Merry Christmas from the PA BON

Trauma Columnist · Dec 20, 2015

Ugh! Sorry for the frustration.

Soyou completed a CNS program?

Believe me I know your frustration.

imenid37 · Dec 20, 2015

Yes. I have a post-MSN certificate as a Parent-Child CNS from a public university in California. MY sub-specialty is perinatal nursing. Some of my classmates sub-specialized in neonatal or pediatric nursing. The PEDS folks do have an exam they are eligible to sit for. We also had Gero CNS, but because it is not adult-gero, they are not permitted to take ANCC's exam. The program is approved CNS program by the CA BON. I could be licensed as a CNS there BUT I did not apply for a CA license, because I will not work there. FL and AZ also look like states that would issue me a license. To have licenses in all of these states gets expensive. PA, where I live is not a compact state, so I would need both an RN and the CNS license. Ironically, our program chair was NACNS's Educator of the Year.

Psychcns · Dec 20, 2015

The state to state variation for CNS practice is annoying. . Is the national CNS organization of any help in advising you ? What are your career goals? It sounds like you can relocate.

Trauma Columnist · Dec 21, 2015

@PsychCNS - the NACNS is a joke IMHO. I joined but they want nothing and I mean nothing to do with CNS as an APRN role -they are only interested in the "true" CNS role (whatever that is).

@ImEnid - I'm an adult and a peds CNS and the Peds CNS exam retires this month....unfortunately. Yes, I also agree the generalist CNS exam was a frustrating effort by ANCC. I sincerely feel bad for you - as PsychCNS asked: what are your career goals. Are you looking at the APRN role or more of an educator role or something else?

twozer0, NP · Dec 22, 2015

As someone who lives in PA I can tell you that I haven't really seen any CNS practicing in this state. My health organization employs 0 CNS'. This might be the reason you are finding it difficult to become lisenced here. CRNA's arent even labeled as APRN's in this state (only NP's are). It's a weird state for sure when it comes to things like that. Sorry about your application.

elkpark · Dec 22, 2015

I'm a CNS in PA, and my organization (large academic medical center) employs at least a dozen CNSs that I know personally (I don't know how many more there may be within the organization that I don't know about; it's a large system). My (limited) experience with the NACNS is that they are interested in ensuring that those of us who are CNSs who are educated and practicing in the traditional CNS role continue to have the opportunity to do so within the LACE model and continue to be recognized as advanced practice nurses, and are not just wiped out of existence, but not that they have any animosity toward CNSs who are in states and roles in which they have rx authority.

OP, did you talk to anyone at the board about what they were looking for that would have strengthened your application (gotten it approved)? That's what I would do if I were in your situation. It sounds like you do have a CNS program under your belt and a lot of experience. Is the problem maybe that you didn't communicate that to them effectively?

Best wishes!

twozer0, NP · Dec 22, 2015

Elkpark what system are you in? In my experience, it seems academic centers are the only ones who use CNS'.

imenid37 · Dec 23, 2015

I actually work in a community hospital in the CNS role. I think they were looking for more than two-three years in the role to count as worthy "experience." I know two long timers who has 15-20 years in the "role" who are have been licensed as CNS's "without specialty" . I do not know anyone who has just a 2 or 3 years who has been successful.

The BON told me to "get a lawyer" if I want to appeal. They did not like that my clinical courses were graded credit/no credit. I was asked about the credit/no credit status while the application was being considered. I offered to provide the course grade book, graded assignments, and clinical logs. The BON did not "need" them. My course coordinator had emailed me to see how things were progressing with the application. She stated that she was more than willing to provide details about the content of the courses and my grades as needed. She offered to provide a written statement in support of me. My GPA was 4.0 and if the credit/ no credit classes had been graded, their inclusion would not have changed that. I did provide syllabi for every course in my program. Had they looked carefully, they would have seen an explanation of the credit/no credit grade.

I submitted three recommendations as required by the BON. One was a clinical preceptor who is a CNS, The second was a director of nursing who a CNS. The third was the nurse manager of a unit with whom I am aligned. If I am able to obtain a letter from the course coordinator and the actual grades, I will submit those for the appeal. Unfortunately, I do not have the money for an attorney right now. My CNS coworkers have offered to be "witnesses" to attest to my competence.

In the letter I received, it also states that a "decision of denial for licensure" could be reported to the National Practitioner Data Bank. It makes me fell like a criminal! I have done nothing wrong. I just applied for a license. I so wish there was some consistency across states to allow me and others in my position to do what we have been educated to do. I only have until 1/15 to appeal. UGGGGGHHH!

Trauma Columnist · Dec 24, 2015

So, you have an MSN but not the CNS concentration? Is that it? I know in IL where I live, I had an MSN in management and leadership and then did two post-MSN CNSs: adult and peds.

How many clinical hours did you do? For CNS or any APRN role, its 500 hours minimum.

imenid37 · Dec 27, 2015

I have an MSN in Nursing Education with a Perinatal Concentration. That included the three P's and 280 clinical hours, not including the education practicum AND I have a post-MSN with 400 more clinical hours. The post MSN is a Parent-Child CNS concentration. I only did 400 hrs. in the CNS course because I had so many hours in the MSN program which were very similar. I originally enrolled in the MSN program in the Perinatal Educator/ CNS track.The university was dc'ing their CNS degrees so I did not take the final 212 hour CNS course of my MSN program. THEN, several years later, I was hired into a CNS position, contingent on my completing the post-MSN CNS, which I have done. I honestly debated doing an adult-gero program so I could just take the exam. However, I had spoken with several individuals when I was choosing a program who advised me to stick with my specialty and area of expertise. Other than all of the BS with the BON, I do think this was the right decision. I am not a geriatric nurse for sure!

Trauma Columnist · Dec 27, 2015

Hmm...so your issue is that you couldn't take the Perinatal CNS exam? (Sorry for being so dense). If that is the case, can you obtain licensure in another state and then transfer it to your state?

I hold two "retired" certs: Adult health CNS and Peds CNS but as long as I don't let them lapse I can cont to practice. (Kinda silly that my certifications retired before I did but oh well).