Who will do CNS role?

The CNS role is, in my opinion, being replaced the the CNL (clinical nurse leader). If you look that CNL programs, they often look a lot like what some of the old-school CNS programs did before they were blurred with NP roles. The CNL, however, is not an advanced practice role some thing sidesteps some of the blurred lines between CNS and the NP. One new thing about the CNL is a focus on what has been called "horizontal leadership" or what I call "leadership without a title". The idea being that they could be a clinical expert on the floor, server as an informal educator, could work on quality improvement or cost effectiveness projects. The unfortunately reality, however, it that most employers have a hard time seeing the longer term value this work provides and are more focused on staffing shifts than giving nurses the time to use their full skill set to improve healthcare more broadly.

Unfortunately, neither the CNS nor the CNL are very popular. Since they are not intended to be providers (and CNLs cannot), they generally don't generate revenue for organizations. And since any work they do outside the staff nursing role doesn't directly ease the ratios on unit, many administrators find it hard to justify their salary. It's hard because true CNS/CNL are the nurses our healthcare system really needs more of. The IOM recommendation that NPs latched onto about nurses practicing to the full extent of our education is, I think, even more applicable to non-provider roles. Having experts who are not bogged down with patient care or administrative duties and have the knowledge, skills, and abilities to genuinely improve healthcare would be a game changer. They can provide real mentorship and guidance, be a resources for when things get dicey, and take a step back to look at the bigger picture and what needs to happen to provide the best healthcare.

I think many of the larger health care systems still employ Clinical Nurse Specialists in "traditional" roles especially those places that try to maintain ANCC Magnet designation. Our academic medical center have unit-based CNS' (i.e., one for Med-Surg, one for Adult Critical Care, etc.). They have the traditional expert nurse role and is involved in writing nursing procedures and protocols, quality initiatives, and some research and mentoring.

They are not unit educators, we do have specific nurses in that role too and some have CNS credentials actually. I feel like the Wound Care CNS we have closely mimic the true CNS role of being an expert in their specialty and having the ability to prescribe therapeutic options in treating complex wounds yet still being closely aligned to nursing.

If I were considering a CNS role, I would be worried about job prospects in that the pool of job openings are not that extensive and the turn over isn't that frequent. Having said that, many CNS' I know are older and may be retiring in 10 years or less. It also may not matter to someone who is willing to settle into an educator or staff development role that isn't titled as CNS.

Well you guys are definitely giving me a lot to think about !! Perhaps if I want to play multiple roles I should simply play multiple roles.. The staff development stuff seems up my alley. What education do they like for that? I can always stay at bedside per diem... I feel like I love the idea of a masters and the CNS degree looks most interesting and clinicals would be most interesting.. I suppose we always get continuing education as nurses, I don't necessarily need a masters.I'm just grateful to be at that sweet spot in my career where doors open easier. And I don't feel stuck at bedside like I did in the beginning. I'm just there because I want to be!

Well you guys are definitely giving me a lot to think about !! Perhaps if I want to play multiple roles I should simply play multiple roles.. The staff development stuff seems up my alley. What education do they like for that? I can always stay at bedside per diem... I feel like I love the idea of a masters and the CNS degree looks most interesting and clinicals would be most interesting.. I suppose we always get continuing education as nurses, I don't necessarily need a masters.I'm just grateful to be at that sweet spot in my career where doors open easier. And I don't feel stuck at bedside like I did in the beginning. I'm just there because I want to be!

One advice I'd give you is that success in landing a CNS role or any educator-type role would rely heavily on your nursing experience. You certainly won't expect to be hired in a Neuroscience CNS role for example without years of relevant nursing experience behind your belt. It is quite different than NP's in that there is a chance a nurse who for example worked in a Cardiac ICU could be hired working in a hospitalist role as an NP. So I think the best route is to build up your career portfolio in your specialty, connect with other colleagues in your specialty through a local chapter of your professional association, and network well in order to get your name out there. The stakes are a bit tougher than for NP's I would say.

Another example, diabetes educator. I've primarily seen nurses with BSN and a certification for diabetes as an educator/instructor for patients with new or uncontrolled diabetes and to help them with resources for their own management as well. From that standpoint would the CNS take this role? And if so, would that justify more pay or a new role altogether?

I guess my question is, since most roles like those and more, are filled already with BSN/expert certification nurses, how does a CNS elevate that role (or would they?) or how would a hospital or facility justify bringing on a CNS ontop of the other roles already in place. I'm so naive, no insult meant, I'm just trying to clarify the role to learn.

When a BSN does those sorts of jobs, the expectation is that they follow standards of practice that have been researched, established, etc. When someone with an MSN is doing those roles, it is expected that they be developing the standards, doing the research, doing the EBP projects, establishing quality measures to evaluate the care provided, monitor and improve the quality of care, publish, etc. That's why my hospital has 2 levels of Nursing Professional Development practitioners and why the Association of Nursing Professional Development identifies 2 levels of NPD practitioners. Those with BSN's and MSN's practice at different levels.

to TraumaRUs The bridge is a portfolio with specific components. I do have an MSN which I did some of the advanced education. I will be getting education. I am going to get help with CDE and then the bridge. It helps them to train me and get me credentialed.

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Diabetes educator is the exact position that I am hoping to get. Specifically outpatient adult insulin pump education. I have 2 children with T1 diabetes and I am the "go-to" person for pumps already. Our outpatient educator took a different role within the health system and I would replace her.

As far as I have been told, in NC, CNS is considered AP but does not have prescribing privileges.

I am trusting the Advanced Practice Division to have done the research as to my path to a CNS. I am sure I can take the classes, but we already have a CNS (inpatient) that took the portfolio pathway, recently.

to TraumaRUs The bridge is a portfolio with specific components. I do have an MSN which I did some of the advanced education. I will be getting education. I am going to get help with CDE and then the bridge. It helps them to train me and get me credentialed.

So you have completed the 3Ps and have the minimum 500 hours clinical? Thanks for the info - just curious...

CNS isn't a broad program. It's a poorly defined program. Contemplate that. In the OP's post, there's nothing that any RN with volition can do. The only wake to shake the benefits loose are to get a prescriber's certification and work as a clinician of some sort. In which, just become a NP.

CNS isn't a broad program. It's a poorly defined program. Contemplate that. In the OP's post, there's nothing that any RN with volition can do. The only wake to shake the benefits loose are to get a prescriber's certification and work as a clinician of some sort. In which, just become a NP.

Agree with this. The other thing to consider is the Consensus Model and LACE. In my area, central IL, FNPs are no longer able to be credentialed at the hospitals as their education/clinicals are only outpt. CNSs on the other hand, have clinicals in both inpt and outpt roles

CNS isn't a broad program. It's a poorly defined program. Contemplate that. In the OP's post, there's nothing that any RN with volition can do. The only wake to shake the benefits loose are to get a prescriber's certification and work as a clinician of some sort. In which, just become a NP.

I don't think it's poorly defined. I think it's a under-utilized, (and therefore) misunderstood role. I do think there is lack of standardization for CNS preparation -- although the programs I was eligible for are all pretty similar in structure and curriculum -- but each state mandates and allows different things for different APN roles. I think we see this in NP programs, too -- as evidenced by the copious threads addressing such.

I know CNSs who do not prescribe or work as clinicians, and are very happy and successful functioning in the other spheres of the CNS scope. The scope of the CNS is broader than other APRN roles for a reason. Honestly, it is the role that is the "glue" that holds all of nursing together. I really hope nurses will get behind this role and recognize it as being an absolutely essential position to nursing as a profession and for the sake of patients.

There are reasons to become a CNS and the benefits can be "loosed" with or without prescribing privileges.

I keep going back to the fact that healthcare is a business and as such everyone has to be able to accounted for related to dollars and cents. As an APRN, I can bill and pay for my own upkeep. If I was in a "true" CNS role, I could easily be replaced by an experienced RN.