CNS, an APRN role on life support?

adventure_rn, MSN, NP · Dec 2, 2021

A bunch of schools are closing their programs, which isn't helping.

In my experience, hospitals/practices are only willing to pay a provider salary if they're getting reimbursed for something that only a provider can do (I.e. billing for consults, procedures, orders/prescriptions etc.) CNSs can do those things, but they have a more limited breadth of 'billable' abilities than NPs, so employers may prefer NPs.

As for much of the rest of the CNS role (reviewing literature to advise on policies, teaching, research, etc.)--those activities are super-important, but don't legally have to be done by an advanced practice provider. Pretty much any RN with adequate time, training, and experience is able to do them. Therefore, it's way cheaper for a hospital to move existing RNs into educator or research roles, and pawn the literature reviews/policy changes onto managers and committees.

So yes, in theory, the CNS role is great, and the work they do is really important. However, hospitals may be squeezing them out when they can get an NP who is more billable to do patient care, and an RN who is cheaper to do the 'practice improvement' piece.

If you look back at the older posts in this forum, you can see that people in the CNS role have seen this coming for years.

frozenmedic · Dec 2, 2021

Weird.....Nursing invented a role that we thought we needed, but no other part of the healthcare delivery machine wanted, nobody (including nurses) really understood, and the idea tanked.

Trauma Columnist · Dec 11, 2021

I'm an adult CNS (2006) and peds CNS (2011) and I function solely as an APRN who sees pts, bills for my services. I do nothing like the "true" CNS role. That role IMHO is obsolete. Nowadays as an APRN you need to earn your keep and though you do help lower costs by being a "true CNS", its not quantifiable.

Also, as a CNS, I did clinicals in acute care, among other areas and in my area, the hospitals will credential me over an FNP for inpt roles due to LACE and the role delineation between involving NP specialties.

DrNurseCNS · Feb 25, 2023

Yes I think it is a role on life support for a variety of reasons such as those mentioned above. Schools are closing their programs because there are no positions for CNSs and low enrollment, to name two big reasons.

The lack of positions may be because many organizations do not understand the role, do not value the role and underutilize it. The lack of employment opportunities perpetuates the low enrollment because who wants to do all that schooling and clinical with no job prospects at graduation.

In California we have title protection, but no requirement for board certification other than the certification received from the BRN that the person graduated from an accredited program and fulfilled the requirements as outlined by the BRN and NPA. In California, CNSs have no prescriptive authority (unless you work in a Federal facility) so this limits the role because of the importance placed on billable service. Cost avoidance, patient safety, nursing research and excellence don't get the bean counters and the C-suite quite as excited. The only CNS role that gets any respect is the NICU CNS because if hospitals receive CCS money, the state mandates that they have a CNS at least part time. So again, it comes down to $$$$. Also I see a lot of NPs doing CNS roles such as managing programs, but unfortunately the CNS cannot perform the NP role (nor do we want to...we are all about populations and systems).

The National Association of Clinical Nurse Specialists (NACNS) and some of their local affilitates (such as California- CACNS) are aware that the profile of the CNS needs to be raised and become more visible. There is a movement to educate on the benefits of the CNS to patients, nurses, and organizations, but it is slow going.

I am part of a CACNS subcommittee trying to tackle this very subject. If anyone has suggestions or questions, I would love to hear from you.

Trauma Columnist · Mar 10, 2023

Like everything in nursing, the states run the system. I'm in IL where an APRN is an NP, CNS, CNM, CRNA. We all have the same practice act and we all bill. As a CNS (adult and peds) if I couldn't bill just like my NP colleagues I would be out of a job. I do nothing with systems or managing programs. I see pts, order tests, diagnose and treat. Again, just like my NP colleagues.

In my area, the colleges of nursing don't even offer the CNS any longer. To me, that speaks volumes.

I think we are beyond life support, we are now DNR

beachbabe86 · Mar 12, 2023

2 of my friends from school, from the dark ages,became CNSs. One was fired from her job and the other let her license lapse due to the fact she married a doctor.

TXRNblue, MSN, RN, APRN, CNS · Sep 27, 2023

I'm interested in this thread because like the person from IL, I also work in a non traditional role. The program that I graduated from expected us to function in a provider role. I'm curious where other folks are working in this capacity. Are IL and Texas the only places?

Trauma Columnist · Nov 24, 2023

@txrnblue - what type of role are you in???

TXRNblue, MSN, RN, APRN, CNS · Nov 24, 2023

traumaRUs said:

@txrnblue - what type of role are you in???

I work in a cardiology practice. Primarily outpatient, but we do provide coverage for the hospital as well so it's about an 80/20 split outpatient/inpatient. I do this with my supervising physician as Texas is not an independent practice state.

I do have prescriptive authority and have a DEA license, however everything is done under the collaborating agreement that I have with the physician that I work with.

Prior to this I was doing internal medicine in an LTAC. Many of my classmates and grads from my program are in LTAC, hospital based palliative care, working in SNFs (we're all AGCNS), or working in specialty practices like cardiology, endocrinology, or neurology.

One reason I commented on this thread is that I wonder about my ability to find similar work if I were to leave Texas, or even my area of Texas. I have a friend who had a job offer in another part of Texas and they had never hired a CNS. The employer wanted her but the hospital didn't understand what do with her so she just moved on. Many people have no idea what a CNS is.

My program is still graduating about 10 new grads every year. We all have found work doing what we wanted to do and I think we all agree that we received a great education.

Still, I worry that I might be best off getting a post-MSN certification as an NP just in case I want to move to another area.