CNS! Is this a Dying Specialty!?

Trauma Columnist · Mar 14, 2011

I'm both an adult health and peds CNS and yes I wish I had done FNP. However in my state IL, CNS is an APN which makes the nurse practice act the same.

I work in nephrology and it's a very flexible position so works well for me. I do feel that CNS ISA dying degree because an NP cn do everything a CNS does.

I did these two programs because I didn't look around enough to get it right the first time. Also I have to say that I've never functioned in the true CNS role. Last but not least if you don't generate money for a practice or hospital those are the first line jobs to be cut.

elkpark · Mar 14, 2011

I'm both an adult health and peds CNS and yes I wish I had done FNP. However in my state IL, CNS is an APN which makes the nurse practice act the same.
I work in nephrology and it's a very flexible position so works well for me. I do feel that CNS ISA dying degree because an NP cn do everything a CNS does.
I did these two programs because I didn't look around enough to get it right the first time. Also I have to say that I've never functioned in the true CNS role.

Not to be argumentative, but how can you say that "an NP can do everything a CNS does" and then go on to say you've never functioned in a true CNS role? Just because you work in a state and in a position where a CNS is allowed to function as, basically, an NP, that doesn't mean that a CNS is basically an NP. The roles were orginally entirely separate and different -- it's only since some states have started offering Rx authority to CNSs that the roles have become so blurred in some places.

I've been a child psych CNS for many years -- I've never wanted Rx authority (have worked in states where I could have pursued it and chose not to, although I prefer to just stay in the states where that's not an option -- because the CNS role hasn't been "ruined" in those states), have never had a CNS job that could have been done by an NP, and, although times have been v. hard for CNSs in recent years, I am currently job-hunting and have noticed a recent resurgence of classic, "old school" psych CNS positions (I don't know about other specialties -- obviously, I'm only looking at my own specialty). I've never considered becoming an NP -- pushing pills isn't something that interests me. I just talked last week to the DON of a major hospital which is recruiting for a psych CNS because they're in the process of replacing all their nursing educators with CNSs in each specialty area/department. They have brought several CNSs on board already, and are so delighted with the results so far that they're v. exciting about filling the remainder of the positions.

On the other hand, now that so many schools offer combined NP/CNS educational programs, I do fear for the future of the "true" CNS. I'm not sure graduate programs like mine even exist anymore -- which I believe is a big loss for nursing. By the time nursing and healthcare employers realize what they've lost, we'll be extinct. :crying2:

Trauma Columnist · Mar 14, 2011

No argument from me at all Elkpark. I was hoping you and llg and some of the other CNS's that have experience with the more traditional CNS role would come and offer something other than my "I wish I had done the NP route" sentence.

Thanks for offering a different opinion.

llg, PhD, RN · Mar 14, 2011

I think it is a role "in trouble" because schools have not supported it lately. Many have switched their programs to prepare CNL's instead.

I never wanted to be an NP and do "primary care" of patients. I always wanted to focus on supporting staff nurses through staff development and providing leadership to clinical projects designed to improve nursing practice. That made the traditional CNS role the best fit for me. NP's don't get the advanced education in staff development, project management, change theories, etc. that CNS's do. NP education is focused on the provision of primary care -- and mostly in an outpatient setting (though some APN progms do include in-patient care now.)

As the traditional CNS role became muddled with attempts to combine it with the NP role and education, it became much less attractive to me. So I switched my focus to staff develoment, research, and evidence-based practice -- getting my PhD and certified in Nursing Professional Development. I work in a hospital doing stuff that is consistent with an advanced, but traditional, CNS role.

Advanced Practice Columnist / Guide · Mar 14, 2011

Just my observation as an NP...

I haven't really seen the role of a CNS being extinct at this point because I still see quite a few hospital-based CNS in traditional roles. I have worked with awesome, highly experienced CNS's in acute and critical care who function in traditional roles, are well versed in their field, and are invaluable sources of information for nurses and even us providers (both NP's and MD's). Our ICU medical director even lamented the fact that though our CNS contributes a lot to the operations of the ICU, this role is very much undervalued. In his own words, he said, "how do you even justify not being reimbursed for such expert services?" .

My worry right now is that most CNS I know are past their early 50's, have been in nursing for a long time, and will likely be retiring in less than 15 years. Is there a new crop of young aspiring CNS out there who could fill the void when these people are gone? and do we still have the educational programs that can prepare these aspiring CNS appropriately?

eagle78 · May 7, 2011

I realize this post is kind of old but I hope someone responds. I am in Michigan and one of the universities here, U of M, has the acute care cns program. I am very interested in this program and this thread has kind of scared me :eek: . Of course I have not gotten my BSN yet, but it is something that I am very interested in pursuing. I may not be a young student but I am a diligent one who has a deep desire to be a nurse.

One other question, my strong interest in CNS as opposed to NP is because from all that I have seen it appears as if the CNS is more of an inpatient type of position, ie in the hospital?? As opposed to NP being more of an out patient?? Am I reading this right??

I really hope that CNS stays around so that I can join the ranks. Thanks for any feedback you can provide. Be blessed.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · May 7, 2011

As a CNS with prescriptive authority (functioning in the "NP" role), I can tell you that I would rather have kept my job as a CNS that I had prior to the hospital eliminating the majority of the CNS positions. My CNS job was very challenging but it took a TON of work. I loved working with systems, processes, and nurses to help them take better care of their patients. In my role as an "NP" I have some autonomy, I don't have the long hours or the political landmines that I was constantly dodging as a CNS. I certainly don't have to work as hard (that isn't to say that NP's don't work hard- I am just stating that in terms of my current position). However, the NP role isn't as rewarding for me- I miss my CNS role.

So in short if you are looking for a job that you work with individual patients primarily then NP is likely a good choice for you. If you are looking to change how nurses work by changing policy, systems processes and work with populations of patients then CNS is a good fit for you.

I believe that CNS' have not done an adequate job of documenting what we do, how we decrease cost by improving outcomes. In addition, the CNS's have a harder time billing for their services than NP's do, thus it is easier to justify the role of a NP to the bean counters.

llg, PhD, RN · May 7, 2011

I totally agree with everything Moonshadeau just wrote. 100%

I think for any one interested in doing traditional CNS work today, as eagle78 is, should not get totatlly discouraged -- the healthcare system still needs people to do the type of work done by the previous generation's CNS's. It's just that the roles and titles are evolving and we all need to pay attention to that and be a little flexible with our expectations.

The CNS education and certification is still valuable. You just need to understand that your job might not called "CNS." You may have to take a job called "program coordinator" or "clinical educator" or a job in quality management, evidence-based practice, magnet coordinator, etc. You may also find it helpful to supplement the CNS education with continuing education and/or certifications in related functions to make you really attractive to an employer.

For example, my hospital has no positions technically labeled "CNS," -- but we have lots of people doing CNS-type work in positions with different labels. And we are almost always looking for people who can fill those positions because they are hard to find.

eagle78 · May 7, 2011

Thank you both for your encoraging responses. I will keep my goal of getting CNS certification. Everything you both described is exactly what I am looking for. You really inspire me and I hope to be able to contribute as you two obviously have. Thank you again, this really helps. Be Blessed!!!

Trauma Columnist · May 7, 2011

I do not disagree with anything moonshadeau or llg said. However my experience has been that the NP is hired over the CNS. What I see in my world is that the CNS role is steadily eroding and/or changing to that of an APN.

And bottom line if you can't bill for your services or show tangible money saving ideas, you will be looking for a new job.

My best advice is the dual MSN/MBA with an NP focus.

llg, PhD, RN · May 7, 2011

I do not disagree with anything moonshadeau or llg said. However my experience has been that the NP is hired over the CNS. What I see in my world is that the CNS role is steadily eroding and/or changing to that of an APN.
And bottom line if you can't bill for your services or show tangible money saving ideas, you will be looking for a new job.
My best advice is the dual MSN/MBA with an NP focus.

TraumaRUs and I are "old friends" here. So, everyone, please don't think we are fighting here. We're discussing this nicely. :)

Trauma ... I think you missed an important point here. Some people are not interested in the provision of direct patient care as the main focus of their. We don't want to do primary care as our focus, etc. So the reimbursement issue is totally different for us. We WANT to do things like staff development, quality assurance, evidence-based practice projects, write policies, evaluate care provided, etc. We don't want to do the things that are the essence of the NP role. That's the whole point. We want to provide those services that hospitals need that are not covered in either NP or MBA programs.

People like us don't fit the NP/MBA niche. We fill roles like "patient educator," "magnet coordinator" "staff development instructor" "diabetes coordinator" "infection control specialist" etc. if not actual "CNS" roles.. These are not NP roles and in fact, most NP programs do NOT provide nurses with the skills they need to succeed in thee roles.

You come from the perspective of someone who has been educated in the blended NP/CNS role -- where the roles have a lot of overlap. That's just your corner of the world. Much of the rest of the world is not like that. Many of us still recognize that the 2 types of roles are different. Many CNS-type jobs are much more like a CNL role than an NP role. Hospitals need advanced nurses who focus on helping the staff provide great traditional nursing care -- and not focus on the provision of services that used to be provided by physicians. And someone interested in those types of functions should NOT get an NP/MBA combo. They need a CNS or CNL educational foundation.