CNS vs NP?

Dieselmota · Aug 1, 2006

bump or -moderator please move to the board about advancepractice nurses- thanks!

Trauma Columnist · Aug 1, 2006

Okay - hope I can help. There are few differences between the CNS and the NP. Nowadays, in fact there is even talk (by the NACSBN) that the CNS role should be eliminated and there should only by NPs.

I am an adult health CNS and the main difference between a CNS and an NP is the core courses in the CNS track are more education-focused while the NP has core courses in billing, reimbursement, etc. The clinicals are very similar and in some cases, exactly the same.

llg, PhD, RN · Aug 1, 2006

There are significant differences in the histories of the CNS and NP roles which lead to different foci. However, some people would like to see the roles combined and minimize those difference.

The history of the NP role involves the need for nurses who could function in a "physician extender" role in outpatient settings. While the NP role has grown and further developed over the years, most NP students spend a lot of time learning how to provide primary care to patients in outpatient settings.

The history of the CNS role lies in the need for Master's prepared specialists to support nursing practice in hospitals -- to be clinical experts in traditional nursing care to serve as resources for staff nurses, provide consultation and expert advice regarding the care of the most complex patients, to develop nursing policies and procedures based on scientific findings, assist with staff development, etc. CNS students learn how to be successful change agents, teachers, etc. within health care organizations and focus on the care of hospitalized patients more than the provision of primary care.

Many CNS students spend little or no time learning primary care -- and many NP students spend little time learning how to teach, manage, or work within the hospital system. If you look closely at various academic programs, you will see how some programs emphasize inpatient care and the completion of "change agent" projects while others have long hours of clinical focusing on primary care in outpatient settings.

Which type of work interests you the most? If you want to work in a hospital and help staff nurses provide the best nursing care possible, then a CNS role is probably the right role for you. If you want to work in an outpatient setting and focus on providing primary care, then an NP role is probably right for you.

Of course, there are exceptions to what I have said. Some programs try to merge the 2 roles ... as do some employers. But this gives you a place to start as you examine different jobs and different academic programs.

Good luck with whatever you decide.

llg

Trauma Columnist · Aug 2, 2006

llg - you bring up some very valid points. The program that I attended as a post MSN certificate did not differentiate much between the CNS and NP. I will also say that my employer makes no differentiation - they have 3 NPs and me, a CNS. In IL (where I live) there is no difference per the SBON in an NP versus a CNS versus a CNM. Our billing is the same.

llg, PhD, RN · Aug 2, 2006

llg - you bring up some very valid points. The program that I attended as a post MSN certificate did not differentiate much between the CNS and NP. I will also say that my employer makes no differentiation - they have 3 NPs and me, a CNS. In IL (where I live) there is no difference per the SBON in an NP versus a CNS versus a CNM. Our billing is the same.

Thanks for understanding. I was trying real hard not to offfend anybody.

My experience has been the exact opposite of yours. I have practiced as a CNS in hospitals in several different states off and on since 1981 and everywhere I have worked, we have distinguished between the two roles -- even though many NP's work in the hospitals in a blended role.

Most CNS's I know are not licensed or certified as NP's and did not take the primary courses required to get licensed or certified as NP's.

It really does depend on your exact location and the particular preferences of the people in your area. It also depends upon your clinical specialty. No one would confuse a Neonatal Nurse Practitioner with a Neonatal Clinical Specialist. On the other hand a Pych CNS and a NP working in psych might have almost identical roles -- as might a Community Health NP and a Community Health CNS.

llg

Trauma Columnist · Aug 2, 2006

llg - you are such a nice person - you could never offend. I have had people ask about the differences between the CNS and NPs a lot. Since I already had an MSN (managment and leadership), I just took the advanced pharm, advance A&P, advanced assessment and 576 hours of clinical. In my area there are few CNS's - the school only graduated me in May for instance. So...most of my clinical experience was with NPs.

However, when I went to interview, I did interview at a hospital for a CNS role where they served as a unit educator: no collaborative agreement, no prescriptive authority, no assessment of pt or deciding on care. I decided not to pursue this job because it seemed all they wanted was a glorified preceptor.

Another position that I interviewed for wanted an APN for a management position - again no patient contact, etc..

So...this tells me that the employers don't really know what they want either. I am unsure where in the country you are located. I would presume that in the bigger cities with more APNs there would be clearer delineation between the roles.

llg, PhD, RN · Aug 2, 2006

It's unfortunate for people entering the profession that the different roles within nursing are not more standardized. I think it is all a continuation of the confusion about entry level.

As I have said many times on allnurses, nurses seem to think it is OK to make up new roles and new educational programs left and right. Any time they can get a little support to try something new, they go for it rather than trying to make things better within the existing framework. Thus, we have too many degree options, program options, job titles, etc.

I would much rather see nursing narrow it's choices of academic degrees, role titles, etc. and develop a concensus on a few major career pathways. Individual job descriptions could then be developed that would allow needed flexibility and individualization, but that would remain consistent under the basic major headings.

Unfortunately ... I don't run the world!

llg

Home Health Columnist / Guide · Aug 2, 2006

There are significant differences in the histories of the CNS and NP roles which lead to different foci. However, some people would like to see the roles combined and minimize those difference.
The history of the NP role involves the need for nurses who could function in a "physician extender" role in outpatient settings. While the NP role has grown and further developed over the years, most NP students spend a lot of time learning how to provide primary care to patients in outpatient settings.
The history of the CNS role lies in the need for Master's prepared specialists to support nursing practice in hospitals -- to be clinical experts in traditional nursing care to serve as resources for staff nurses, provide consultation and expert advice regarding the care of the most complex patients, to develop nursing policies and procedures based on scientific findings, assist with staff development, etc. CNS students learn how to be successful change agents, teachers, etc. within health care organizations and focus on the care of hospitalized patients more than the provision of primary care.
Many CNS students spend little or no time learning primary care -- and many NP students spend little time learning how to teach, manage, or work within the hospital system. If you look closely at various academic programs, you will see how some programs emphasize inpatient care and the completion of "change agent" projects while others have long hours of clinical focusing on primary care in outpatient settings.
Which type of work interests you the most? If you want to work in a hospital and help staff nurses provide the best nursing care possible, then a CNS role is probably the right role for you. If you want to work in an outpatient setting and focus on providing primary care, then an NP role is probably right for you.
Of course, there are exceptions to what I have said. Some programs try to merge the 2 roles ... as do some employers. But this gives you a place to start as you examine different jobs and different academic programs.
Good luck with whatever you decide.
llg

:yeahthat:

It's unfortunate, but as cost cutting took hold in late 80's through mid 90's, many CNS positions entirely eliminated in hospitals. Philly area hospitals especially hard hit.

2-3 years down the road, when standards not being meet, lack of focused education causing huge new grad turnovers, quality of care declining etc CNS role began to re-emerge. Part of issue too is that PA SBON does not recognise via regulation CNS role as APN (been working on that issue for TEN years, finally got hot bill introduced).

Look at your states practice act for guidance along with positions in local facilities, education programs in your area. Good luck in your decision.

llg, PhD, RN · Aug 2, 2006

:yeahthat:
It's unfortunate, but as cost cutting took hold in late 80's through mid 90's, many CNS positions entirely eliminated in hospitals. Philly area hospitals especially hard hit.
2-3 years down the road, when standards not being meet, lack of focused education causing huge new grad turnovers, quality of care declining etc CNS role began to re-emerge. Part of issue too is that PA SBON does not recognise via regulation CNS role as APN (been working on that issue for TEN years, finally got hot bill introduced).
Look at your states practice act for guidance along with positions in local facilities, education programs in your area. Good luck in your decision.

It may surprise you ... but I am not in favor of separate licensure for CNS's if it includes the requirement of prescriptive authority and having graduated from a Master's program specifically designed for CNS's and a few other things like that. I was very happy that my current state of Virginia ended that a few years ago. Too many good nurses with Master's Degrees were being excluded from using the title and it became a joke. Hospital simply made up new job titles to cover those nurses function in "CNS-type" roles but who could not get their license as a CNS because of technicality.

As a CNS, I have never performed a direct patient care function that regular staff nurses are not legally allowed to do. My role has always been to support and enhance the delivery of nursing care through teaching, role modeling, policy & program development, research, etc. -- none of which goes beyond the basic nurse practice act. If I wanted prescriptive authority and a role that included more "physician extender functions," I would have become a NP.

The only requirement I would place on the use of the CNS title is that I would require a Master's Degree in Nursing with a concentration in the area of clinical specialty plus relevant work experience. If a state wanted to write that into its Nurse Practice Act, I would support that.

llg

Trauma Columnist · Aug 3, 2006

Interesting llg. I think I would have been happier in the NP role which is why I chose this job - it blends the roles of CNS and NP. In IL, the SBON does also and does not differentiate between CNS and NPs as to prescriptive authority, collaborative agreement, etc.

NrsKaren also posted some info from the AACN about the CNL - clinical nurse leader that they are considering. I am like Karen in that I believe we are so fragmenting our profession that if WE don't understand the differences between all our options, how do we expect the lay public to be able to tell the difference?

llg, PhD, RN · Aug 3, 2006

Interesting llg. I think I would have been happier in the NP role which is why I chose this job - it blends the roles of CNS and NP. In IL, the SBON does also and does not differentiate between CNS and NPs as to prescriptive authority, collaborative agreement, etc.
NrsKaren also posted some info from the AACN about the CNL - clinical nurse leader that they are considering. I am like Karen in that I believe we are so fragmenting our profession that if WE don't understand the differences between all our options, how do we expect the lay public to be able to tell the difference?

I just saw Karen's thead and posted to it. I agree with you 100% on the need for more clarity. I think the leaders of our profession who keep muddying the waters with more degrees, more job titles, etc. etc. etc. should be ashamed of themselves! I truly believe they are doing it to bolster their personal careers and the reputations of their schools and are NOT objectively considering what it truly best for the profession. I believe they are putting personal motivations ahead of the profession's (and the public's) interest.

I think you and I and a few others could easily sit down and come up with a system of credentially and specialization that would make sense. It wouldn't be that hard to solve with just a little common sense. However, common sense has been thrown out the window as each professor and each school wants to develop it's own degree, it's own role, and it's own title in order to "be the leader" and receive grant money, etc. to establish and monitor the effectiveness of the role. The individuals want the publication and presentation opportunities that come with creating a new role in order to bolster their applications for tenure.

The profession and the public would be much better-served with more clarity, more simplicity, and more consistency -- but that doesn't serve the personal career ambitions of the people calling the shots at the moment.

Too bad for all the rest of us ...

llg