CNS and Clinical/Practicum

Thanks for the information traumaRUs. I live in NJ and CNS and NP are pretty much the same. I also want to focus on primary care and am curious how many CNSs there are in this area. I realize to be well rounded all the spheres should be included but there are many ways to do that in the primary care setting. Tons of educational opportunities with health promotion, for example.

The program I am looking into is flexible with regard to clinical placements which is really nice but I am curious how one sets up their own objectives in this setting since as you said it is pretty non-traditional approach for CNS. I like how you put it best-pursued it as an "advanced practice nurse".

Did your program include prescriptive/pharmacological content integrated into the curriculum or did you just have to complete an advanced pharmacology course to be able to prescribe?

You mentioned that you have to do the same courses. Did the school require you to retake the physiology, assessment and pharmacology courses for the post master's?

I completed an adult health CNS in 2006 and did clinicals as advanced practice nurse, not in a true CNS role:

1. Large outpt surgical practice - made rounds with NP, placed central lines, art lines, did H&Ps, consults, discharges.

2. Level one trauma center where I saw pts as a mid-level with an MD as a preceptor.

3. Rounded in-pt with adult health CNS that worked with a thoracic surgeon - she did a lot of teaching and case management type duties.

4. Rounded with an FNP who ran the "wean team" to get folks off ventilators.

5. Worked with an ICU ACNP - very interesting!

So...that was most of my clinical. I currently work with a large nephrology practice as a mid-level provider. They have 3 FNPs, a PA and me and we all do the same job.

Of course, I live in IL where CNS's are APNs.

Let me start off by saying that I am really glad that I found allnurses.com! The dialogue has been invaluable...an incredible eye-opener.

If I could describe my ideal clinical experience (I am a CNS student), and then job description, they would be identical to those of traumaRUs! Interestingly though, and sadly, I have yet to find anyone, except for a gentleman in Indiana, near Chicago, who has "seen" pts and given me "permission" to see pts as a CNS.

In trying to get an idea of what my future might hold for me, if I continue with my CNS program (as opposed to changing to an NP program), I have contacted "VIP" CNSs around the country, asking that they please help me understand the role of the ED CNS. And, so far, none of them have described such an active participation in pt care (assessment, workup, dx, tx, etc.). I have e-mails and published literature from the creme-de-la-creme, and except for an occasional pt "consult," they have more less cautioned me about being a CNS and working more like an NP.

Currently, there is an ENA task force who is working on the ED CNS role. The ENA has already put together guidelines for the ED NP, however, ED CNS guidelines have yet to materialize. I contacted a member of the task force who is working on the ED CNS guidelines, and I specifically asked about "seeing" pts. I was not told that that would be impossible, but I did interpret their feedback to mean that that would probably be unlikely. "Consulting on 'difficult' patients" would be more along the lines of an ED CNS; but, regularly "seeing" patients would not.

I called the Indiana BON at one point. I was told my practice as a CNS would depend on the physician(s) with whom I had a collaborative agreement.... so, I imagine I could practice much like traumaRUs in Illinois, WHICH I WOULD LOVE TO DO! BUT, I am wondering if I will have ENA (Emergency Nurses Association) support? What would the implications be if I were to have a collaborative agreement allowing me to do much, but the ENA taking a more restrictive stance?

The ENA is based in IL and IL holds out the CNS role as that of advanced practitioner. I have a DEA number (in order to write narcotics) as well as an NPI number (so that I can bill). I also order home care services. I'm credentialled at five hospitals for my nephrology role and one hospital for the ED.

I would sincerely hope that the ENA would not take a restrictive role stance on the CNS in the ER.

With the current state of healthcare, I, too, would hate to see restrictions. As a CNS student though, I am just trying to understand. I would love to have a practice that mirrored yours, but when I mention "seeing" pts (to instructors and those who are working on CNS guidelines in general & in the ED), I am reminded of the different functions of the CNS (the "spheres") with little emphasis on "seeing" pts...I am spoken to as someone who probably has not done any research on the role, and it is suggested that I consider NP programs... I would not mind being a change agent, for example, implementing evidence based practice in EDs for example, but considering my education consists of assessment, pharm, & patho, in preparation of obtaining prescriptive authority, why would I NOT aspire to see pts as needed? Now, if my educational track were administration or education, that would be a different story... I am not sure that those tracks would prepare one to see pts, nor are they considered APN roles.

I live in a moderately-sized town in central Indiana, an hour north of Indy, where APNs in general are non-existent... I think I asked you previously, but I would really like to hear your thoughts on HOW I would go about MAKING my way in this little town. My ED is screaming that they want to start using more mid-level providers...they are throwing around the terms "nurse practitioner" & "PA," so how do I get CNS mentioned?! My docs are asking me, "When are you going to be done with school?!" How do I convince them to use me with my specialty as a CNS?

What does your nurse practice act say you can do....its strange we moved to central IL from Indy in 1996 when my husband retired at Ft Ben....we almost stayed when he was offered a job in Muncie - I'm gathering that the area you are in. I went to Marian College for the LPN to ADN bridge - small world.

Anyway...I would tell your doc....hey there, I can do what an NP or PA can do and I already know the ins and outs of this particular ER so that would cut down on the learning curve.

(IF this is true per the IN BON).

Again, I want to thank you for your responses! YOU ARE MY IDOL! And, I mean that sincerely.

So, is that what you did when you were trying to establish your practice...tell the docs that they needed to hire you? I've thought about it! They are aware of what I can do, and who I am. And, I know that they are interested in me. I very much want to "see" pts, but I do really appreciate the change agent role of the CNS. I personally do not see why the CNS could NOT see pts, unless one's education was strictly research- or education-based. All of my courses are the same as the NP, until, of course, I am ready to do my CNS classes & clinicals.

Would you be willing to talk to the Indiana BON? (can't blame a guy for asking). I'd like to get your first-hand impression on the role of the CNS. When I called, the lady that answered the phone was able to help me, and it only took a few minutes. I purposely repeated what she had told me, to make sure that I understood correctly, because it WAS what I wanted to hear --that the CNS was only limited by the physician with whom they were practicing (collaborative agreement). The role was pretty open. Unfortunately, or fortunately, (depends on how you look at it), I would have to be the trailblazer in the area, cause there just aren't any CNSs to provide any guidance.

Hi Rolo. I already sent you 2 private messages, but now I remember, on reading your posting here, that private practices often have NPs on staff. They assess and treat patients in the office and also go see the patients from their practice when they are hospitalized. This is besides the NPs/CNSs that might be on actual hospital staff. CNSs at the med/surg hospital wherein I worked, saw patients on a consultation basis, and made recommendations to the doctors for care in whatever specialty the CNS had, and made nursing recommendations to the nursing staff. Most units/specialties did not have a NP on staff but alot of them had a CNS on staff. The CNSs in that hospital did not have prescriptive authority (or at least they didn't use it in the hospital). The NPs did. Getting prescriptive authority is a whole new topic, though, and it's rather complicated to do in Indiana.

I'm rambling....It's a big topic!