Shame on you ANCC : Psych CNS: Don't precept Psych NP's

Specialties CNS

Published

ANCC is not recognizing our 500+ clinical hours as a Psych CNS's stating that maybe we did not preform "clinical" work for those hours and instead did some other type of managerial or organizational work, therefore they will not allow us to sit for the Psych NP exams despite meeting all the requirements. Even if you had a dual program and decided to sit for the CNS vs the NP exam (because it was the thing to do at the time) and even if you had hours in more than one modality as required, ANCC will give you a hard time saying that your hours don't count. It makes no sense and this is an unfair practice by the ANCC. If we as CNS's aren't able to take the same exam as the students we are supposedly fit to precept then we shouldn't precept them at all. Don't Precept Psych NP's until the ANCC makes changes to their policies. If their practice is so different then ours then nursing programs can go find all the experienced psych NP's out there to precept instead (aka NP's with less than 3 years experience).

Trauma RU and other's

Something you all may not know is that the APRN role came about through manipulation. Those that chose not to practice medicine have been disenfranchized. RNs in at least some states are synonymous the role of an LPN. They can only work at the bedside no matter what their level of education. Nice, right? I'm close to finished with my Ph.D. I do NOT want to medicine, I want to practice nursing. Who is going to hire a Ph.D. at the bedside?

Do you know that advanced practice nursing (APRN) is based on your medical education? It is not based on your nursing education? The way that the APRN came about is that anyone who did not agree with the proposal was uninvited or "overlooked." Their vote was not considered in the ratification process, so the proposal for the Consensus Model was ratified on the basis of a full consensus of those in attendance. I have that referenced appropriately but am not including it intentionally.

Some states have now recognized the CNS role as an APRN role but it depends on which of the roles each state chooses to recognize. Most universities in FL no longer offer the CNS b/c FL is only interested in nurses that practice as medical providers. The CNS role is still advertised on their websites. When someone calls about it they are told no they have the APRN and nurse are not educated about their profession enough to realize there is a difference.

For the reward of doing what one has been manipulated into doing. they will be used to provide medical services and will be paid less. That is a bargain for whom? Not the nurse that is paying higher insurance premiums, and that has much more responsibility. The APRN position is much more demanding, The APRN now is rewarded with an 80 hour per week. So that lovely raise they got by being an APRN if calculated is now far less money than one could have earned if they worked a few hours of overtime in the ICU. Calculate it out if you don't believe me. I've helped more than one APRN that was running KP service for the MDs they work for and they figure out that they were making less doing physicals and paperwork--not seeing patients and providing nursing care.

You become a bargain to the system that pays you a reduced rate b/c you are a nurse providing medical services.

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Specializes in Vascular Neurology and Neurocritical Care.
14 hours ago, the4ofus said:

Trauma RU and other's

Something you all may not know is that the APRN role came about through manipulation. Those that chose not to practice medicine have been disenfranchized. RNs in at least some states are synonymous the role of an LPN. They can only work at the bedside no matter what their level of education. Nice, right? I'm close to finished with my Ph.D. I do NOT want to medicine, I want to practice nursing. Who is going to hire a Ph.D. at the bedside?

Do you know that advanced practice nursing (APRN) is based on your medical education? It is not based on your nursing education? The way that the APRN came about is that anyone who did not agree with the proposal was uninvited or "overlooked." Their vote was not considered in the ratification process, so the proposal for the Consensus Model was ratified on the basis of a full consensus of those in attendance. I have that referenced appropriately but am not including it intentionally.

Some states have now recognized the CNS role as an APRN role but it depends on which of the roles each state chooses to recognize. Most universities in FL no longer offer the CNS b/c FL is only interested in nurses that practice as medical providers. The CNS role is still advertised on their websites. When someone calls about it they are told no they have the APRN and nurse are not educated about their profession enough to realize there is a difference.

For the reward of doing what one has been manipulated into doing. they will be used to provide medical services and will be paid less. That is a bargain for whom? Not the nurse that is paying higher insurance premiums, and that has much more responsibility. The APRN position is much more demanding, The APRN now is rewarded with an 80 hour per week. So that lovely raise they got by being an APRN if calculated is now far less money than one could have earned if they worked a few hours of overtime in the ICU. Calculate it out if you don't believe me. I've helped more than one APRN that was running KP service for the MDs they work for and they figure out that they were making less doing physicals and paperwork--not seeing patients and providing nursing care.

You become a bargain to the system that pays you a reduced rate b/c you are a nurse providing medical services.

I don't follow many of the points made here. Maybe it's just me, but several things here could use some clarification.

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Neuro Guy NP, DNP, PhD, APRN thank you for your comments.

I'd be happy to engage if you would like. What are your points of contention?

I recognized that what I said would ruffle some feathers of some people on this board.

Advanced practice is based on whether one provides medical diagnosis and prescribes. It is also interesting that an APRN can teach but a Nurse Educator cannot. APRNs have no educational pedagogy so how are they qualified to teach?

I realize not all states have legislated all RN and APRN roles equally.

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Specializes in CVICU, MICU, Burn ICU.
2 hours ago, the4ofus said:

I'd be happy to engage if you would like. What are your points of contention?

I recognized that what I said would ruffle some feathers of some people on this board.

I am not sure that we are understanding your points enough for any feathers to be ruffled. Your comments were a bit disjointed -- and I am getting the feeling that you are very passionate about the points you are trying to make. Forums like this are not always ideal for discussing nuances of a matter.

I think I hear you saying that APRN is based off the medical model. I think while this is more true for CRNA -- I still don't think it's completely accurate. That said, I have no problem with with nurses straddling the nursing/medicine fence -- it is what is necessary in advanced practice. Honestly in terms of philosophy, and even practice, nursing and medicine overlaps quite a bit. I have never understood the notion of "nurses are not supposed to understand medicine" -- which is kind of the direction your argument is headed in. APRNs do practice nursing and medicine.

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I agree that there is an overlap of medicine and nursing. There must be an overlap if the two professions are to collaborate effectively with each other for the benefit of the patient.

My point of contention is that when the Consensus Model was approved they knowingly disenfranchised nurse that did not chose to be APRN based on prescribing and making a medical diagnosis. They lifted one form of nursing above the other. The Consensus Model lifted the medicalized version of nursing above others. How can one nurse with a master degree be advanced practice and another not be?

How can an APRN be an educator with no educational pedagogy? I realize this is an overly zelous interpretation that some states chose. That is also part of what I'm trying to bring to the forefront. The Conscensus Model is myopic and considers only what was important to one set of professionals at the expense of others who do not follow their beliefes. Why the divide? Shouldn't we all be working together for the benefit of those who need care? I would understand if all nurses with MSN, PhD, or DNP were advanced practice but that is not the case.

When I use the word disenfranchise I mean those who have been disenfranchised can not support themselves…as in they can’t work unless they take a demotion. That is counterproductive. The profession needs diversity of thought and ways of caring for others that shows respect to all ways of caring and being with each other.

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Specializes in CVICU, MICU, Burn ICU.

@the4ofus thank you for clarifying. I understand your points now. You feel that all nurses with advanced education (graduate level) should be considered "advanced practice". I think you make a valid point. I do think there should be distinction for provider roles for the sake of public understanding, if nothing else. But as I am just pondering this thought for the first time right now - I have to agree it would be good for the nursing profession to have a broader application of what "advanced practice" is. To me, this is expressed in the CNS role, but I see how that is not acknowledging the advanced practice of nursing that occurs with educators, researchers, and administrators.

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My point of contention is that when the Consensus Model was approved they knowingly disenfranchised nurse

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Specializes in Vascular Neurology and Neurocritical Care.

Advanced practice doesn't include those that have an MSN Education focus because they are not advancing their practice. At the end of the day, their scope is still that of an RN because they didn't attend NP, CRNA, or CNM school. In fact, besides perhaps an advanced patho and pharm course, I really wonder if their body of knowledge in terms of Nursing and medicine is at all deepened given that the focus is on pedagogy and not so much in further nursing coursework. Whereas the current definition of APRN is what it is because APRN has a scope that is beyond that of traditional because nursing duties.

As far as how APRNs are qualified to teach without formal educational pedagogy, I can somewhat see your point. Having formal educational pedagogy would definitely be beneficial but remember that the vast majority of university faculty DON'T have that. Getting your PhD in business, history, biology, or anything else doesn't actually prepare you to teach but yet here we are with all these professors. And notice that the educational system isn't crumbling in terms of quality (maybe cost but that's an entirely different discussion). We have very good universities here in the States.

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...and the only reason that APRN are deemed advanced practice is that advanced status is measured on medical practice--not nursing practice--so saying that someone is not advancing their nursing practice is not accurate. What they are doing is learning to perscribing, and provide medical diagnosis.


Many nurses don't know nursing process. If nurses don't use nursing process to chart nursing as a profession becomes invisible. The two professions, nursing and medicine are two different professions. If one wants to practice medicine why not just go to medical school?

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Specializes in CVICU, MICU, Burn ICU.
12 hours ago, Neuro Guy NP said:

Advanced practice doesn't include those that have an MSN Education focus because they are not advancing their practice.

Hmmm. An often stated complaint in nursing circles revolves around the lack of standards/standardization. While the following document does not guarantee such standardization in academia and practice, it is a place to start. And it looks like the end product of an MSN is advanced nursing practice to me. I am open to correction/suggestions, if this is not what that is....

AACN Essentials of Master's Education in Nursing

Nursing and medicine are different disciplines. The current prevailing idea is that APRNS are at the top of nursing practice, however, it is probably more accurate to say they are nurses who practice medicine (including CNSs in the provider role). There is a difference.

I see both points of view. I am also old enough to know I have only so much energy -- this is not a hill I will die on. @Neuro Guy NP and @the4ofus both make good points - and each is representing a different perspective of APRN

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