DrNurseCNS

I'm a fan of Hokas. I have high arches and also wear custom orthotics. Hokas are very supportive and come in some wild color combinations. It's a little challenging to find them in stores (REI has them) but they are readily available online. I am a size 9 and usually buy the 10 to allow for compression socks, orthotics, and swelling.

Yes I think it is a role on life support for a variety of reasons such as those mentioned above. Schools are closing their programs because there are no positions for CNSs and low enrollment, to name two big reasons. The lack of positions may be because many organizations do not understand the role, do not value the role and underutilize it. The lack of employment opportunities perpetuates the low enrollment because who wants to do all that schooling and clinical with no job prospects at graduation. In California we have title protection, but no requirement for board certification other than the certification received from the BRN that the person graduated from an accredited program and fulfilled the requirements as outlined by the BRN and NPA. In California, CNSs have no prescriptive authority (unless you work in a Federal facility) so this limits the role because of the importance placed on billable service. Cost avoidance, patient safety, nursing research and excellence don't get the bean counters and the C-suite quite as excited. The only CNS role that gets any respect is the NICU CNS because if hospitals receive CCS money, the state mandates that they have a CNS at least part time. So again, it comes down to $$$$. Also I see a lot of NPs doing CNS roles such as managing programs, but unfortunately the CNS cannot perform the NP role (nor do we want to...we are all about populations and systems). The National Association of Clinical Nurse Specialists (NACNS) and some of their local affilitates (such as California- CACNS) are aware that the profile of the CNS needs to be raised and become more visible. There is a movement to educate on the benefits of the CNS to patients, nurses, and organizations, but it is slow going. I am part of a CACNS subcommittee trying to tackle this very subject. If anyone has suggestions or questions, I would love to hear from you.

This thread started as a discussion regarding for-profit, non-selective NP schools and their effects on the profession. The NP v MD thing is tired and boring. NPs are here and are not going anywhere for the foreseeable future. After 40 years in this business, I am no pollyanna, and have seen progress in the Us vs Them attitude in the clinical setting; let's forget about the AMA's position on NPs for the moment it's another thread for another time. I know I prefer hearing about actual experiences with NP education and more ideas to improve, strengthen and uplift our profession. The vitriol is not helpful.

My mistake as I thought she was looking at a faculty position. A terminal degree seems a little excessive for a clinic position. There was a lot of ruminating about EdD, PhD versus a DNP in addition to does the name and reputation of the school matter.

Thus, my original comment: "Does it matter where you go to grad school to obtain an educator position (especially a clinical educator), I'm going to say no. Employers do not care for the most part. I would say it matters more if you are getting an advanced degree for a clinical role such as CRNA, NP, CNM, or CNS. " It seems I was very specific since I actually named the four advanced practice roles that require 500 hours (or more) of clinical practicum. As CNSs, you and I already know this. Hospitals do not care what program was attended by their clinical educators. Academia may or may not care. Doctoral programs care where your undergrad and masters degrees were earned. . Since the OP is already employed in academia and the employer has made it clear they don't even really care which terminal degree is obtained, they are probably not going to nit pick over where it was obtained. But I stand by my opinion to attend the best program you can afford in terms of time and money. In the end, it is all about the effort you put into learning and earning your degree. If you are going to put in the time, you might as well study an area of interest or you will be stressed and miserable. Especially when it comes time to do your dissertation, capstone, or project (depending on your program) because you will be living with that subject in depth for quite a while!

I did specify in my answer advanced degree in a clinical role. I could have been more specific in saying a role that requires 500 or more hours of practicum. Educator degrees from some schools require a teaching project or a "practicum" but I assure you it is no where near 500 hours in a clinical setting. I have an MSN in nursing education and administration as well as a post- MSN APN certificate and a doctorate so I think I am well versed in what is an advanced degree. I have also worked in clinical education in hospitals and I know they do not care where the degree is from as long as you have a diploma with MSN on it (and many accept a BSN). I agree faculty positions are a different animal. In academia, where I have also held positions, the school and program certainly do matter. Transcripts are submitted and reviewed when applying for faculty positions (tenure and non-tenure) and should include the things you listed in the last paragraph. Agreed, go to the school with the best program you can afford for the degree you seek. You want to be proud of where you went to school and you want your degree to mean something.

Does it matter where you go to grad school to obtain an educator position (especially a clinical educator), I'm going to say no. Employers do not care for the most part. I would say it matters more if you are getting an advanced degree for a clinical role such as CRNA, NP, CNM, or CNS. You would want to research the school thoroughly, find out about clinical experiences, and what is the pass rate for board certifications. It really matters if you decide you may want to go on to a doctoral program. Transcripts will be scrutinized and if you are lacking in foundational classes/content you may not be accepted into the program OR, you will have to take a lot of extra classes before taking the core degree classes costing you precious time and money.

My point is that 500 hours of clinical preceptorship is an arbitrary number that schools use so that their graduates are eligible to sit for the national certifying exam. It's not about whether it's an adequate or inadequate number of hours, it's the minimum required number. It's just a fact. Many schools (including mine) require more hours from their graduates, but the MINIMUM is 500. Preceptors and preceptorships are just like schools. There is a lot of variability in the quality.

The 500 hours of preceptorship has nothing to do with competence, confidence or fitness to practice, independently or otherwise. It is the number of hours required to sit for a national certification exam (ANCC or AANP). Most NPs need the certification to get a job so the practice is able to bill MediCare and other insurance. The bottom line is money.

Agree! The thread was about for profit schools and their impact.

This exemplifies "school is what you make of it" and "you get out of it, what you put into it". I have 3 degrees and a post masters certificate from 4 different schools. They all offered something, and some had higher standards than others (one was a "for profit school"--never again!). My own standards are high and so I put in the work so as not to waste my own time and money. However, I have noted that in graduate school there is a lot of writing and very little test-taking. Therefore, I feel the same as some others out there that people are getting by and are not submitting graduate level work. How can you publish and contribute to nursing as an advanced degree nurse and or practitioner if you cannot clearly and effectively express yourself via the written word? How about going to court with your documentation projected on a 10 foot screen so everyone can see your command (or lack) of the English language and your ability to intelligently and cogently express thoughts, diagnoses, prognoses, and other patient data? I have seen some very poorly written papers and notes that make me wonder, how did this person get through grad school? These diploma mill schools need some serious intervention and oversight.

Hmm, sounds like a future cervical cancer patient.

It is totally normal to feel like a novice again and to be frustrated by that feeling when you were "the expert" in your previous position. I have seen (and guided) dozens of nurses through the process of transitioning from Med-Surg, Tele, and PCU into ICU/CCU. You have skills and knowledge that will serve you well and you will ask different questions than a new graduate nurse would ask, so it helps if you have a preceptor who is comfortable with that sort of situation. It's a good opportunity for new grads to learn from you, and preceptors too! Don't discount the knowledge and experience you bring with you going into a new area, but give yourself some grace as you transition into being an ICU nurse.

Most of the time, I'm like the rest of you talking back to the TV, "Oh so you're an ER doctor AND a neurosurgeon, AND a cardiothoracic surgeon?" Also yelling, "Where are the nurses Greys Anatomy, when was the last time an MD pushed a med in a code or at any time?" Seriously! I only liked the show The Resident because at least they showed an NP who seemed somewhat realistic in her role...then of course they killed her off. Chicago Med is OK in that at least nurses are visible and are not complete doormats. For the most part I have given up hope for a realistic portrayal of a nurse or nursing on TV dramas, rom-coms etc. Some of the shows on the Discovery channel have somewhat realistic portrayals of nurses, but they are heavily edited and of course, focus on the most dramatic cases and personalities. What is really frustrating is that there are plenty of nurses qualified to speak on news shows and to give information to the public. However, news outlets usually seek out an MD spokesperson. There are some fairly well known media savvy nurses such as Nurse Alice Benjamin, but there needs to be more visibility and respect given to nurses' knowledge and expertise. We ARE the most trusted profession and we (and the media) should really capitalize on that fact.

I just love encephalopathic patients and I really love it when they are on Lactulose enemas Q 4 hours... Said No Nurse EVER!