Who will do CNS role?

[anewsns]

Lately I've been thinking about my future as a nurse, and started to consider a CNS role. I think that would be an amazing way to make a true impact as I would have options as a nurse educator, quality improvement, research, bedside care etc.

However, I'm reading that they are phasing out the CNS role?? They still have them at my hospital but I don't know if I would stay there forever. I don't want to be a manager, or in administration, or a clinical instructor, or a provider. I think it would be really cool to get the education to be an adult-gerontology CNS and have more broad and versatile roles. If I got a masters, I would want to put it to use (and also make enough pay to cover the education.) Are there any other similar roles out there?

From what I'm reading, a lot of other nurses are having this dilemma as well. In case you were wondering I've been a bedside nurse for about 8 years and am almost done my RN-BSN program.

[mmc51264, BSN, MSN, RN]

I am going by what my hospital is telling, which has been approved by the NCBON. I have not delved into what are the exact requirements and time frame is for the portfolio requirements. I am assured that I will be able to be licensed as a Clinical Nurse Specialist and an Adult Diabetes Educator. I originally applied for an adult diabetes educator, in fact they rewrote the job description because I did not have the CNS cert. When speaking with the ACNO over the AP nurses, she is the one that brought up the idea of working toward the CNS via portfolio. I had never heard of it before.

As soon as I get particulars, I promise to share them.

[traumaRUs, MSN, APRN]

I am going by what my hospital is telling, which has been approved by the NCBON. I have not delved into what are the exact requirements and time frame is for the portfolio requirements. I am assured that I will be able to be licensed as a Clinical Nurse Specialist and an Adult Diabetes Educator. I originally applied for an adult diabetes educator, in fact they rewrote the job description because I did not have the CNS cert. When speaking with the ACNO over the AP nurses, she is the one that brought up the idea of working toward the CNS via portfolio. I had never heard of it before.

As soon as I get particulars, I promise to share them.

Thanks - when looking at adult diabetes educators, ANCC no longer offers this as certification. I would wary of the hospital deciding this for you. Best to do your own research. You are the one in charge of your own practice.

[mmc51264, BSN, MSN, RN]

I am not terribly concerned about the title I get. The plan is to be a CDE and if I can get the CNS great.

[SummerGarden, BSN, MSN, RN]

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...

I want to concur with what you have written... My organization is literally supporting local programs and encouraging nurses to earn an MSN to lead to CNL certification, but will not hire a nurse with a CNL to function outside of roles that already exist and can be acquired by BSN prepared nurses (i.e. quality nurse, clinical nurse educator, ANMs, etc). However, I believe the hope is that the RNs who further education and preparation as CNLs will develop into nurses who will function at a higher level and will produce more quality outcomes for patients and the organization on the front-lines. On the other hand, CNSs are completely different as you have noted, and are being treated completely different by my organization.

My organization is hiring CNS nurses and using them to support specific protocols and advance level disease management education within the hospital setting. This is a change because BSN prepared RNs used to be hired into those roles. They never hired NPs to function in those roles, which is now strange to me from what I have read on this forum.

[SummerGarden, BSN, MSN, RN]

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.

CNL prepared RNs is not a role that actually exists anywhere in healthcare from what I see and what I know of the future. MSN leading to CNL is a degree created by academia where some employers see value for the organization, but no value in carving out a position that is protected like that of a CNS or NP in the health care setting. So an MSN with CNL certs have jobs that already exist in the hospital setting and can be acquired by BSN prepared RNs and other MSN prepared RNs.

For example, CNLs are considered to be change agents, but so are other MSN prepared RNs. Thus, the role of clinical nurse educator, quality assurance nurse, and front-line nurse leaders are all roles that can be acquired by an MSN prepared RN with or without a CNL. In fact, many organizations will hire a BSN prepared RN into the aforementioned roles too, but are hoping to move to MSN only in the future (we shall see). This is why I did not push to return to school for an MSN in CNL and instead I am earning an MSN in health care and leadership (less money for tuition in my area).

It is good you are doing your research before deciding. However, be sure to do your research on the market in your area or the area you plan to live throughout your career too.

[traumaRUs, MSN, APRN]

Found this:

What is the difference between the CNL and CNS?

Now you might be asking, "But isn't this what CNS does?" The answer is no. While there are similarities between the two, they are separate roles that can function in unison for the betterment of the patient, family, or community they serve.

How exactly do the CLN and CNS differ and how are they similar? The CNS is an APRN with a focus on macrosystems with three spheres of influence: patient, nursing, and healthcare system. The CNS follows Core Competencies as outlined by the National Association of Clinical Nurse Specialists:

Diagnosis and treatment within the context of the 3 spheres of influence

Individualized patient treatment options

Serve as a leader in the nursing community

Utilization of evidence-based practice to advance nursing practice

Collaboration with other healthcare disciplines

Guidance within the organizational system to assure appropriate nursing care

Continued growth within the nursing profession through continued research and nursing advancement

Economic responsibility to ensure that resources are appropriately managed.

As mentioned earlier, the CNL is an advanced generalist (not a specialist, like the CNS) with a focus on microsystems meaning hospital units, outpatient clinics, and home health agencies. In response to confusion from the nursing community, the AACN released a statement to delineate the similarities, differences, and complementarities between the CNL and CNS.

Functions of the CNL and CNS that the AACN statement discusses are roles, use of the nursing process, support of nursing personnel, position in the organizational system, support of evidence-based practice, and position in leadership.

Role

The CNL provides, as well as supervises, direct care to clients, whereas the CNS is a clinical expert in a particular area. In many states the CNS has prescriptive and diagnostic authority as part of a collaborative practice. Both roles provide care in various healthcare settings.

Nursing process

The CNL oversees the plan of care for clients by assessing and anticipating risks as well as developing, implementing and overseeing plans of care for the clients at the unit, microsystem level. The CNS exemplifies his or her expertise at a macro level by developing plans of care at an expert level within a specialty aimed at reducing potential health problems, promoting injury prevention, and maintaining comfort for clients and populations they serve. Both roles are essential in providing skilled care and being advocates for clients they serve.

Nursing personnel

The CNL directly delegates and oversees the care of other nurses on a unit, whereas the CNS provides more of a mentoring role to nursing professionals to advance their nursing practice and as a consultant when patients do not respond to plan of care. Both are important in the planning of patient care and developing relationships with patients and families.

Organizational systems

The CNL coordinates and communicates with the healthcare team at a microsystem level whereas the CNS communicates within the macrosystem level and across organizational systems. Both roles require effective communication with other healthcare professionals as part of the interdisciplinary team.

Evidence-based practice

The CNL uses evidence-based practice and quality improvement methods to improve patient care, whereas the CNS expands on these skills by advancing nursing practice through generating research, engaging in research utilization, and translating evidence-based research into practice. Both roles are important in the provision of evidence-based care.

Leadership

The CNL is not in an administrative role but is at the frontline of patient care. The CNL reports to the manager of the unit he or she is assigned, whereas the CNS as a clinical expert in a particular area of nursing traditionally either reports to the administrator of a specialty area or to the CNO of an organization. Both roles exemplify leadership in healthcare but at different levels in a health care system.

Clinical nurse leaders and clinical nurse specialists: harmonious partners - American Nurse Today

[PICCRN79]

There is so much value in the CNS role. Not everyone want to be a provider. Many if not all of the policies and procedures that you follow as a NP were written by a CNS who is an expert in that field.

[PICCRN79]

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.

There is so much value in the CNS role. Not everyone want to be a provider. Many if not all of the policies and procedures that you follow as a NP were written by a CNS who is an expert in that field.

[Thefourofus]

CNS are APRNs.

[Oldmahubbard]

A zillion years ago, I got my Psych CNS on the way to Psych NP. In my locale, absolutely nobody knows what a Psych CNS is, and you can get hired nowhere, except as an RN.

[Dodongo, APRN, NP]

On 11/25/2018 at 12:11 AM, PICCRN79 said:

There is so much value in the CNS role. Not everyone want to be a provider. Many if not all of the policies and procedures that you follow as a NP were written by a CNS who is an expert in that field.

Um, no, the things I do were developed or written by physicians, predominantly.

I can't say I have ever met, or know of any CNS in my area. Certainly not in my hospital system.

[WestCoastSunRN, MSN, CNS]

14 hours ago, Dodongo said:

Um, no, the things I do were developed or written by physicians, predominantly.

I can't say I have ever met, or know of any CNS in my area. Certainly not in my hospital system.

As it's been stated before, CNSs are in and out of flux depending on where you are in the country. If you've never met or worked with one, I am truly sorry (not being snarky) --- this is a role that encompasses all the very best things about nursing and promotes nurses working at the top of their licensure and developing professionally. Where CNSs are used, yes .... they influence much of what is done at the bedside, and yes, they are absolutely involved in helping providers (not just bedside nurses) stay current and safe with best evidence-based practice -- because that is a major part of their role -- they get paid to be an expert in a very specialized area. They are, in some states and depending on their preparation, providers as well.

As nurses I hope we can respect each other's roles and when we don't know much about a role, I hope we can approach each other with curiosity and humility. I can understand the inquiry regarding level of preparation for CNSs -- I think you will find them as well prepared to do their job as any other APRN from a non-profit school. CNS programs are not abundant and certainly not sexy. You will not find a for-profit institution peddling a CNS program. That said, CNSs have been around a long time.