CNS vs. CNL

[BittyBabyRN]

I know that this may be addressed in another thread, but if someone could either answer my question, or direct me to an answer, I would appreciate it.

I know that a CNL is more of a generalist than a CNS, but what does this really mean? I know that in CNL training, in obtaining your MSN, you still have clinical rotations, and become an "expert" in a field.... but currently I work as an RN in a level III NICU, and would preferably stay with babies, or at the least, pediatrics. I feel that the program offered close to me that offers training to become a CNL is better for me due to the length, and online options, but I am unsure if the degree itself would be better as CNS or a CNL?

SOOOOO

My main question is: What in the world is the real difference between a CNS and a CNL?

Thanks!

Amanda

[Psychcns]

Not really. The CNS folks are usually attached to a service line. We have quite a few working with Wound/Ostomy Care some Stroke CNS (Stroke Coordinators), CV Specialists, etc. There really aren't that many around. They are only on the floors when there is something that pertains to them or they have been consulted.

The mixing of titles isn't helpful. CV Specialist, Nurse Navigator, CNL, Clinical Coordinators all do similar things in different ways. The largest "blurring" was between case management/social work and myself. They felt like we were stepping on their toes. The bigger picture stuff that CNLs focus on is more the WHY. CM/SW will figure out where this patient can go post D/C. I'm looking for patterns among the noise. Why did this patient return after only 10 days at home? What education did we provide on his last discharge? Why did that facility send him back? It's like doing miniture root cause analysis. Those insights get shared among all of the other disciplines, and can affect how changes are rolled out, orders are placed, etc.

The hardest part is keeping focused on my unit. People have found my analysis helpful, and I get pulled in 100 directions at once. I should be an expert on my floor, so if it's related to clinical issues then I get brought in to help elaborate. It's not always good news either. It's easy to forget my main role, which is patient rounding. I try to meet with every patient in my assignment (15 peeps) daily, but if I can't then I focus on the more complex patients.

CNLs have it tough, we are going through the same trials that the CNS nurses did 20 yrs ago. Trying to fit into a system that has very little money to go around. You have to remember that most of the work we are trying to do has never been done before. Data on PICC line placement was collected but no one ever used it for anything. People were reactive, not proactive. True change takes years, and that gets expensive to sustain a CNL program. I find myself having to justify myself by working on cost savings projects more often than not. The cost benefit of a CNL is great, but we are most effective in larger hospital systems and focusing on the 12 bed model. 12-15 is ideal. Most smaller hospitals can't afford to hire nurses that don't contribute to "productivity" i.e. don't have a direct patient assignment.

It is so good to hear of new advanced roles for nurses. there was an article recently on Medscape about the "Nurse Attending"at Massachusetts General Hospital in Boston which sounds like a similar role to yours. The roles sound so right but also vulnerable to cost cutting.

Thanks for your post.

[salasrn]

Brian, I see this is an old article but I am researching to get in touch with CNLs who are working in as you are to get a feel for how to emerge into the role. I have worked on my unit for 12 years. Three years ago I moved from bedside nurse to Unit Educator and just completed the CNL program at my hospital's affiliated university. I am now actually doing both jobs until a Educator is hired, but much of what I have been doing is what you describe on my unit. Using data to detect issues that need attention and focusing on those and monitoring changes to see progress or need for adjustment. The challenge is the role adjustment with the other disciplines, physicians and advanced practice nurses. They have seen me in the old role for so long that I am not sure how to go about getting more involved in the day to day aspects of patient's needs with them. I especially need to focus on discharge assessments to decrease LOS and readmission. Any suggestions from one with experience is appreciated. Academia are great, but most have never worked in the role and experienced the role adjustment. I am the only CNL at my hospital and want to see this work.

[traumaRUs, MSN, APRN]

Is there a national CNL organization?

What have other CNL grads done?

Can you network with them?

[janeybirdRN]

There is an association. I know the president of the CNLA works in Philadelphia. I have been in contact with the director of the program I am in because I would like to shadow a CNL in my area...

Here is my dilemma- I don't know if I really want to get my MSN-CNL or any MSN for that matter. I used to think I would be in school forever. I liked it but now I'm just done. I have a BS in Psych from PSU, an ADN from a local community college and I am enrolled in the MSN-CNL at Drexel but I am doing it online. All I do is write papers and read discussion boards. Sometimes I like online school but when I think I have 14 more classes to go and at over $600 per credit, I just don't know if it's worth it. I'm going to look into PSU WC and see how much it would take for me to just complete my BSN. I like the idea of the MSN-CNL but there's a chance this role will not survive. I want to work a M-F 8-5 and stay in direct patient care. I want to be a leader and an educator but not have to deal with managing people. That's what is so great about the CNL role. NP's have a lot more liability and the hours will not be great but on the other hand, school reimbursement is great through the NHSC. I just don't know what I want to do. I am an RN at a rehab hospital and I want to get ER/ED experience. I like my job now but it's not a long term commitment.

Thoughts? Anyone?

[end3r]

sorry, i know this is an old thread, but i'm having a very similar situation, janeybirdRN. could you shoot me a PM? i'm having a lot of apprehension going into my MSN program and with a lot of questions that no one has been able to answer. it'd be greatly appreciated.

[TIHealth]

Dear Amanda,

The traditional colleges with a pure CNS track are very specific and involved. As a CNS you are a exert clinican in specialty area like surgical critical care, pedi icu.

The subroles of the track are leader, educator, change agent, researcher,consultant. The advance sciences involve medical physiology, advanced pathophysiology, research, healthcare policy etc. to name a few. The clinical and research in these tracks is comphrehensive. A pure CNS should be able to function in all of the roles as an expert in their specific field. This is very different than the tracks as a educator or administrator. I have practiced, served as graduate faculty and precepted and hopes this helps you. Sage College in NY and other NY schools did have the traditional tracks.

[TIHealth]

As a Critical Care CNS, ACNP, ANP I serve as a provider, expert, consultant throughout the country. After reading all

of the above comments I would encourage all of you to look into a traditional CNS programs. Again, Sage, Skidmore--- the NY colleges were one of the pioneers in the CNS programs with outstanding faculty. You need the theory, sciences and most important the clinical faculty to be there for you. Sometimes we need to explore our options. I can state that the courses, clinical internships, and research were above and beyond the two NP tracks I did in Boston.