Please clear some things about CNS for me!

llg, PhD, RN · Apr 8, 2005

The CNS role varies from place to place. It tends to be a jack-of-all trades role that hospitals use to meet needs that require clinical expertise and a Master's level education. So ... while I can understand why you are confused, there is no simple answer for your dilemma. For every CNS who might respond here saying that she does very little staff education, there might be another who does spend a lot of time doing education.

I think the people who are the most happy in a CNS role are those that are prepared to be flexible. Sometimes, there is a need for the CNS to do a lot of direct patient care and clinical consultation. At other times, there might be a need for a lot of "office work" and "going to meetings." At another time and place, there may be a need for lots of staff education.

When I first became a CNS about 25 years ago, many CNS roles included an equal balance of education, management, research, consultation, and patient care. Then there was a big push among CNS's to increase their direct contact with the patients and to decrease the management and educational aspects of the role. Where I work now, they ended up combining the CNS and staff development educator roles resulting in a role that does include a lot of staff education.

What you are trying to do is to figure out what the role will "look like" in the next 10-20 years. All you can really do is prepare yourself to be useful to the health care system in as many ways as you can so that you can adapt to whatever market forces you may encounter in the future. Rather than think of your education as "stamping" you as qualified for a specific job that may or may not be there in the future -- think of it as giving you skills that you can adapt and use in a variety of roles over time. Pick the program that will teach you skills that will be valued in the future and that you will enjoy using. Don't think in terms of a specific job title that may or may not be in vogue 10 years from now.

Just a few thoughts from someone who has been around a while ...

llg

elkpark · Apr 8, 2005

ITA with everything llg said. The title is clinical nurse specialist for a reason ... The education prepares you to be a clinical expert in a specific area of nursing practice. Out in the wonderful world of employment, some employers may want you to use that clinical expertise to provide direct patient care -- some may want you to use it to help improve the skills and understanding of the nursing staff to improve overall patient care. Often, the roles combine or overlap to some extent.

In most of my child psych CNS positions over the years, I was hired to provide direct patient care and spent the bulk of my time doing that -- but also was used by the hospitals as an expert resource for staff nurses (some limited staff education and consulting).

Then, there's also research, teaching, consulting, management -- you can pretty much make of the role whatever you want.

elkpark · Apr 8, 2005

I'm curious -- what is it that you're wanting to do as a "CNS who specializes in surgery"? That's not a role I've run into before, but, since I'm in psych, I'm sure there's a lot out there I haven't heard of.

imastudent · Apr 8, 2005

I'm curious -- what is it that you're wanting to do as a "CNS who specializes in surgery"? That's not a role I've run into before, but, since I'm in psych, I'm sure there's a lot out there I haven't heard of.

there's a specialty called med/surg for CNSs..

llg, PhD, RN · Apr 9, 2005

there's a specialty called med/surg for CNSs..

Within the broad realm of med/surg, there are a million sub-specialties. I met one CNS many years ago who started out as a med/surg CNS, then focused on post-op care ... and eventually became one of the leading experts in wound healing.

I remember another med/surg CNS who focused on cardiac patients ... then on cardiac rehab ... then on the needs of patients with pacemakers.

Another good friend whose education is that of a med/surg CNS focused on adult oncology patients ... then on leukemia patients ... then on bone-marrow transplant recipients. She set up and ran a special program for such patients to leave the hospital sooner and get most of their care at home.

Adult med/surg is the broadest of specialties. As you get more experience with nursing, you'll begin to focus your attention on a couple of areas that interest you more than others. I recommend taking a little time with your career to discover what types of patients, what types of care, and what types of job functions you enjoy most in nursing before you make any irrevocable decisions about your career.

Good luck,

llg

miriambender · Apr 15, 2005

Out in the wonderful world of employment, some employers may want you to use that clinical expertise to provide direct patient care -- some may want you to use it to help improve the skills and understanding of the nursing staff to improve overall patient care. Often, the roles combine or overlap to some extent.

As a pre-med graduate researching becoming a CNS, I also have had confusion about the medical/surgical CNS "role". I have read the posts and am understanding more and more everyday. What a newbie like me doesn't understand is the idea that an organization defines the role, not your title as CNS (as opposed to being a neonatologist looking for a neonatology position in a neonatology hospital; all pretty straightforward). I wonder about being hired in different organizations when at each place I might be doing completely different things. So is it not my skills that are being hired, but my potential?

Miriam

llg, PhD, RN · Apr 15, 2005

I wonder about being hired in different organizations when at each place I might be doing completely different things. So is it not my skills that are being hired, but my potential?
Miriam

Sort of ... but not quite. It IS your skills that are being hired. But in this case, your skills encompass a wide range of organizational and role function skills as well as clinical skills. A CNS education includes knowledge and skills related to education, management, research, etc. that can be used by an employer in a variety of ways. For example, I was an expert in neonatal ICU nursing. My graduate education also taught me a little about education and management. So ... I was prepared to be a leader in a NICU -- able to provide expert patient care when needed -- but also able to teach others how to provide expert care, assess the needs of the unit (as well as the patient), evaluate the quality of the care provided by myself and othes, establish new programs, develop new policies and procedures, etc.

A CNS is usually hired to assure that the patients are receiving the best care possible -- not only by directly providing that care to the patients, but also by helping others to provide great care. A CNS works with others to improve their practice by role modeling, teaching, developing new programs, establishing new procedures, educating staff, etc. You do whatever needs to be done to assure the best care. That's why it varies from time to time, place to place.

Some CNS's do find themselves a niche in which they establish a routine and do the same things over and over again. An employer has a consistent need that the CNS can fulfill on a regular basis. That need might be for a direct care provider ... or for a staff development educator ... or for a special program director ... etc. In such cases, the CNS role is much less varied from day-to-day, but still varies from one person/place to another. But the education for the CNS role prepares the nurse to be flexible and perform a wide variet of advanced skills within an organization.

If such variety doesn't appeal to you, you might be more interested in a Nurse Practitioner position -- one that consistently assesses and treats patients every day and only does a little of the other stuff, if any.

llg

miriambender · Apr 16, 2005

It IS your skills that are being hired. But in this case, your skills encompass a wide range of organizational and role function skills as well as clinical skills.
If such variety doesn't appeal to you, you might be more interested in a Nurse Practitioner position -- one that consistently assesses and treats patients every day and only does a little of the other stuff, if any.
llg

Thank you llg for the very informative answer. I think the variety of the postion sounds very exciting. From what I have read though CNSs do not yet have a large role in the hospital nationwide. Is this true or not? Is it normal for each department within a hospital to have a CNS, or is it still the exception rather than the rule? Is cost a big factor in this? Appreciate any response!

llg, PhD, RN · Apr 16, 2005

Thank you llg for the very informative answer. I think the variety of the postion sounds very exciting. From what I have read though CNSs do not yet have a large role in the hospital nationwide. Is this true or not? Is it normal for each department within a hospital to have a CNS, or is it still the exception rather than the rule? Is cost a big factor in this? Appreciate any response!

CNS's have been around for over 30 years and are common in larger hospitals, academic medical centers, etc. However, they often practice in jobs with titles other than CNS. For example, my job title was CNS for many years -- but now it is Clinical Practice & Education Specialist.

As you get more familiar with the health care environment and get to know the nurses in advanced roles, you'll see there are really lots of opportunities for nurses prepared as CNS's -- IF they are flexible enough look at roles that might not be the ideal they had in mind. Advanced practice roles usually evolve over time and are shaped by the people who occupy them. So it is often worth it to take a job that is "similar" to the one you dreamed of and then work to modify it after you have earned the respect and trust of your colleagues.

llg

miriambender · Apr 16, 2005

Advanced practice roles usually evolve over time and are shaped by the people who occupy them. llg

How interesting, the CNS job is what you make of it, which I can see is why it is so hard to explain to a newbie. Coming from a medical background, where there is no such flexibility, it is a bit of a leap, but the more I learn, the more I am attracted to the position. I am still a little nervous about job prospects after I graduate though, not for my 'dream job' but any job where I could start using the CNS skills -I am out in Southern California where I guess many of the CNS positions were eliminated in the 90's due to budget concerns, and are only now starting to repopulate the hospital community. The nursing school I am interested in applying to says there is a great demand now for CNSs, but I still am a bit unsure.

Thanks for this enormously informative dialogue!!

llg, PhD, RN · Apr 16, 2005

How interesting, the CNS job is what you make of it, which I can see is why it is so hard to explain to a newbie. !!

Exactly! Now you've got it! It's a very "intrapreneurial" role (as opposed to "entrapreneurial"). An employer hires a CNS because they have some specific needs to be filled -- but a CNS has a lot of generalized skills that can be useful. A good CNS can "sell" the employer on the benefits of using the skills he/she wants to use and shape the role over time.

It's a great role for people who like flexibility and variety in the life -- and who can tolerate the ambiguity of it and the need for self-responsibility and self-direction. CNS's often have to oversee their own orientations and provide direction for themselves in establishing priorities, etc. If you need an employer to lead you by the hand, provide a lot of direction and support, etc. then the role is probably not for you. But if you're the type of person who does not need those things ... then it can be great.

llg