Future of the CNS

Trauma Columnist · Nov 20, 2012

I'm both an adult and peds CNS. I think as long as you stick to an APN role and live in a state where you can function and bill as an APN you will be ok. I'm seeing that as a viable role for the CNS. I think the traditional CNS role, that of a change agent, is falling by the wayside and easily eliminated in tough economic times.

SycamoreGuy · Nov 20, 2012

Thats the rub, if I am in an APN role anyway, I think to myself why not just become an NP? I will likely stay in Indiana and they are very similar to Illinois as far as the nurse practice act is concerned so I am not worried about practice rights.

I guess I'm really in a good situation no matter which direction I go. I'm young enough that even in the worst case scenario I can pick up a post-masters cert in a NP specialty.

llg, PhD, RN · Nov 20, 2012

I am a former CNS. I think the CNS role became doomed years ago when people tried to merge it with the NP role. By blurring the lines between the two roles, it made the NP role the more attractive of the two. CNS students decreased in number ... schools focused more on the NP role ... and gradually, the CNS role as a unique role in hospital-based nursing practice became an easy target for budget-cutters. Add in the schools' creation of the CNL role ... and now the old CNS niche is being eroded from both sides.

I made the switch to Nursing Professional Development years ago.

Trauma Columnist · Nov 20, 2012

llg - I'm so glad you came along to provide another opinion. I've only been a CNS since 2006 and have been in the APN role the entire time.

elkpark · Nov 20, 2012

I am a (child) psych CNS who has functioned "in the APN role" all of my advanced practice career, providing direct care to clients, diagnosing and treating psychiatric disorders -- just not with medication. The psych CNS role has always been (until fairly recently) that of psychotherapist; I've never had prescriptive authority, have never wanted it, and wouldn't take it if you tried to give it to me (I have lived and practiced in states where that was a possibility, and haven't pursued it). I'm one of the many who is somewhat offended by the recently developed notion that "advanced practice nursing" is defined as "having prescriptive authority." There is a lot more to advanced practice in nursing than pushing pills, which, to me, is more "medicine lite" than advanced nursing practice. If people want to do that, I have no objection, but I do object to the idea that what I do isn't advanced practice nursing. :)

llg, PhD, RN · Nov 20, 2012

I totally agree with Elkpark. The original CNS role was developed as a purely advanced "nursing" role -- and there was no question that we needed a special licensure because we weren't trying to practice outside the basic nurse practice act. We were just practicing that basic nursing role at an advanced level. Then they tried to merge the role to give CNS's prescriptive authority -- thus raising the question of "Why not just be an NP? Why be a CNS?" The CNS's who did not have or want prescriptive authority were made to seem "less than" those who did -- and schools were overrun with faculty pushing the NP role -- and pretty soon, the CNS role and CNS opportunities were on the decline.

I thought it was a great role, but now see the CNL role as taking over many of the functions performed by some of us CNS's. Though there still are a few areas of CNS practice that the CNL's are not prepared to cover. But that is easy enough to change if and when the CNL role really becomes commonplace.

llg

Trauma Columnist · Nov 21, 2012

Elkpark and llg. Thanks to both of you. You two bring a lot to this forum. Thank you.

siaknikikoRN · Nov 21, 2012

Thank you guys for this informative thread! I am on my last three courses to become a CNS and to tell you honestly, I had some regrets going into this track. First, my workplace has started to replace CNS with the CNLs. So the job opportunity has decreased. And the thing that bothers me most is, the difficulty of articulating what CNS really do. This question pops up everytime I meet during my first clinical course. I live in Texas where CNSs are APNs and it's sad that majority of my healthcare colleagues are not familiar with this role. I am thinking about changing tracks. So my dilema right now is, is it too late to change track?

llg, PhD, RN · Nov 21, 2012

So my dilema right now is, is it too late to change track?

It's never too late -- it's just a matter of how much additional work you are willing to do. Talk to your school about what a change would require and make your decision based on the facts. Good luck with whatever you decide.

I have to admit ... as I have never had any interest in an NP role, if I were young and doing grad school today, I would probably choose a CNL role for my Master's level nursing education. Then I would supplement that with some courses in nursing education and/or staff development. (Leaving the PhD option open for later.)

llg, PhD, RN-BC

Whispera, MSN, RN · Nov 22, 2012

According to what I've recently learned through the APNA, the psych CNS as well as the adult psych NP roles are being phased out in favor of the generic psych NP role. This is leaving those who are psych CNSs and adult psych NPs with a problem. I don't know how it will end up, but as a psych CNS it truly bothers me that I may not be able to renew my certification in the future, and essentially will be unable to practice as I have practiced...

Trauma Columnist · Nov 22, 2012

Whispera. I hold the retiring adult health CNS and my understanding is that as long as we don't let it lapse we are ok.