juan de la cruz, MSN, RN, NP Guide 53,452 Views
Joined: Nov 14, '06;
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Based on the application form and California's Business and Professions Code Section 2838.2, it is possible for a nurse with any type of graduate nursing degree with a clinical focus to qualify for California CNS Certification if he/she can prove to the board that he/she have verifiable experience in all of the 5 activities that define the CNS role in the state. These are: expert clinical practice, education, research, consultation, and clinical leadership. OP, you do have a master's degree in an area of clinical nursing practice (i.e., FNP) but have you practiced previously in a role that utilized all of those 5 elements of CNS practice? that is the criteria the board uses if you were not trained in a formal CNS program and do not have national certification as a CNS.
What test did they have you take?
I'm in California and I do see postings here that states that specific language skills are preferred or required such as Spanish or maybe Cantonese. These jobs require providers who will work closely with immigrant communities who represent the specific language group so it makes sense to prefer someone who not only have an ability to speak the language of the patients but also know cultural mores that help with success as a provider.
In our hospital, we see patients from all backgrounds so it doesn't make sense to require specific language skills only. We also have a 24/7 in-person Spanish translator. For other languages, we have a video language line and sometimes in-person translator depending on the time of day. We also offer a phone conversation test for providers who can speak another language to certify them to translate for their patients and not have to ask for a translator. I'm bilingual and took the test for my native language and got through with the bare minimum score to pass so it goes to prove how hard it is to translate medical information to non-English speakers.
In order to qualify for a billable service in dietary counselling that falls under "medical nutrition therapy", one must be a Registered Dietitian. Also, an order for referral to the dietitian must be written by a licensed provider (physician, NP, or PA). Medical nutrition therapy is only indicated in people with medical conditions that warrant counselling such as diabetes and kidney disease.
If you are looking into nutrition counselling for physical fitness or weight loss, you fall into a gray area that is vastly unregulated and are not always the purview of legitimate nutrition experts. It's kind of a free enterprise situation where some people set up shop and advertise to the public and claim expertise. These are cash only operations and insurances are not involved.
Having said that, you certainly can provide primary care as an FNP while focusing on a niche market along the lines of healthy eating and nutrition. Some physicians and NP's do that already. Just be aware that you can only be reimbursed by the insurance companies for the billable medical decision-making that you will be doing and not this extra layer of service you offer.
Prescribing FDA approved drugs are not billable acts themselves as they are already part of your evaluation and management plan that you bill the patient for. Selling over the counter preparations of nutritional supplements in your clinic (such as those already sold at GNC) can be lucrative on paper but you can run into some huge legal and ethical issues so that's not really advisable.
I agree that graduate education should leave room for flexibility based on the student's career goals and nursing should not be the exception in most cases. However, both the CNS and NP roles have evolved over time and with the push for some CNS' to align their practice to NP's by including diagnosing, prescribing, and treating, which ultimately led to some states adopting identical Scopes of Practice statements for NP's and CNS'.
We owe it to the public or the consumers of health care to ensure that the product of these programs are competent providers who have received specialized and focused training in their chosen fields. Having said this, if we were to establish both NP's and CNS' as providers, we need to hone in on the CNL role as the de facto replacement for what the CNS programs used to be: a flexible graduate school trained nurse that can assume various nursing-based expertise in a variety of hospital unit-based roles.
NP's are nurses and for that reason, our training programs will never be structured under the guidance of established physician training programs. Post-graduate training programs for NP's have adopted the word "fellowship" to refer to any type of structured educational offering fresh NP grads can avail of in order to sub-specialize or fill-in educational gaps not offered in any of the Consensus Model based tracks (FNP, AGPCNP, AGACNP, WHNP, NNP, PNP-AC, and PNP-PC).
In my opinion, it doesn't make sense to have a fellowship program in General Psych for grads of PMHNP programs because that should already be the focus of PMHNP programs. However, a fellowship program in Psych may sell itself as having a focus on Psychotherapy training for instance which does add a layer of skill and specialization not offered as an intensive to the PMHNP track.
I've also seen Primary Care fellowships for new FNP's and AGPCNP's and again, I feel that Primary Care is already the focus of those programs so I'm not sold on having another year of fellowships for the same skills that the NP training program should have already prepared the new provider for. However, some graduates do feel a need to have additional exposure to the same field in order to gain confidence as providers especially in some job markets where new grad on-the-job training does not exist and new NP's are expected to hit the ground running when they land their first job.
I happen to work for an Academic Medical Center that offers a fellowship program for new AGACNP's in Critical Care and Surgery and I'm designated as one of the Preceptors for the Critical Care portions of the training. It is an additional layer of intensive training that AGACNP's don't all get in their program. Yes, the pay is much lower than the rate for NP's in the medical center, however, the position is not listed under the medical center but rather the School of Nursing which was able to secure funding for the program.
Is it fair? maybe, maybe not. That fellow is a board certified NP and fully credentialed by the medical center to write orders, write notes, and perform procedures under supervision initially just like a new NP would be. Even with full university benefits, that does sound like cheap labor. But then it's also a two-way street because we are offering a service to the fellow and making sure they have structured rotations in various Critical Care and Surgical settings with seasoned NP's and physicians throughout the fellowship year.
We've graduated 4 fellows since we started this program and all 4 have worked for us in various Critical Care and Surgical Specialties where their job applications were given priority over outside applicants. Typically, we get numerous resumes submitted when we have openings and they were considered before anyone else. In the end, I think it's a win win for both fellow and the medical center. Our program is currently applying for accreditation with ANCC which has become the equivalent of ACGME for nurses in terms of post-graduate training programs for nurses.
Does your attending have to see all of your patients or do they just cosign your notes?
Well, I wouldn't claim to have the expertise on both fields but being a PMHNP and being a researcher with a PhD in Neurosciences are related but are entirely different career trajectories. PMHNP's are providers working in a mental health clinical setting.
At a minimum a PhD is not required for an NP in that setting. The only setting I could see both fields merging into one role would be as a faculty member in academia where you may be allowed a percentage devoted to clinical practice (let's say 50%) and the other half devoted to your research in Neuroscience.
It can be a prestige thing to some institutions if you could attract the kind of funding for research as a member of the faculty and have significant yield of research output as a result. I don't know if doing both is indeed do-able because my understanding of nursing faculty with PhD's who are also NP's but are heavily involved in research is that they are left with very few time devoted to clinical practice anymore if at all.
Respectfully...the ideals of that designation in our nursing culture? hmmm...
Do I/we qualify?
Gee, I passed my boards and do my continuing education is that not good enough in my short staffed almost daily working world?
Little rant...I'm thinking 'magnet' designation needs to include things like providing sufficient staff including experienced and qualified medical staff as well as ancillary staff and sometimes providing enough of even the basic medical equipment to get the job done efficiently e.g. enough wheelchairs to help with providing basic such so-called magnet care.
That's real life~ hire more nurses, retain nurses by pay raises and providing respect for your nurses more often, both new and experienced, maybe buy some wheelchairs...
I used to try to believe in the 'magnet' then I stopped. What are the real changes? They stay in business by paying for an ideal title? The nurses and doctors all have the same license at other hospitals. Yet this 'magnet' hospital wants to act as if its superior. It's not bad to try to be good but paying for it just doesn't seem ethical.
Don't hospitals pay big bucks for this? By doing what, cutting nurses and some of the very basic necessities to get the basic job of patient care done efficiently?
If I'm wrong about buying the designation, let me know. Union vs Non-union is the question in this thread. I apologize for getting sidetracked. The magnet word just sucked me in. Let me go take off this metal armor! It's way too heavy anyhow.
I'm just worried that if I'm on salary they can make me work a billion hours a week (the clinic will be open 24/7) or change up their medicial benefits Bc initially they said they wouldn't offer any, but then the medical director said they would have catastrophic and prescription coverage.
I'm so used to travel contracts that spell everything out.
NONPF is an organization that represents faculty members of NP programs across the US. They certainly can make recommendations but are unable to force the certification boards to adopt a change in certification requirements for NP practice nor mandate state boards of nursing to act according to their whim.
Universities come in various forms and some have to comply with internal review and budget approval in terms of adding a new degree which is why many public universities in California are just now starting a DNP program that are not even poised to admit students directly after a BSN (all are post Master's at this point).
AACN's previous recommendation obviously did not materialize but in in my eyes, that organization would have more of a clout because they are an accreditation entity and could enforce a rule that all MSN degrees leading to NP tracks would cease to be reaccredited by 2025 but even that is unlikely to be a route they would take.
Sadly, the CNS option is getting more limited. The university we're affiliated with now only offer an Adult CNS option as this is the only ongoing certification currently offered by ANCC. It's a shame because we have a separate children's hospital and in-pt mental health facility with no existing source of training for CNS' in these respective specialties when the ones we have on staff retire.
I'm in California. Our hospital has CNS' in the traditional role as expert nurses in various specialty units or service lines (i.e., one for Adult Acute Care floors, one for Adult Med-Surg ICU, one for Neurosciences etc.). I don't know anyone who is active in this site but one thing in common is that our current crop of CNS' are older, highly experienced nurses, who have been in the role for years. There is some turn-over (i.e., retirement and promotions) but many stay in their roles long term. Maybe your best bet is to get in touch with the state's CNS association: CACNS. Of note, some of the senior nurses in our ICU's are actually CNS trained as well but have taken advantage of the ladder promotion model we have where they continue to be staff nurses but have the highest designation in terms of title and pay and are considered clinical resource for the individual units they work at.
I know Allina Health always has a statement that reads: "Allina Health does not hire new grads from all academic institutions. Many proprietary on-line schools do not meet Allina Health's standards due to the minimal oversight of the student's clinical experience, the high faculty/student ratio, and the lack of focus on national certification standards in the curriculum" in their NP job postings. For what it's worth, both Allina Health and Mayo are based in Minnesota. A well known proprietary on-line school is based in Minnesota.
Nurse Practitioner II Description at Allina Health
...on second thought, the CCNE document as revised does appear more concise if you take away the elaboration statements. However, it's still a combined standard for baccalaureate, master's, and DNP programs. I feel that NP programs are so complex and deserve its own separate standards independent of CNS, CRNA, and CNM educational standards. Each APRN role is unique enough on their own. If that is not something CCNE can come up with, then maybe we should have a separate commission that will accredit NP programs similar to how CRNA and CNM programs currently have their own commissions for program accreditation.
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