generation of top-talent nurses. Conduct learning needs assessments, and design/implement/reevaluate educational programs to meet the needs of our amazing nurses. Conduct clinical rounds to identify the individual and collective learning needs of staff and use cutting-edge technology. Promote evidence-based practices that inspire award-winning nurses. Regularly evaluate staff competencies, mentor clinical nurses in professional development, and serve as a role model for professional nursing practice across the organization. Collaborate with departmental and interprofessional teams to determine policy, standards, and clinical procedures that guide nursing practice; and participate in the development and implementation of continuous quality improvement programs. Conduct nursing research, outcome measurement, and utilize findings to enhance nursing practice and patient care outcomes.

I really need to reach out to one of the CNSs here at the adult hospital to really see the role, however I assume it's similar.

I definitely want to stay in the inpatient setting, however I'm not as sold on the roles of inpatient NPs/PAs as perhaps I used to be, though I haven't completely ruled it out. Seems as if the most fully autonomous clinicalrole for nurses in the inpatient setting is the CNS (not sure if I'm articulating that correctly). Conducting research, being an "expert", being a "resource", staff development, etc. are where I see myself at this point.

Anyway, I have a lot of time before I even apply to graduate programs, just considering all the opportunities available in nursing.

MGMR · May 11, 2017

Really interesting/good discussion. I've been having a hard time deciding what I want to do for the future as well regarding the CNS vs NP routes. I work in a pediatric cardiac ICU, and I honestly really love being a bedside nurse in this environment - granted I work in a great unit and hospital. I have a good amount of autonomy and am always in the discussion of the medical decisions being made for my patients.

My ideal job for the future would be exactly what i'm doing now, with advanced knowledge and slightly more autonomy - I would love the ability to start PICCs, arterial lines, and even intubate. I know flight/transport nurses in some NICUs for example do these things, so I don't need to be an NP to do this. Honestly, the NP role is not appealing to me outside of the procedural advantages like intubation/CVL insertions. I like managing my patient, their lines, titrating sedation at the bedside, etc. I work very closely with NPs on my unit and have a very good understanding of their role. Have nothing but respect for them and their knowledge/role, but it doesn't seem like the direction I want to go.

The CNS role was very appealing to me because, like everyone here mentioned, it seems like an advanced practice "nursing" role. The problem for me is that it doesn't seem as clinically based in practice or in its education, like the NP education is. I'm also in the NYC metro area, and there are no CNSs at my hospital. The NICU just hired one recently, and no one seems to know what she does or what she is. And (my worst nightmare) she seems to be completely removed from the bedside - she's off the unit in meetings and committees constantly. I do see their importance, but I also think it's essential to remain current with bedside practice as well. It seems like I can't find a role that fits my ideals outside of what I'm currently doing at the bedside. The CNS role seems great for education (I love to teach), remaining in nursing practice, and advancing my education. The NP seems good because I can learn to intubate, place invasive lines, etc. What's worse is that every nurse I talk to seems completely shocked as to why I'm interested in possibly pursuing the CNS route, which is also discouraging.

Sorry for rambling and not really saying much - just trying to add to the discussion.

MurseJJ · May 12, 2017

Really interesting/good discussion. I've been having a hard time deciding what I want to do for the future as well regarding the CNS vs NP routes. I work in a pediatric cardiac ICU, and I honestly really love being a bedside nurse in this environment - granted I work in a great unit and hospital. I have a good amount of autonomy and am always in the discussion of the medical decisions being made for my patients.
My ideal job for the future would be exactly what i'm doing now, with advanced knowledge and slightly more autonomy - I would love the ability to start PICCs, arterial lines, and even intubate. I know flight/transport nurses in some NICUs for example do these things, so I don't need to be an NP to do this. Honestly, the NP role is not appealing to me outside of the procedural advantages like intubation/CVL insertions. I like managing my patient, their lines, titrating sedation at the bedside, etc. I work very closely with NPs on my unit and have a very good understanding of their role. Have nothing but respect for them and their knowledge/role, but it doesn't seem like the direction I want to go.
The CNS role was very appealing to me because, like everyone here mentioned, it seems like an advanced practice "nursing" role. The problem for me is that it doesn't seem as clinically based in practice or in its education, like the NP education is. I'm also in the NYC metro area, and there are no CNSs at my hospital. The NICU just hired one recently, and no one seems to know what she does or what she is. And (my worst nightmare) she seems to be completely removed from the bedside - she's off the unit in meetings and committees constantly. I do see their importance, but I also think it's essential to remain current with bedside practice as well. It seems like I can't find a role that fits my ideals outside of what I'm currently doing at the bedside. The CNS role seems great for education (I love to teach), remaining in nursing practice, and advancing my education. The NP seems good because I can learn to intubate, place invasive lines, etc. What's worse is that every nurse I talk to seems completely shocked as to why I'm interested in possibly pursuing the CNS route, which is also discouraging.
Sorry for rambling and not really saying much - just trying to add to the discussion.

Thanks for participating! Interested in hearing more thoughts as well.

As an aside, Morgan Stanley Children's Hospital in NYC hires CNSs, including in their cardiac PICU (i see openings for CNSs in their cardiac PICU, PICU, NICU, and peds ED). They're also opening a new infant cardiac NICU soon and are hiring CNSs (and NPs).