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Who will do CNS role?

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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.

This statement causes me to wonder how many non-provider CNSs you have known. I understand your personal experience with the role has been that of provider. I also understand the idea of being able to bill for provider services. That said, APRN does not equate the ability to bill for service. Also, it is not fair to say any experienced RN could perform the job of a "true" CNS. Any experienced RN could apply to a CNS program, get the education, become credentialed and then work as a MSN or DNP prepared APRN CNS. But experience at the bedside does not make a CNS (just as it does not make any other APRN role).

I have had to explain and "defend" the CNS role to several people, including nurses for all the reasons already discussed in this thread. I was not prepared, though, to defend it to an actual CNS! LOL. And I say that in a lighthearted way -- not being argumentative. I understand how you, as soley a provider, say you would choose an NP program today as opposed to CNS.

But yeah, CNSs are APRNs. Even if they don't prescribe. And for what they contribute to not only nursing, but medicine as well, more than validates that. Perhaps that comes from knowing some pretty amazing CNSs. It is those examples that inspire me as I work through adv. physical assessment, adv. pathophysiology, adv. pharmacology and 800 hours of clinicals.

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This statement causes me to wonder how many non-provider CNSs you have known. I understand your personal experience with the role has been that of provider. I also understand the idea of being able to bill for provider services. That said, APRN does not equate the ability to bill for service. Also, it is not fair to say any experienced RN could perform the job of a "true" CNS. Any experienced RN could apply to a CNS program, get the education, become credentialed and then work as a MSN or DNP prepared APRN CNS. But experience at the bedside does not make a CNS (just as it does not make any other APRN role).

I have had to explain and "defend" the CNS role to several people, including nurses for all the reasons already discussed in this thread. I was not prepared, though, to defend it to an actual CNS! LOL. And I say that in a lighthearted way -- not being argumentative. I understand how you, as soley a provider, say you would choose an NP program today as opposed to CNS.

But yeah, CNSs are APRNs. Even if they don't prescribe. And for what they contribute to not only nursing, but medicine as well, more than validates that. Perhaps that comes from knowing some pretty amazing CNSs. It is those examples that inspire me as I work through adv. physical assessment, adv. pathophysiology, adv. pharmacology and 800 hours of clinicals.

Totally respect your opinion. Thank you.

Yes, you are totally correct, I've never seen a CNS in a non-provider role. Our hospital systems locally employ CNSs totally as providers. The educators are RNs (BSN), staff development is actually run by business people (lol) so only a few nurses involved in this aspect. Change agents are usually the unit managers or co-managers and/or nurses doing research.

Its hard to define the "true" CNS role locally. Really appreciate and respect your input. Thank you

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Hmm.. well, like I said, I definitely do not want a provider or prescribing role. From my observation, NP's get locked into that pretty easily I don't see many NP's who are only educators. Please correct me if I'm wrong, but NP school and clinical is geared towards being a provider, correct? It is starting to sound like my ideas may be more geared to a bachelors level, if I primarily want to do education (either nurses or patients) but, not in the classroom. The CNS role still sounds most appealing as I could have some effect on improving overall policies and nursing care on a unit/ in a facility but I don't have unlimited time and money to get a masters and then end up with a role and pay of a bachelors degree nurse. It sounds very unfortunate that these are fading out. (This brings me back to my original question, who is going to do this role?? ) I feel like there's really no other role with that level of independence and effectiveness in the nursing realm. Masters in education puts you in a classroom, and NP puts you in a provider role- and CNL more of a management/admin role? Correct me if i'm wrong.

So lets say I went into education or professional development at inpatient hospital or rehab. Do you think my BSN will stay marketable for these types of roles or will they start asking me to get some sort of post grad education for those as well?

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In my hospital system unit educators are BSNs. Some do only the educator role, some do a mix of bedside and educator or charge and educator. There is a pay increase for the educator position and often flexibility in scheduling. Administrative nurses are sometimes involved in change, but are always guided/directed by the CNS over that department. The CNSs where I work do a mix of providing direct education, mentoring, consulting, policy updating, leading research and bringing in new tech and updating evidence based practice. They often speak and teach at conferences, are contributing authors for text books, and adjunct university instructors. Some are independent consultants. The pay is on par or better than NP pay.

At the VA, the CNSs do all of what I described above in addition to being providers in their respective specialties.

I think you could not go wrong pursuing a unit educator position and seeing how you like that. While it is true that some CNSs work in that capacity, because the CNS position where they work/live is being phased out, it is NOT a CNS position. However, it a natural steptoward a CNS position. Who knows, if you find yourself in a role you like, but your facility asks you to get a Masters, maybe they will pay for it! And you can expand the role.

I have talked to CNSs that basically designed their role, pitched it and got it. Now I would never bank on that -- and given the realities of inconsistency in how CNSs are utilized, I personally would not be pursuing this degree if I did not have several different, acceptable and realistic ideas of what I will be able to do with it.

 

Like I said, I'm paying the same as I would for an MSN in Education for an APRN degree. I have a lot of clinical experience and am building on that with advanced education. I'm not sure what doors will open up yet with this degree, but I know doors will open.

 

Who will do the CNS role? Golly, hopefully it will be CNSs! It is a very unique advanced practice role. My point in all of these posts is to answer your question that no one is qualified to do the role except CNSs. An institution can cut the role, like they cut other essential staff. Have you seen that happen? I have -- you probably have -- most of us have. And staff and patients suffer. CNSs don't ask us to work harder. They ask us (and then show us how) to be better. They don't just influence nursing, but medicine and administration as well.

Edited by WestCoastSunRN

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Hmm.. well, like I said, I definitely do not want a provider or prescribing role. From my observation, NP's get locked into that pretty easily I don't see many NP's who are only educators. Please correct me if I'm wrong, but NP school and clinical is geared towards being a provider, correct? It is starting to sound like my ideas may be more geared to a bachelors level, if I primarily want to do education (either nurses or patients) but, not in the classroom. The CNS role still sounds most appealing as I could have some effect on improving overall policies and nursing care on a unit/ in a facility but I don't have unlimited time and money to get a masters and then end up with a role and pay of a bachelors degree nurse. It sounds very unfortunate that these are fading out. (This brings me back to my original question, who is going to do this role?? ) I feel like there's really no other role with that level of independence and effectiveness in the nursing realm. Masters in education puts you in a classroom, and NP puts you in a provider role- and CNL more of a management/admin role? Correct me if i'm wrong.

So lets say I went into education or professional development at inpatient hospital or rehab. Do you think my BSN will stay marketable for these types of roles or will they start asking me to get some sort of post grad education for those as well?

It will actually depend on where you work. I happen to work at a medical center in a university setting where nurses with a Master's degree are not unusual even at the bedside RN level. Our Nurse Educators are all Master's prepared. Our CNS' are all certified as CNS' by the state. This will ring true in states where the CNS title is protected by law in the Nurse Practice Act. In such states, the CNS title may not be given randomly to any nurse who does not meet the educational and certification requirements for the role.

Clinical Nurse Educators — UCSF Nursing

Clinical Nurse Specialists — UCSF Nursing

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This statement causes me to wonder how many non-provider CNSs you have known. I understand your personal experience with the role has been that of provider. I also understand the idea of being able to bill for provider services. That said, APRN does not equate the ability to bill for service. Also, it is not fair to say any experienced RN could perform the job of a "true" CNS. Any experienced RN could apply to a CNS program, get the education, become credentialed and then work as a MSN or DNP prepared APRN CNS. But experience at the bedside does not make a CNS (just as it does not make any other APRN role).

I have had to explain and "defend" the CNS role to several people, including nurses for all the reasons already discussed in this thread. I was not prepared, though, to defend it to an actual CNS! LOL. And I say that in a lighthearted way -- not being argumentative. I understand how you, as soley a provider, say you would choose an NP program today as opposed to CNS.

But yeah, CNSs are APRNs. Even if they don't prescribe. And for what they contribute to not only nursing, but medicine as well, more than validates that. Perhaps that comes from knowing some pretty amazing CNSs. It is those examples that inspire me as I work through adv. physical assessment, adv. pathophysiology, adv. pharmacology and 800 hours of clinicals.

What will you be doing during those 800 hours? Not denigrating, I'm curious.

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What will you be doing during those 800 hours? Not denigrating, I'm curious.

600 will be working with CNSs and/or prescribing providers. I definitely have to work with CNSs and I definitely have to work with prescribing providers to fulfill the full scope of the CNS curriculum -- since not all CNSs prescribe, I do not have to work with a prescribing CNS for the whole of my clinical -- so long as I do have at least one preceptor who prescribes such as an NP or MD/DO.

In order to write for the AGCNS exam, my clinical rotations must be carefully chosen to make sense from a population perspective, ie., my clinicals will be focused in my chosen specialty.

The other 200 will be spent student teaching in a university bc education is my sub-specialty.

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traumaRUs I don't have the documented 500 hours, but they know me, know what I do and told me that I am basically doing the job w/o title. I will be teaching insulin pumps and basic diabetes education until I have the hours documented officially (in case of an audit, although my current manager would sign an affidavit confirming my education hours)

As far as the 3 Ps, i believe mastery of these are part of the portfolio presentation.

Like I said, I am counting on the AP ACNO to know what she is doing so that the requirements needed by ANCC, NCBON, and NCBDE for me to be a board certified diabetes educator w/my CNS.

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traumaRUs I don't have the documented 500 hours, but they know me, know what I do and told me that I am basically doing the job w/o title. I will be teaching insulin pumps and basic diabetes education until I have the hours documented officially (in case of an audit, although my current manager would sign an affidavit confirming my education hours)

As far as the 3 Ps, i believe mastery of these are part of the portfolio presentation.

Like I said, I am counting on the AP ACNO to know what she is doing so that the requirements needed by ANCC, NCBON, and NCBDE for me to be a board certified diabetes educator w/my CNS.

Wow is all I can say! What an incredible put down to CNSs that went to school for this. I've never heard of this "portfolio" way of gaining the title of CNS. Can you please elaborate. And no offense but I was an RN for 14 years prior to becoming an APRN and the 3Ps are not job-specific, meaning I learned a lot more than just the job I work at now. This is what ANCC states are the requirements to take the Adult-gerontology CNS exam:

RN License

Hold a current, active RN license in a state or territory of the United States or hold the professional, legally recognized equivalent in another country.

Apply from Outside the U.S.

Learn about additional requirements for candidates outside the U.S.

Master's, Postgraduate, or Doctoral Degree

Hold a master's, postgraduate, or doctoral degree* from an adult-gerontology clinical nurse specialist program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN) (formerly NLNAC | National League for Nursing Accrediting Commission). A minimum of 500 faculty-supervised clinical hours must be included in the adult-gerontology clinical nurse specialist role and population.

Three Separate, Comprehensive Graduate-Level Courses In:

Advanced physiology/pathophysiology, including general principles that apply across the life span

Advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts, and approaches

Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents

Content In:

Health promotion and/or maintenance

Differential diagnosis and disease management, including the use and prescription of pharmacologic and nonpharmacologic interventions

*Candidates may be authorized to sit for the examination after all coursework and faculty-supervised clinical practice hours for the degree are complete, prior to degree conferral and graduation, provided that all other eligibility requirements are met. Please note, the Validation of Education form and official/unofficial transcripts showing that coursework (and faculty-supervised clinical practice hours) is completed are required before authorization to test will be issued. ANCC will retain the candidate's exam result and will issue certification on the date the final, degree-conferred and official transcript are received, all other eligibility requirements are met, and a passing result is on file.

(ANCC will accept unofficial transcripts, which ANCC defines as either a photocopy of a transcript, a comprehensive record of your academic progress or a print out of all work completed, to date, including coursework, grades and degree(s) earned or in progress - which will allow ANCC to process and review your application. ANCC reserves the right to reject any unofficial transcript that appears to be altered.)

Per the ANCC site for the advanced diabetes educator certification:

Advanced Diabetes Management Certification

PRESENTED BY

ANCC

Clinical Nurse Specialist Certifications

No Credential Awarded

ANCC no longer accepts applications for certification in Advanced Diabetes Management. Please direct inquiries to the American Association of Diabetes Educators (AADE).

Effective January 1, 2010, ANCC discontinued administration of Advanced Diabetes Management (ADM) certification examinations. AADE now administers ADM certifications for nurses, dietitians, pharmacists, physician assistants, and physicians.

As part of the sale of the Advanced Diabetes Management Program to AADE, AADE is now responsible for all activities related to both initial certification by examination and renewal of certification, including but not limited to the application process, eligibility determinations, exam administration, score reporting, issuance of initial certification, renewal, and appeals. Verification of credentials and certification renewal should be directed to AADE.

From the AADE site for the advanced diabetes educator eligibility to test:

BC-ADM

Current active RN license

Master's or higher degree in a relevant clinical, educational, or management

500 clinical practice hours within 48 months prior to taking certification

examination. (Clinical hours must be after relevant licensure and advanced

degree has been obtained.)

Is this what you are doing? If so, this is NOT a CNS but rather an advanced diabetes educataor role.

Believe me, I've been round and round with ANCC in order to take exams by portfolio. However, at least thru ANCC APRNs can not do this. Correct me if I'm wrong please.

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Wow is all I can say! What an incredible put down to CNSs that went to school for this. I've never heard of this "portfolio" way of gaining the title of CNS. Can you please elaborate.

Ditto. I've heard of states giving the title to people who completed a CNS program in a specialty for which there is no certification exam (that's been an issue for a lot of people over the years), but not that you can just get the title through OTJ experience and any random MSN.

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I have only seen one CNS since 2010 when i got done with nursing school. I can see the value they could bring to a unit but honestly hospitals just do not seem to have any reason to hire somebody with a CNS over a regular nurse with lots of experience on that unit.

And apparently state practice laws vary a lot...

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I have only seen one CNS since 2010 when i got done with nursing school. I can see the value they could bring to a unit but honestly hospitals just do not seem to have any reason to hire somebody with a CNS over a regular nurse with lots of experience on that unit.

And apparently state practice laws vary a lot...

CNS is an APRN role which is truly where our value lies. I've been a nurse since 1992 and prior to moving to IL had never heard of CNS either. However, its what our hospital affiliated college of nursing offered so thats why I did it. In retrospect, I probably would have done the FNP. However, nowadays with (at least in my area) FNPs can't be credentialed at hospitals, the CNS is the way to go in order to care for pts both in the outpt and inpt venues.

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