Neonatal MSN-CNS vs BSN


I'm jumping the gun because I am a BSN student, but I am trying to understand what an MSN-neonatal CNS is and if there are specific positions in NICUs for nurses with this degree. If so, what would be the general role and pay difference for the CNS versus the BSN? I already work in a level III as an OT and have a pretty clear understanding of the NNP role, but my real interest is ongoing direct patient care and family education, not diagnosis/treatment. I'll appreciate any information you can share-- thanks in advance.


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Specializes in Level II & III NICU, Mother-Baby Unit. Has 21 years experience.

I may be wrong but my understanding that both the CNS and NNP (Clinical Nurse Specialist and Neonatal Nurse Practitioner) have Master's Degrees in Nursing. In most states they are both considered Advanced Practice Nurses (APNs). I have heard only a few states do not recognize the CNS as an APN. So, before you can get your Masters in Nursing (MSN) you need to have a BSN (unless you are doing some sort of fast track ADN-to-MSN program I suppose). Being Master's prepared the Clinical Nurse Specialist would make about the same salary as a Nurse Practitioner. A BSN working as a bedside nurse makes a regular staff nurse's salary with usually a little differential of about $1 per hour for having their BSN.

I once heard that the nurses in a Master's of Nursing program start together and then about mid-way through their program they split off and the NNPs learn more about managing and giving care and the CNSs learn more about teaching and research. It reminds me of when I took A&P and Micro... we had a bunch of students studying with us who went on to become Dental Hygienists.... we all started studying similar things and then "split-off" into other areas. Am I making any sense?

I can pretty reliably say that the smaller hospitals will not have a CNS as Unit Educators as often as the main mega-center type hospitals do. They just don't have the money to spend on their salary and that is so very, very unfortunate for the nursing staff, physicians, NNPs, managers, patients and families. A good CNS is worth her/his weight in gold as they can help all the people I've mentioned to do better work, more effectively and more efficiently and with better evidence-based outcomes. I'd imagine if you became a CNS you would also be qualified to teach in a nursing program but I'm not positive about that.

The CNSs I've worked with did a little bedside care which mostly revolved around changing PICC and Broviac dressings. They spent a lot of time on policies, procedures, setting up protocols (like hypothermia protocols for babies at risk for HIE) and teaching everyone how to do it and being a resource person to us all, designing, implementing and evaluating research projects, keeping up with statistics about infection rates, etc, helping set up and prepare staff nurses for transport team, teaching classes to new NICU employees and updating the older nurses as well. They taught all kinds of continuing education classes too. The NNPs and MDs appreciated their knowledge and ability to find out answers to questions on all types of topics. They were respected by the staff nurses because they really knew their stuff, respected by the NNPs, MDs and Management on all levels for their education and abilities. They did not act as managers and had no real input into employee evaluations so they stayed neutral with the nurses and the nurses could feel comfortable talking with them and sharing their educational needs without feeling "stupid".

I love CNSs and feel each and every NICU should have one. I guess that's obvious from my post. There is a much higher demand for Neonatal Nurse Practitioners these days though. I believe NNPs are also supposed to be "teachers" as well and are certainly in a perfect position to teach some continuing education classes as well as doing some kind and gentle bedside teaching when they see the need. I would love to see a dual NNP/CNS degree but I suppose to to either job most proficiently they really can't be combined... a person can only do so much!

You mentioned your love of bedside nursing and patient/family teaching. As a staff nurse you would do a lot of bedside teaching as such moments occur all day and night. You could also consider being a Discharge Planning Nurse who helps the babies get ready for final discharge by teaching the parents and caregivers CPR, help them get used to using home oxygen or monitors, set up follow-up appointments, help them understand the road ahead concerning the next 2 years of follow-up care and things like that. The Discharge Planners I have worked with had Associate Degrees or Bachelors Degrees and did not need a Masters Degree. NNPs often work in the Follow-Up Clinics seeing the babies after they have been discharged. They do exams on them to see how well they are doing with their developmental skills and health and help by intervening as needed by setting up appointments with specialist doctors or interventions with specialists in hearing, physical therapy, etc. This is something where lots of family teaching would be involved and you would not necessarily work in a NICU but in a clinic near the hospital and you would see babies from discharge age up to about 2 to 3 years of age. You would get to know them well because they come for follow-up visits every few weeks or months depending on their needs. Just a thought....

Good luck with your decision. I'm sure you have a great career ahead of you! I look forward to hearing what other posters have to say about this topic.