CNS vs NP

[jjk_seeking answers]

Hi everyone, I am currently seeking advice and ideas about a career change. I am a research scientist with a Ph.D. in molecular biology working at a university. I began research because I wanted to help people, but my work became very long-term focused and I can no longer see how what I am doing is impacting people now.

I have been thinking for a long time to enter into the nursing field because of amazing and selfless nurses I interacted with when my mother was hospitalized with chronic kidney disease and required surgery for kidney removal. Without these nurses, I would have been lost as to what was happening and how to care for my mother, as I rarely saw the renal surgeon/doctor at all during her stay at the hospital. I am sure that the nurses were delivering care as they usually do, but for me it impacted my view of how people can make such a big difference in the lives of others as daily work. Thank you nurses!!!!

I am considering to apply to a masters entry program which requires selecting a specialization. I have just found out which specialties are associated with an NP track and which ones are in a CNS track.

Because of my background in research, I originally thought that a specialization in oncology (ONC) and genomics would make the transition easier for me. But then I found out that the ONC specialty is a CNS track only. I was reading for job postings which all mention that you need 3-5yrs experience to apply for the position of an oncology CNS. So, I do not understand what kind of degree I will have after graduating from a 3yr program which will allow me to work as a CNS. Or, do I become an NP at the end and after working for a number of years become a CNS?

The other specialty I considered was NNP (Neonatal Nurse Practitioner) because the thought of caring for new life was something that I found amazing, and as an NNP I would specialize in a particular area, as opposed to caring for a broad range of patients. However, I also found from some online searches that an NNP requires many years of training in a neonatal ward, which I guess is done before applying to a masters program.

Please could anyone offer some advice on choosing CNS vs. NP, especially how CNS are viewed in the current health care market vs. NP. Also if anyone could share their personal experience in Oncology nursing/oncology CNS/NP, or neonatal NP (what is your day-to-day like; how do you deal with the loss of patients) I would really love to hear about it!

Thank you!

[llg, PhD, RN]

Your questions are so big, it's hard to know where to start. You will also find that there is a lot of variation in the CNS role in different parts of the country. So, it's a little hard to get a firm view of the role in an internet discussion with people all over the world.

I suggest you make a trip to medical center library (or search the CINAHL data base online) and spend some time browsing 2 journals -- the one targeted for CNS's and the one targeted for NP's. Browse the articles there and see for yourself how the focus of the 2 roles tends to vary. I forget the EXACT title of both of those journals, but their names are something like "CNS" and "Nurse Practitioner."

What you should notice is that many CNS roles (but not all) are in hospitals and focus on helping the staff provide the best care nursing care possible to hospitalized patients. CNS's do some direct patient care, but a lot of their role involves working on projects that help the staff provide the best care possible. Most NP roles are in outpatient settings and involve the direct provision of patient care to amulatory patients (e.g. seeing patients in clinics). Those roles are very different and most people strongly prefer one role over the other.

Some nurses hate working in hospitals with acutely ill patients. Other nurses would be bored seeing multiple patients every day in a clinical setting and like the high acuity of the hospital setting. Some nurses enjoy working on projects, doing staff education, developing new programs, etc. that take them away from the bedside -- and other nurses hate that stuff and only want to see patients all day. You may not know which role you prefer until after you have worked in nursing for a while and gotten a taste of what it's actually like to be a nurse. That's the problem with programs that begin at the graduate level. The student doesn't have a chance to explore multiple roles before having to decide upon one.

The neonatal NP role (NNP) is different. NNP's function in the NICU the same way that pediatric residents do. So they are involved in the medical management of some of the sickest, most acutely ill patients in the hospital. It's a great role, but you have to like NICU's -- and not everybody likes working in that environment. It can be overwhelmingly stressful. (I am an old NICU nurse -- NICU CNS).

I'm sure others will be along to add to my initial thoughts. I wish you the best of luck in your explorations. Please don't rush into anything. Talk to lots of people -- and spend as much time in the actual patient care environment as you can before making a big committment of money and time. Perhaps you could volunteer in a hospital to see how you feel about working in that environment -- and maybe make some connections that might help you. You could be a volunteer in a NICU to see if you like that environment, for example.

llg, PhD, RN-BC

[jjk_seeking answers]

Hi llg,

Thank you so much for your thoughts. I will definitely read more about the differences as you suggested. Also, I applied for a volunteer position at a local hospital and will have an interview next month. I have read that NNP, NICU nurses really love their jobs and the turn-over rate is very low. Do you have any feelings about current opportunities in neonatal units; are they one of the most difficult wards to get a job in?

Thank you so much again for your reply!

[llg, PhD, RN]

It can be hard for a new grad to get a job in a NICU unless that new grad has some relevant experience as a nursing assistant, extern, does a senior year preceptorship in a relevant clinial area, etc. A lot of new grads seek NICU jobs and the good units usually have more applicants than jobs. So, if that is where your heart lies, then I recommend positioning yourself to be one of those lucky people to get a NICU job by being the "most attractive" new grad you can possibly be. Experienced NICU nurses have remained in demand even through this latest economic recession. NICU's require lots of specially trained staff -- and if you have the experience, it's not hard to find a job.

NNP's are also in high demand. There aren't many schools that prepare NNP's , so there are usually more jobs than there are applicants.

Just keep in mind that it can be a tough field -- one that is not right for everyone. There are a lot of ethical issues and it can be very intense. But if you love NICU, there are lots of career opportunities there.

[jjk_seeking answers]

Hi llg,

I will keep this in mind. I think right now, I need to get into a hospital as a volunteer and really see what NICU is like and talk to more nurses like you, who have experienced the in's-and-outs of caring for NICU patients.

Thank you for all the great advice!