CNS in genetics?

Trauma Columnist · May 14, 2008

Hi there and welcome. Have you looked at infertility issues and the interaction of genetics on birth? Is that what you are talking about? Sounds very interesting. Hopefully there will be someone along soon to help you out.

core0 · May 14, 2008

Hi everyone,
I have been trying to find out more about genetic nursing for some time, and it has been difficult. I have found a lot information via isong and such, but wanted to see if there were any advanced practice nurses out there who specialize in genetics in particular? I am slowly working on my CNS, but really want to eventually end up in the field of genetics and have not been able to find much out there as far as what options are with an advanced degree.
Can anyone offer any information or advice?
Thank you in advance.

As a PA I did something similar in GI. I did genetic counsellings for hereditary colon cancer and pancreatic cancer including testing and recommendations. My undergraduate degree was in molecular genetics and I have around 25 graduate credits in genetics. One of my SPs did a lot of research in genetics and had a masters in genetics. The advantage as an NPP is that you can bill for genetic counseling and initiate treatment. This is a distinct advantage over genetic counselors.

The issue with genetic counseling as in most time intensive areas is that reimbursement is poor compared to other things that you can do with your time. Our practice was willing to eat those costs to provide the service, but thats relatively rare.

The issue with Isong as you have probably found out is that the "NP" certification is not recognized by any state. You would probably be violating most state practice acts by claiming that your are an NP. Depending on your state a CNS tailored toward genetics (most genetics counseling programs will allow non-students to take classes) would work. A FNP or ANP (or PNP) for those states that do not recognize CNS as APNs would generally allow you to work in genetics as an APN.

For what its worth most NPs (and PAs) that work in genetics programs seem to be working in pediatric programs. Most of the hospitals that have genetics departments are children's hospitals. In genetic counseling most counselors specialize in a certain aspect such as neonatal, breast or colon cancers. The one non-pediatric NP that I know that does genetics is a WHNP that does breast cancer counseling. Its an interesting subject, but like the MD side, compensation is pretty poor.

David Carpenter, PA-C

Myethpio · May 17, 2008

So my understanding of this is that the ISONG certification is something that an epxerienced APN, who has been working as a genetic nurse, can apply to get. It's a basically an additional certification you can add to your license if you've worked in the field of genetics and have had a certain number of cases.

You cannot claim to be an NP as you said, unless you've gone through some type of APN program and received this certification, at which point *maybe* you could work as something similar to a genetic counselor. And this is still blurry to me.

My idea is to get my parent-child CNS, which I am half way through. What I'd like to find out about is if there is a genetic CNS or something of the sort. I guess I'm trying to incorporate my experience, the Master's I would have, and somehow be in the field of genetics.

You mentioned that, depending on the state (I'm in CA) a CNS tailored toward genetics might work. From what I've seen not only are most CNSs general (such as the parent-child I'm doing) except for a few programs here and there, but where you can work afterwards is very dependent on what experience you've had and in what field. So if someone like me would like to break into this field somehow, what would be the best way? Genetic programs such as working with newborn screening and such require experience... but where does one start? And is there anything one can do with a CNS if the intent is to get into the genetic field? (other than take the place of a genetic counselor?). What might be some ideas for a CNS wanting to get into genetics?

more school?

genetic counseling degree?

start off in NB screening or AFP?

community health?

research nurse?

get the CNS and just apply to something genetic related?

I guess I had the idea that a CNS could "specialize" in a particular field in which they are "clinical experts" in...?

core0 · May 18, 2008

So my understanding of this is that the ISONG certification is something that an epxerienced APN, who has been working as a genetic nurse, can apply to get. It's a basically an additional certification you can add to your license if you've worked in the field of genetics and have had a certain number of cases.
You cannot claim to be an NP as you said, unless you've gone through some type of APN program and received this certification, at which point *maybe* you could work as something similar to a genetic counselor. And this is still blurry to me.
My idea is to get my parent-child CNS, which I am half way through. What I'd like to find out about is if there is a genetic CNS or something of the sort. I guess I'm trying to incorporate my experience, the Master's I would have, and somehow be in the field of genetics.
You mentioned that, depending on the state (I'm in CA) a CNS tailored toward genetics might work. From what I've seen not only are most CNSs general (such as the parent-child I'm doing) except for a few programs here and there, but where you can work afterwards is very dependent on what experience you've had and in what field. So if someone like me would like to break into this field somehow, what would be the best way? Genetic programs such as working with newborn screening and such require experience... but where does one start? And is there anything one can do with a CNS if the intent is to get into the genetic field? (other than take the place of a genetic counselor?). What might be some ideas for a CNS wanting to get into genetics?
more school?
genetic counseling degree?
start off in NB screening or AFP?
community health?
research nurse?
get the CNS and just apply to something genetic related?
I guess I had the idea that a CNS could "specialize" in a particular field in which they are "clinical experts" in...?

To me there are several advantages of a CNS working in genetics over a genetic counselor. The principle one is that as a CNS you can diagnose and treat. Traditionally if you refer someone to a genetic counselor they do the family history, do a pedigree and then send you a report with their recommendations. Some of them do a fair amount of counseling about the consequences of the decision, but that largely has to be repeated as the liability still rests with the provider. The advantage of the CNS for example, is that you can not only do the pedigree and the counseling but also order any tests and initiate treatment. Essentially you would be working in the same role as a clinical geneticist. Most of these programs are housed in Children's hospitals. I don't know of any that use NPs or CNS, but there is no reason why they couldn't. A lot of this is episodic specialty care and education which would be right up a CNS' alley. Here is an example of the conditions treated in a genetics clinic:

http://www.thechildrenshospital.org/conditions/genetics/conditions/index.aspx

The other big advantage for the CNS is that you can bill for your services. Most genetic counselors are hired by either academic centers or hospitals. Finding genetic counseling for patients on medicaid outside of academic centers can be difficult.

The only person that I know that works in an inherited metabolic clinic is a PA but there are probably NPs and CNS out there.

Another possibility would be research. There are a lot of trials ongoing in genetics.

As to how you get there, this is such a unique role that you would have to design your own program. Coursework in genetics and genetic counseling would be helpful. I don't think that you need the entirety of a genetics counseling certification.

Good luck

David Carpenter, PA-C