CNS vs NP

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

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.