Limited CNS schools should I be worried?

llg, PhD, RN · Dec 29, 2010

Re-reading my previous post, it seems a little harsh. I was a part of all that years ago -- and it still hurts to think about the role that I helped to pioneer get all blurred by everyone involved trying to "be all things to all people."

Everyone had the best of intentions, but by allowing too much overlap/merging with the NP role, the CNS role got lost -- and what CNS's (without the primary care, Rx authority) can bring to the health care system got under-valued and cut from lots of budgets. Now when we need people with those "traditional, original" CNS skills, we don't have them -- and they create a new role, CNL, that includes some of those skills but not all -- and disenfranchise the existing CNS's in the process.

It's all just so sad.

Advanced Practice Columnist / Guide · Dec 30, 2010

I'm just wondering what specialty field the OP was interested in. I'm a critical care NP and being unit-based gives me a lot of interaction with nurses who work at the bedside and Clinical Nurse Specialists who help bedside nurses hone critical care skills. As far as my own experience, I haven't seen the field of critical care abandon the expertise the CNS role can offer in a critical care unit. I've worked in ICU's in Michigan and California and in both states, there have always been a team of unit-based CNS'. I've actually worked with very talented ones who have extensively published in critical care literature and are fellows of SCCM. So, what I'm saying is that if the CNS role is in your interest, critical care is one that definitely utilizes role.

llg, PhD, RN · Dec 30, 2010

So, what I'm saying is that if the CNS role is in your interest, critical care is one that definitely utilizes role.

I agree, Juan. ICU's maintained the distinction between the NP role and the CNS role more so that some other areas -- and that's where you will find less confusion. That's been very true of my clinical are, Neonatal ICU, in which the role of the NNP is strong and has never been confused with that of the Neonatal CNS.

Unfortunately, as the OP has found out, a lot of the schools that used to offer CNS education have closed their programs -- which does not bode well for the future of the CNS role.

Advanced Practice Columnist / Guide · Dec 31, 2010

Unfortunately, as the OP has found out, a lot of the schools that used to offer CNS education have closed their programs -- which does not bode well for the future of the CNS role.

That brings us to your earlier post stating that when some CNS's started expanding their roles to include prescriptive authority, the lines between the CNS and NP roles blurred and many schools thought that they could combine the programs as one. An example is the program I attended which allowed students progression through two separate tracks in the adult acute care specialty, one in the NP role, the other in the CNS role. The problem I saw in that set-up was that the school thought that it was enough to keep the didactic portions completely similar in both tracks and only make clinical rotations different (the NP track students were rotated to NP-led or Physician-NP collaborative clinical practices while the CNS track students were rotated to settings where traditional CNS's practice). Both students had the same advanced pharm and medical diagnostics courses necessary for the NP role but could also be useful for the CNS role. However, none of the CNS students received courses in nursing staff development, clinical nursing program design, and such. In the end, the interest toward the CNS track waned because many students preferred the NP route due to it's clear role as a provider by state law and the ability to practice as such regardless of geographic location. The school eventually dropped the CNS program due to low enrollment even though there were still job openings which were clearly asking for a traditional CNS role. I personally felt that had the lines between the 2 roles been kept clear and educational paths between the 2 kept distinct from each other, many students would have been able to assess what their career goals are and would have made an informed decision of which track made a better fit prior to embarking on graduate study.

tyloo · Dec 31, 2010

thanks for your comments. i like the traditional role of cns. although in my state the cns have prescriptive authority i don't really want that responsibility. i would like to have the knowledge of the advance nursing and use it towards educating either the patient, student nurses, or staff. i would like to develop programs and monitor outcomes in the future (after many more years of nursing). maybe even research.

i favor the adult/gero population or perhaps acute. however, the acute program usually is tied in with the icu so that may not be an appropriate option for now. i never worked in an icu. i wouldn't rule it out. i have always liked the micu, just never worked in it.

presently i have a job at an ltach and love it. i know in general, i favor working with the complex medical patients. i have prior experience in med-surg, acute and chronic dialysis, and cardiopulmonary. i always wanted to go back to school. i am in no immediate rush though (just itching to learn). however school costs $$$ so i don't want to jump into the wrong program.

would you guys recommend a cns and educator degree? would that be too much overlapping of education?

thanks again for all the input. i found an interesting article titled, "role preservation of the cns and np," at http://www.ispub.com/ostia/index.php?xmlfilepath=journals/ijanp/vol5n2/role.xml.

llg, PhD, RN · Dec 31, 2010

Both students had the same advanced pharm and medical diagnostics courses necessary for the NP role but could also be useful for the CNS role. However, none of the CNS students received courses in nursing staff development, clinical nursing program design, and such. In the end, the interest toward the CNS track waned because many students preferred the NP route due to it's clear role as a provider by state law and the ability to practice as such regardless of geographic location. The school eventually dropped the CNS program due to low enrollment even though there were still job openings which were clearly asking for a traditional CNS role. I personally felt that had the lines between the 2 roles been kept clear and educational paths between the 2 kept distinct from each other, many students would have been able to assess what their career goals are and would have made an informed decision of which track made a better fit prior to embarking on graduate study.

:yeah: :yeah: :yeah:

I agree with your assessment 100%. As I once told an NNP who thought his NNP education enabled him to do everything a CNS does plus more... "No, while you were off learning about medical management, I was learning about project managment, quality management, staff education, etc. A real CNS has expertise in those areas that you do not have." He went on to say that he had a class in staff education as part of his NNP program: it lasted a total of 3 hours! I told him that I took 2 full semester classes in education as part of my MSN program and his 3-hour lecture did not begin to scratch the surface. Fortunately, we were friends and he took my point well.

The expertise of the CNS role got de-valued and eventually eliminated when people tried to combine the roles. The CNS role was the big loser. Now, we have few people with MSN's who have expertise in how to do that type of work -- and the profession of nursing suffers from that lack. We need leaders who have expertise in those things.

However ... like many old CNS's, I have switched my focus to Nursing Professional Development. That's another specialty that tends to "get lost" in schools of nursing. Most schools don't teach courses in staff development, wrongly assuming that course geared towards academic teaching will suffice. But a savy student can usually make it work by adapting the content and choosing student projects that focus on topics relevant to staff development. The National Nurses in Staff Development Organization is strong and employers still recognize the need for orientation, staff development, etc. So the jobs are still there even if the MSN programs are not -- and they are often high-quality jobs for people interested in the functions that CNS's used to do. My hospital has combined the roles of CNS and Staff Development Educator and it works quite well. Each unit has a MSN-prepared nurse who does both education and also clinical projects like a CNS would do. It works for us.

I think anyone interested in a CNS role should at least consider jobs in Nursing Professional Development. They might not be the right choice for everybody, but they are worth considering -- and may offer a better job market and career opportunities long term.

llg, PhD, RN · Dec 31, 2010

Would you guys recommend a CNS and educator degree? Would that be too much overlapping of education? QUOTE]
I think the CNS/educator combo is a great one -- and quite viable (and versatile) in the job market. See my previous post (immediately above) for my comments on this combination.
FYI: My MSN was in Perinatal Nursing, with a minor in Nursing Administration and elective coursework in Nursing Education. That was back in the olden days when MSN programs were much longer and required more credit hours than they do now. (Mine was 51 standard credit hours, while most today are about 36 standard credit hours.)
After practice as a CNS and Staff Educator for 10 years, I went back to school and got a PhD in Nursing. Immediately after graduation, I took a job that combined the CNS and Staff Development roles in a NICU ... but after a couple of years, switched to my current position. I work on hospital-wide projects such as our extern program, coordinating with local nursing schools, teaching some staff development classes, and heading our research and evidence-based practice efforts. I'm kind'a the "odd job person" in the Staff Development Dept., focusing on things that are more academic than bedside.
Good luck with whatever you decide.

elkpark · Dec 31, 2010

For anyone reading this who is new to the CNS discussion threads ... elkpark and I have been discussing these things for a long time. We come from very different CNS backgrounds and viewpoints, but we have always remained friendly as we discuss thesse things. That said ...
You're right. The Psych CNS's always wanted Rx authority, unlike the other CNS's. Back in the old days, the Psych CNS's were the "different" ones who pushed to expand the CNS role to include that aspect of practice. The other specialties had established a clear distinction between the CNS and NP roles and wanted to maintain them as 2 separate roles. But in the name of "flexibility" and "inclusivity," they supported the Rx authority addition to the CNS role and that started to creep Rx authority and primary care into other CNS's who were having trouble finding CNS jobs and wanted to take some NP jobs that were open. Once the lines blurred ... everyone just went their own way and did their own thing ... and then there was no clear role to defend.

I do not at all question your veracity on this, but just wanted to say this is the first I've heard of how all this came about. Thank you for clarifying this for me. Not only have I, as a (child) psych CNS, never wanted Rx authority (and passed up opportunity to have it when I was temporarily in a state in recent years other than my permanent home state, where it is not an option), I haven't even been aware that other psych CNSs, specifically, had been pushing for this, certainly not any that I knew personally, despite being active over the years in my national professional organization and the active state psych and CNS organizations in my state ... Frankly, I had always wondered where that came from.

Although our backgrounds are certainly different, I don't think our viewpoints are much at odds. I am v. much an "old school" CNS (despite that making me virtually unemployable now in most of the US :mad: ), and share your admiration for and commitment to the traditional CNS role. My only point, in my original post, was to clarify that the psych CNS role has always apparently been somewhat different than other CNS specialties, with an emphasis on direct care (psychotherapy) in addition to the other CNS functions -- I see so many posts on this site that emphasize that CNSs only do education, project development/management, etc., and one should become an NP if one wants to remain in direct care (again, something I had never heard before I started participating on this site), and I always try to add to the conversation :) that that's not necessarily the case; in my experience and opinion, it's a v. varied and rich role with many possibilities and options.

I hate to see us being reduced to just another group of "pill pushers." (And don't get me started on the whole "CNL" nonsense ... :rolleyes: )

Trauma Columnist · Jan 2, 2011

LLG and Elkpark. Thanks very much for your thoughtful answers.

When I look at my educational path. It's more like the NP than CNS.

I did both my CNS's as post MSN certificates. My MSN was management and leadership.

For the post-MSN certificates I took adv path, adv pharmacy and adv assessment. The adult CNS had 576 hrs clinical and the pees CNS had 512 hrs.

I never took a CNS specific roles class though an APN roles class was part of the MSN. I also had project management, finances for healthcare admin, etc.