CNL vs APRN?

Jules A, MSN · Sep 10, 2015

As a CNS, in many states (including IL where I practice) CNS is an APRN with the same scope of practice as an NP.
Personally, education is a product that I purchase. My education provided me with a job (APRN) but I already had a career (nursing).
The lines of nursing education have become so blurred that its laughable.

In some states CNS have prescribing rights and so then CNS and NP are the same, right? Sometimes I confuse CNL and CNS in discussion but only the letters because role wise they are very different. Leave it to nurses to come up with another set of letters to confuse things, lol.

PG2018 · Sep 10, 2015

Yeah, this underscores the problem with advanced practice. There is no uniformity. Here, CNS people are APRNs too, but they don't really do anything advanced unless they jump through some extra hoops to gain a prescriptive certificate then they do advanced things. Without this they're RNs with extra letters.

Trauma Columnist · Sep 10, 2015

Agree with you both: nursing has set themselves up to fail education-wise because of lack of standardization.

elkpark · Sep 10, 2015

Yeah, this underscores the problem with advanced practice. There is no uniformity. Here, CNS people are APRNs too, but they don't really do anything advanced unless they jump through some extra hoops to gain a prescriptive certificate then they do advanced things. Without this they're RNs with extra letters.

That is only true if your definition of "advanced" is limited to rx authority. Most of the CNSs I know (including mysefl) would argue that CNS practice is the true "advanced practice nursing," and what NPs do is "medicine lite."

PG2018 · Sep 11, 2015

That is only true if your definition of "advanced" is limited to rx authority. Most of the CNSs I know (including mysefl) would argue that CNS practice is the true "advanced practice nursing," and what NPs do is "medicine lite."

What is advanced practice to you if not finally diagnosing and treating disease? Compare this to caring and using those ridiculous NANDA diagnoses. The CNS is a foreign beast to me. I've only knowingly encountered four of them. Only one did anything 'advanced.' Two taught. One did wounds. I'm all for you exercising your authority, but unless the CNS role is beyond the scope of a RN I don't see how it's advanced.

APRN., DNP, RN, APRN, NP · Sep 11, 2015

Maybe in that they can work as nurses or supervisors on more units but NPs prescribe so its like an entirely different profession. I'm able to work inpatient and outpatient also and I make twice what a well paid CNL makes.

Are you speaking from experience as a CNL?

I would imagine that pay is highly regional. I am in a position to compare CNL to APRN pay. I am seeing NP's make less than a CNL who works in a hospital.

Of course, I live in California.

I think it is more important to focus on patient outcomes. Each title has its place. It is best not to discount either one.

APRN., DNP, RN, APRN, NP · Sep 11, 2015

That is only true if your definition of "advanced" is limited to rx authority. Most of the CNSs I know (including mysefl) would argue that CNS practice is the true "advanced practice nursing," and what NPs do is "medicine lite."

My preceptor for my CNL program was a darn fine CNS.

I learned that the difference between the two was that the CNS focuses on the Macrosystem IN the area of Specialty.

The CNL focused on the Microsystem OF an area. Not just a specialty. That is where the "Generalist" comes from.

The term "Generalist" is getting interpreted as something that is watered down. This is not so. The Generalist requires that the CNL be well versed in ALL areas of practice.

elkpark · Sep 11, 2015

What is advanced practice to you if not finally diagnosing and treating disease? Compare this to caring and using those ridiculous NANDA diagnoses. The CNS is a foreign beast to me. I've only knowingly encountered four of them. Only one did anything 'advanced.' Two taught. One did wounds. I'm all for you exercising your authority, but unless the CNS role is beyond the scope of a RN I don't see how it's advanced.

I've been a child psych CNS for twenty years. I do diagnose and treat child and adolescent psychiatric disorders -- just not with medication. There are other modalities, y'know. My graduate training was rigorous training as a child, adolescent, and family psychotherapist, which is outside the scope of practice of generalist RNs, in addition to the core CNS competencies, which are not literally outside the scope of practice for generalists, but are roles and activities for which generalist RNs are not educated, equipped, or qualified. All of the CNSs I've known over the years, in a wide variety of specialties, have practiced clinically at a level well beyond the scope of generalist RNs.

It is only relatively recently that "advanced practice" is becoming so specifically defined as rx authority, and I consider that a big loss to nursing as a whole. If you've only encountered four CNSs in your career, I guess I can understand why you have so little understanding of and regard for the role. The organizations I've worked for, and staff nurses I've worked with, over the years have highly valued what CNSs have to offer, and have considered themselves fortunate to have us.

Jules A, MSN · Sep 11, 2015

Are you speaking from experience as a CNL?
I would imagine that pay is highly regional. I am in a position to compare CNL to APRN pay. I am seeing NP's make less than a CNL who works in a hospital.
Of course, I live in California.
I think it is more important to focus on patient outcomes. Each title has its place. It is best not to discount either one.

If I was speaking from experience as a CNL I wouldn't have said I make twice as much money as they do. Granted I don't know all their individual salaries but in my area from what I have heard and seen advertised experienced ones in supervisory positions are making in the $40-50 and hour range whereas the new grads working on the floor are making new grad rates between $25-$30 an hour.

I'm only referring to my anecdotal experience from working with new CNL grads where the majority of them were as I stated earlier underwhelming to me. In fact I had one who managed to graduate with their masters in nursing without ever having given an actual injection. This person had no understanding of where the plunger went into relation to the ticker mark on the syringe and wanted to argue with me as I attempted to assist with getting an accurate dose. Another time I attempted to show them how to set up and program the IV and was told "later I have charting to do". Again underwhelming. You might be a wonderful resource for your hospital but my biggest complaint about this degree is that the ones I knew had zero nursing experience and yet thought they were in a position as a new grad to "lead".

PG2018 · Sep 12, 2015

I've been a child psych CNS for twenty years. I do diagnose and treat child and adolescent psychiatric disorders -- just not with medication. There are other modalities, y'know. My graduate training was rigorous training as a child, adolescent, and family psychotherapist, which is outside the scope of practice of generalist RNs, in addition to the core CNS competencies, which are not literally outside the scope of practice for generalists, but are roles and activities for which generalist RNs are not educated, equipped, or qualified. All of the CNSs I've known over the years, in a wide variety of specialties, have practiced clinically at a level well beyond the scope of generalist RNs.
It is only relatively recently that "advanced practice" is becoming so specifically defined as rx authority, and I consider that a big loss to nursing as a whole. If you've only encountered four CNSs in your career, I guess I can understand why you have so little understanding of and regard for the role. The organizations I've worked for, and staff nurses I've worked with, over the years have highly valued what CNSs have to offer, and have considered themselves fortunate to have us.

No, no, I think actual psychotherapy qualifies as advanced practice just fine. It's clearly beyond the role of basic nursing. I'm interested to learn how your practice operates, where you fit into the picture with other therapists, etc. Tell us some about it because you represent a bygone era, and I'm interested in the history of psychiatry. Are you by chance doing EMDR?

APRN., DNP, RN, APRN, NP · Sep 12, 2015

If I was speaking from experience as a CNL I wouldn't have said I make twice as much money as they do. Granted I don't know all their individual salaries but in my area from what I have heard and seen advertised experienced ones in supervisory positions are making in the $40-50 and hour range whereas the new grads working on the floor are making new grad rates between $25-$30 an hour.
I'm only referring to my anecdotal experience from working with new CNL grads where the majority of them were as I stated earlier underwhelming to me. In fact I had one who managed to graduate with their masters in nursing without ever having given an actual injection. This person had no understanding of where the plunger went into relation to the ticker mark on the syringe and wanted to argue with me as I attempted to assist with getting an accurate dose. Another time I attempted to show them how to set up and program the IV and was told "later I have charting to do". Again underwhelming. You might be a wonderful resource for your hospital but my biggest complaint about this degree is that the ones I knew had zero nursing experience and yet thought they were in a position as a new grad to "lead".

If you are comparing your income as a NP to a new grad CNL, since all of the CNL's where you are are new gradsâ€, then I can completely understand why you would make twice as much.

You mention that the experienced ones are making 40 - 50 per hour as a supervisor. They are not functioning in the role of a CNL if that is the case. Here is a job description by Texas health that utilizes over a hundred CNL's across their campuses:

CLINICAL NURSE LEADER CSO/RN V Job

The CNL is not meant to be a supervisorâ€. Neither is a Nurse Practitioner. Nor is a CNS for that matter. If you're going to compare your wages to a glorified supervisor, then you're going to come away with a misconception of what a CNL makes.

In my area, I am making more than a NP does, working the same amount of hours, with the same years of experience. That is the norm here. The NP, in California, cannot practice independently of a physician (which, by the way, they rightly should be able to - SHAME on my home state!). That factors into the pay scale here. Perhaps you get to practice independently where you live?

Here is some more helpful information, which is consistent with the above information:

Clinical Nurse Leader Salary | Programs and CNL Certification | Jobs

[h=2]CNL Salary Expectations[/h]Because a CNL is a relatively new nursing role, up-to-date statistics regarding CNL salary expectations are not readily available. However, the Bureau of Labor Statistics, Occupational Outlook Handbook 2010, reported that the median pay for medical and health service managers and healthcare executives was $84,270 per year in 2010. The top 10 percent of earners earned an average of $144,880. The Bureau of Labor Statistics also noted that employment for medical and health services manager is expected to grow by 22 percent from 2010 to 2020 â€“ faster than the average for all other occupations.

The Bureau of Labor Statistics' (BLS) Occupational Employment and Wages report for 2011 showed that the mean annual wage for medical and health services managers was $96,030 in 2011, and the top 10 percent of earners in this field earned an average annual salary of $147,890. These year over year comparative figures show an increase in compensation that aligns with increasing demand.

Nurse Practitioner Salary | Certified Nurse Midwife | Anesthetist Salaries

[h=1]Nurse Practitioner Salary[/h]The American Academy of Nurse Practitioners (AANP) conducted their 3rd annual nurse practitioner salary survey in 2011, which revealed a salary range of between $83,000 and $107,000 reported as annual base salaries among full-time NPs. Income varied most by area of specialty and work setting, with the highest salaries reported in the respective categories as follows:

By specialty area â€“ Neonatal and Psychiatry/Mental Health
By geographical region â€“ Western, Southwestern, New England, and Mideastern states
By practice setting â€“ Emergency Department and Veteran's Administration facilities

The survey showed an overall trend toward increasing salaries among nurse practitioners, even in the years since the economic downturn that began in 2008. It also revealed that 31% of those working full-time received additional bonus compensation based on practice revenue, outcome measures, and the volume of patient encounters.

of a I am not a statician, nor do I claim to be knowledgable about what goes on across the US. However, I am led to believe that what I am observing in my own area seems to trend the same according to several sources such as this one that I've included.

Nurse Practitioners did not have an easy time of it when they first came about either. Such as it is with the Clinical Nurse Leaders. There will always be a faction of people who will not make positive observations of the CNL's.

AllIcanbe · Sep 12, 2015

Quite disturbing nursing is turning into a title factory.... With no defined boundaries... More like a homeless child trying to fit into many different homes.. Where did Nightingale go wrong?