NP vs. CNS

Trauma Columnist · Aug 22, 2011

I'm an adult health CNS and a pads CNS too. Much depends on what state you practice in, what a CNS scope of practice becomes. I live in a state where I'm an APN (advanced practice nurse) and there is no difference in practice act between a CNS and an NP. However, not all states are like this.

If you are sure advanced practice is what you want, than I would vote for NP. With an NP you can teach and practice as an APN. I do feel the CNS role (by the book at least) is being phased out in favor of NPs who can do everything: teach, be an APN, be a change agent, educator, etc..

I've been an APN for over 5 years now and have seen the evolution: my college of nursing just quit offering the pads CNS. They now have an adult health CNS, FNP, DNP, CNL.

The writing is on the wall for CNSs who want to be an APN IMHO.

elkpark · Aug 22, 2011

There are a bunch of existing threads here about the NP role vs. CNS role -- you can use the "search" feature to look for them.

abass211 · Aug 23, 2011

Thank you very much for your insight !!

CCRNDiva, BSN, RN · Aug 25, 2011

I'm starting my ACNP program next week so I can only tell you what I've observed in my area, but here goes! I live in IN and a CNS in my state can prescribe and assess pts but they are mostly used in research driven or educator roles within hospitals here. For instance, our unit CNS develops our policies and procedures while implementing evidenced based practice, assures we meet SCIP measures and the like. The overwhelming majority of her practice is away from the bedside and instead in the office (which at times causes some resentment from the unit staff). There are exceptions to this, as a former coworker just signed on as a CNS for a private radiology group and has obtained prescriptive authority. She evaluates pts pre and post-procedure. She is the only CNS in our area that functions in that manner to my knowledge. Our hospital has finally started using NPs for inpatient care but the pay leaves much to be desired. The NPs round during the day and don't have to take call or cover the wknds for now but that may change. The hospitalist service is currently interviewing for a NP (offered one our former RNs $69k) and the trauma service has added an ACNP in the past month. She rounds on all of the trauma patients and the day shift RNs in the unit seem to really enjoy working with her.

I must note, however, that many of our CNS positions have been eliminated during rounds of budget cuts in the past 5 yrs. Our COO told us that the further we get from the bedside, the more dispensable we are (his words, I promise). The CNSs who remain have found their hours cut while their level of responsibility has increased. For instance, our CNS is often required to develop policies or address patient care issues for other units throughout the hospital while working part time. I can't tell you the last time our hospital has had an open CNS specific position posted though.

I think you would have more options for the future and job security as an ACNP than a CNS. You could always join a cardiology or pulmonology group later on and manage patients who have chronic or acute exacerbations of chronic illnesses in clinics or even take an administrative role in a trauma department.

Just my :twocents: but I hope it helps!

kyboyrn · Aug 25, 2011

You may also consider looking into the FNP route. I know that the ACNP route is great for acute care and ER, but in many ERs, they want the NP to be able to see children (there was actually one who had their ACNP certification and was told that they had to get their FNP or Peds NP certification so they could see kids or they would not be allowed to work there anymore). All ERs are different, but where I work, as long as you can get a ER rotation in school (although I didn't. I was just lucky because I was a ER nurse there for five years so they knew and trusted me) that you can work ER. They will not hire a NP with ACNP certification unless they are dual certified because they need them to see children. I'm sure in bigger areas, and possibly where you work, the ER or trauma center is split up into an adult area and has a seperate Peds ER. In that case, ACNP certification would probably be more desirable as ACNPs get more training in acute care, including procedures such as central lines and chest tubes. Still, where I work, the "mid-levels" (that's what they call us) such as the NPs and PAs aren't allowed to be priviledged to do these procedures anyway. Any central lines, chest tubes, intubations, LPs, etc. must be done by the physician. Even conscious sedation with reduction of dislocations must be performed under the supervision of the physician. Therefore, at least in my facility and many others I've heard of from other NPs, the FNP route is perfectly acceptable, if not more desired, in many ERs. Just a thought and something to consider. I would have loved to have the ACNP training, but the FNP route was more accessible to me, and it actually worked out better for my desired area of employment. Just something else for you to consider. Oh, and I have nothing but the utmost respect for CNSs, but as mentioned by many of the others, they are so few and far between these days, and many facilities are phasing them out because they are choosing to find less qualified workers to try to fill their void in order to save money. It doesn't work, I believe the patients suffer, but that's the sad state of things in healthcare right now. Hospitals and other healthcare facilities are cutting corners. NPs aren't going anywhere though, because even if the hospitals don't need us at all times, primary care always will. I love my ER position, it pays well, and is very rewarding (but stressful at times) but as I get up in the years I can definitely see myself going to work in a family practice office, seeing 20-30 patiets a day, and having my evenings, weekends, and holidays off. Right now though, I'm enjoying my acute care. ER is all I've ever done since I because a nurse, and I really don't know anything else. Good luck in your decision. Look into the requirements for the location or setting you're gonna work. Like I said, FNP may not be the choice for you, but it's something to consider!!!

bsnanat2 · Aug 25, 2011

Before you make a decision please take a look at the proposed APRN Consensus Model. Hopefully when adopted, all states will follow its recommendations and recognize CNS's as APRN's. I honesty feel that the role is being/has been minimized for some time. I have recently noticed an upswing in advertised true CNS positions. As healthcare changes and reimbursements become more tied to results/outcomes, I think the CNS role will see a resurgence. When you look at the Consensus Model, CNS is actually a very attractive role. You may be able to find a program that will allow you to qualify for both roles (NP/CNS) with minimum extra classes.

Every individual must make their own decisions, but the more I research, the more I am afraid of this "FNP is the best route" view. It seems that there are positions out there that ask for FNP that really don't require you to see children. Most specialty practices do not see children but ask for FNP because that's all they know about. The APRN really has to take more initiative and educate people about their role and scope of practice. Adult NP's can see adolescents and in many states ACNP's can too. The FNP training is very much primary care. While their are many inpatient cases that a primary care provider can take care of, it would be much safer (as in liability) to make sure you have the proper training, whatever that means for your state. One thing is for sure: When it comes to kids inpatient, you'd better make sure you know what you're doing. I think I'll pass. Again, look at the Consensus Model; it stresses that your training dictates who and what conditions (level of acuity) you can treat, not the setting. NP's/APRN's have long enjoyed low liability rates and a good reputation. Rest assured, that as APRN's are utilized more, a couple of things will happen.....Attorneys will start to see APRN's as a ready, untapped source for lawsuits and many APRN's will put themselves in a position to be sued by overstepping their scope of practice and then insurance rates will go up for all. My point? Be smart, do your research, make the right choice for you and then "stay in your lane!"

abass211 · Aug 25, 2011

Thank you all for your information. I have been looking into many different schools and have been leaning toward fnp. I would love to get the trainjng that come with the acnp. However not being able to treat kids is a big downfall and I'm afraid I wont be marketable. Just looking for all areas of input because the er I work in is a level one traumas center n a teaching hospital. So residents are mostly used for procedures. Also the er docs are outsource by a group and that groups policy does not hire nps. They only hire pas. So just wanted to see how how other ers function. I love the er n trauma drama however I can't do this job forever. I want a more normal job as I get older n have kids.

Thanks again.

CCRNDiva, BSN, RN · Aug 27, 2011

There are some programs that offer combined FNP/ACNP, ACNP/ER, FNP/ER that would train you to work in the ER. For instance, my school offers FNP/ER and ACNP/ER programs that provide additional coursework in Peds and ER. An emergency certification for NPs does not exist. Maybe you could attend a duel program that would allow you to keep the trauma drama now and then transition into a outpatient role later.

It's unfortunate that your ER group only hires PAs. Our ER and anesthesia groups only use docs, no midlevels at all. I think some docs feel that FNP programs do not adequately train NPs to function in the ED. Maybe if you enrolled in a program that offered specific training in the ER you could approach them and show them the benefits of including a NP in their practice. I know that our GAS group has expressed negative views of CRNAs but our hospital has formed an alliance with another hospital that uses a lot of CRNAs so I'm not sure if that will change.

Our hospital had been very resistant to allowing NPs to practice inpatient but as new docs have moved into the area that are more familiar with practicing with NPs and health care environment evolves so have their views. It is difficult to attract talent to our area. Most docs in our area graduated from our state's med school (the only one in the state). Our trauma docs had to push for the hospital to hire a NP. The head of our trauma department told me that their certifying body actually recommended the use of NPs/PAs and questioned why they didn't have any during their last evaluation. He actually preferred a NP so that's why they chose the NP route.