CNS in emergency department

OldIsNew · May 12, 2020

Hi there!

Thank you for enjoying nursing and the ER well enough to keep studying!

I am a Critical Care CNS in the ER. Unfortunately, I do not have a very good response for you. I am practicing as a staff RN, not as a CNS. There is currently not a certification exam for Adult Acute Care or ER CNS.

IMHO, the CNS role has always been difficult to define. We tried for many years to keep strong and explain the importance of advanced learning in nursing that stayed close to the bedside. In 2015, the consensus model for APRNs was finalized, and we got the very short end of the stick.

I no longer can even come close to explain what a CNS is to the majority of administrators, especially when most applications are electronic! Almost unanimously, I am asked to practice as an NP. I ended up in Quality and Patient Safety for many years, which I loved. I was teaching on the side, which I also loved. I loved the work I was doing, but it left me in an office, and away from the bedside. I became a CNS because I wanted to be an "Advanced Nurse".

Fortunately, I found a strong hospital system which has a nursing ladder that rewards expertise at the bedside. This allows me to participate in research as well. My income would not be much higher if I became an NP (at this stage). It was not easy to find, and I hope it lasts!

Be very careful when you go to grad school. It has become big business. The professors can have up to 50 students each! I was one of 9!

There are other opportunities at the graduate level, not just NP or CNS. You can specialize in education, or clinical leadership (CNL), which is very close to what I used to do. There's also case management (a very cost effective way to reduce chronic disease ED abuse.)

I've been a CNS now for 30 years, which is a long time. I will never regret my decision. It just hasn't been easy!

At the end of the day: where do you see yourself in 30 years? How flexible are you? Are you planning to stay in your current facility? Does your facility use CNS? If not, contact one in a facility and practice where you think you would like to practice.

I think ER would be a great place to practice as a CNS!! We still have many quality indicators to meet, and the staff education is also in demand. As above, a CNS could also assist in the development of alternative pathways for chronic disease visits. Sadly, I do not see that it would be supported much by administrators or ED docs. That would be something you would need to explore as well.

PS--If you do decide to go the NP route, please be sure that you go to a school for ED NP! There are many NPs in ED who are practicing beyond the scope of their education and license. It does not fare well for them during malpractice lawsuits.

I wish you the very best of luck in your decision!!

Raven Sierra, BSN, RN · Jul 23, 2020

Thank you, OldIsNew. I appreciate your candor.

I've been looking around, and almost every APRN job posting in the area wants NPs, not CNSs. The rare CNS posting has nothing to do with ER. I don't want to leave the ER.

My facility is part of a small system, and they do not have any CNSs, as far as I'm aware. They like NPs, and we have many. I honestly doubt I could convince our ED higher-ups that they need a CNS in the ED. We have several big academic systems nearby, but, again, they want NPs.

It's a shame, really - the CNS could be so helpful to our healthcare system nationwide, but I think poor understanding of the role has made it difficult.

I appreciate and will take your advice about ED NP. I still have some soul-searching to do to see if I want to go that route. Thank you again!

HiddencatBSN, BSN · Aug 24, 2020

It's such a bummer- when I think about getting a Master's degree, really nothing interests me other than the CNS degree. I don't want an education degree and to spend time learning adult learning models and curriculum development. I don't want to practice as an NP. I want to practice as a bedside nurse with advanced knowledge and to use that to improve care in the department. My ideal job would be a mx of bedside and staff development/training and process improvement, and I suppose I could do that with an education focus but what makes sense to me is to gain the advanced clinical knowledge to be able to lead from a position of experience and knowledge.

I've found exactly 2 CNS programs that are peds specific that I can complete clinicals in in my state, and my state BON gave me a "well, apply for licensure and find out" response when I asked if the schools' curriculums would be considered equivalent to their (very limited and not in my specialty) list of verified programs. At this point, without any local CNS jobs or strong desire to have an official CNS job, I'm thinking about doing it anyway for the degree and not licensing as a CNS but just having the knowledge and the MSN.

When I worked in PA they used CNS a ton in specialty units like the ED, ICU, etc.