Published Feb 15, 2015
I am almost finished with my Adult-geriatric CNS program. I have had clinical rotation in wound-ostomy and Emergency.I have bariatric and diabetes clinical rotations left to complete. (These were my choices). For the first time I had a FNP say to me she wishes she had gone the CNS route. She feels she will be stuck working in a minute clinic. I see FNPs working at the hospital, but she may be correct that some hospital options may not be open to her. I have been blessed with wonderful preceptors. My wound-ostomy preceptors spent about 50% to 90% of their time in direct patient care and the rest in staff education, creating order sets and procedures, working on committees etc. My emergency preceptor does no direct patient care. She oversees the ER remodel, works with informatics committee, writes policy and procedure, creates order sets, data mines information for core measure reporting and quality initiatives, is on a variety of committees, and seems to be the go to fixer for everybody for everything ER. I never understood the whole spheres of influence blather until now. Physicians, CNOs, nurse educators, managers, staff, construction engineers, everybody turns to her for advice.
traumaRUs, MSN, APRN
Hi there - what role do you envision for yourself when you get done with school?
I am an adult health and peds CNS with both exams being "retired" this year. I am currently in a post-MSN FNP program and hope that they (ANCC) don't decide to "retire" it before I retire.
Personally, and just my opinion, I'm so very angry that the Consensus Model (NCSBN) said originally that no population-based certifications would be retired. However, that changed as time went on and now both CNS certs that I hold are "retired".
Yes, I know I can keep my certs as long as I do the CME and have the practice hours. Anyway, sorry to derail your thread.
SHGR, MSN, RN, CNS
I spent the majority of my clinical hours with two diabetes CNS's who did a mix of inpatient and outpatient work. One did mostly systems work and staff education, much like the ED CNS you describe, OP. One did more patient education and management work. They both were involved in all three spheres of influence, in varying proportions.
I think the wide variety of work that CNS's do is of great value to an organization, but contributes to invisibility: NP's bill for all of their services, and have clearly defined work. CNS's ability to do a little bit of everything makes them seem expendable.
I want to do direct patient care in a specialty. I wanted to do wound and ostomy, but the certification education is pricey. Some hospitals are paying CNSs without prescript authority less money. I know of at least one hospital that is probably regretting that the decision. Another hospital system that recognized and rewarded talent snatched her up and paid her what she is worth. There are so many regulations, quality initiatives, evidence to be researched and implemented, informatics issues, and coordination between different disciplines and departments that I hope the CNSs that do those jobs will be seen as important assets to the executive team. I do not want that CNS job. I like the research part of it, but I lack other necessary skills such as diplomacy, tact, technical proficiency and speed in informatics. My professors have tried to convince me those are skills that can be learned...
Trauma - I wonder sometimes, just as back up, if I too should do the FNP rotations. If I do them now, I won't have to repeat any of the advanced pharm, assessment or patho. I am an older nurse. I would spend about the same money getting the FNP as the certification in wound ostomy, and I think that the FNP would give me more employability. I also would like to do charity/mission work when I retire and I think the peds/Ob rotations would be valuable assets. Did you have to repeat any classes?
- I wonder sometimes, just as back up, if I too should do the FNP rotations. If I do them now, I won't have to repeat any of the advanced pharm, assessment or patho. I am an older nurse. I would spend about the same money getting the FNP as the certification in wound ostomy, and I think that the FNP would give me more employability. I also would like to do charity/mission work when I retire and I think the peds/Ob rotations would be valuable assets.
The choice sounds obvious to me. RN's I know who went on medical missions were delivering babies in Africa as the provider- scope of practice is so different there. If the cost is the same an FNP will give you the experiences and flexibility you want, do it.
There are so many regulations, quality initiatives, evidence to be researched and implemented, informatics issues, and coordination between different disciplines and departments that I hope the CNSs that do those jobs will be seen as important assets to the executive team. I do not want that CNS job.
And I DO want it! I am so glad that the FNPs excel in direct, primary care. I'll do all the coordination, informatics, QI, and research. It's a deal! We complement each other. It shouldn't be a competition. Sadly, it is.
@madriver - I'm 56 so not young at all!!
I knew the NP role was what I wanted all along but I was working at a hospital that had a college of nursing and only offered the CNS and it was 100% employer funded.
I live in IL where CNS=NP as to scope of practice. I've been in a large nephrology practice for almost 9 years and we have FNPs and PAs and we all do the same job.
My advice is to do the FNP. For my program (and believe me, I looked at a ton of programs): if you have had the three P's across the lifespan, you should not need to repeat them.
I had to take:
Epideminiology 3 credits Spring 2015 (currently enrolled-boring class with lots of stats and research)
Advanced FNP management of pts +124 hrs of clinical - Fall 2015
Advanced FNP management of pts II + 124 hrs of clinical - Spring 2015
FNP practicum - 256 hrs of clinical - Fall 2016
I will graduate in Dec 2016.
I plan to work til I'm 70 and the APN role will allow me to do so.
Best wishes with your plans.
I like the work til 70!
I am considering doing primary Adult- Gero NP & going to Senior Clinic or ECF when I retire from my 40 years in acute care. I also want to teach water aerobics to those seniors!
lol - you are liable to be teaching to all the rest of senior citizen NPs!
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