Category: Just Ask Jen


Just Ask Jen: Why You Should Become a CNS

Join us in welcoming our current President, Jennifer Manning, to her first Just Ask Jen blog! In this quarter’s edition, Jennifer discusses the first steps to becoming a CNS, advice to someone considering becoming a CNS, and the advantages of being a CNS over another APRN role.

1. I am a nurse with a DNP in Leadership, and I am currently in an administrative role in quality and patient safety, however, I would like to pivot to a more patient-facing role in Geriatrics and Psychiatry. What would be the first steps toward becoming a CNS?

The first step toward becoming a CNS is identifying the program you want to enroll in and the population you want to care for. The most diverse population is the Adult Gerontology CNS and there are many in-person, hybrid, and distance learning options to choose from. I recommend you contact a program director from our webpage to further learn about programs you are interested in.

2. I am currently enrolled in an MSN program and teach nurse clinicals as adjunct faculty at the same college in Wisconsin. My primary interest in getting a master’s degree is to continue teaching, so currently, the plan is for me to continue into the CNS track. The college does not offer an MSN-ED degree or a general MSN. While there are other aspects of the CNS track that are of interest to me such as helping to reduce healthcare costs, I am wondering if the CNS is the correct path for me or if I should transfer to a program that offers an educator track. What are your thoughts? 

Wonderful news. I recommend the CNS track, as it offers the most options, including teaching students. You could also practice as an APRN based on the state scope of practice where you live.

3. What advice would you give to someone considering a CNS education path?

I would advise trying to find a CNS in your organization who is in practice and asking to shadow them or meet for coffee. It is helpful to list what is important to you as a career CNS. From there, identify a program to apply to and enroll!!

4. What are the advantages of becoming a CNS over another APRN such as an NP?

The advantage of becoming a CNS is the versatility of the role. Like the NP, the CNS can provide direct care. Unlike an NP, the CNS can also provide care and improve processes at the hospital system level and among nurses in organizations. The versatility is what I love about being a CNS. We improve care across all areas of healthcare.

5. What scholarships are available for those wanting to become a CNS?

Great question. As a member of NACNS, there are scholarships available on our website. I encourage you to go to your nursing school’s website and ask what scholarships are available. Too often, scholarships are not awarded because there are no applicants. If you take the time to look, and ask questions, you will find scholarships out there for you.


Ask Mitzi Anything: Exploring the Path to Becoming a Clinical Nurse Specialist

In this quarter’s edition, Mitzi gives educational advice to submitters, discussing educational pathways, what types  of master’s degrees are needed to pursue a CNS role, and more.

  1. I’m in the process of pursuing an MSN in Healthcare Systems and Leadership. Can I get a CNS position with this degree?

    No, you cannot. The CNS title is protected and can only be used by those educated in a CNS program. See our official definition on the NACNS website. You will need to get a post-graduate certificate after completion of your program OR better yet, transfer now into a CNS program.

  2. I am a CNS certified in Child and Adolescent Psychiatric/Mental Health. Can I also treat adults? My training included the adult population as well.

    Yes, but as an RN and not as an APRN. You will be acting out of scope if you proceed as an APRN and act autonomously in the role.

  3. What type of master’s degree should you attain to become a CNS?

    We have three populations: neonatal, pediatric, and adult-gerontology. You can search for all three using our CNS Program Directory on the NACNS website. As long as the degree is in a CNS program, you can use the title and work as a CNS.

  4. I work in a geriatric clinic in Washington State and am in the process of earning my MSN-Ed. Will this degree qualify me for the Adult-Geriatrics CNS Certification?

    No, it will not. You have to either transfer to an Adult-Gero CNS program now or finish and then get a post-graduate certificate as an AG-CNS. See our CNS Program Directory on the NACNS website to find a program. This is a very popular option.

  5. If I have CNS students, can they precept with NPs?

    Yes, they can, as long as the clinical faculty grading and overseeing the student is a CNS who assures the student is meeting the CNS course objectives by doing CNS activities, then that is fine. It is preferred that the NP preceptor have a DNP so they know some about the system’s level work of the CNS. However, if CNSs are available, they should be used always. So using an NP is only in situations where you do not have CNS preceptors. Physicians are also acceptable but again in rare instances.


Ask Mitzi Anything: Professional Development, Trends, and Advocacy for the Clinical Nurse Specialist 

In this quarter’s edition, explore how NACNS aids in professional development, tackles challenges in the clinical nurse specialist role, and discover resources for staying updated on healthcare advancements and advocacy efforts at the state and national levels.

1. How does NACNS support the professional development of clinical nurse specialists?

We make this a priority at NACNS by using a variety of strategies. Our many committees are constantly working on toolkits to aid in such development. For example, our Professional Development Committee is currently working on coding and billing toolkits. Our Research, EBP and Scholarship Committee is working to update the CNS Outcomes White Paper, and our Leg/Reg Committee just completed an Executive Summary on CNS Title Protection that CNSs can use in their worksites and HR departments.

We also host many learning activities throughout the year, such as our Annual Conference. We put in countless hours to host an extraordinary event for CNSs and always at a reduced discount for our members to attend and receive plenty of professional development opportunities.

We also feature webinars and courses currently hosted on our website. We will continue to explore new ways to meet our members’ professional needs and hope to bring back a consistent webinar series, much like we had in the pre-COVID years.

Our level of opportunities for volunteerism and leadership positions in NACNS is also noteworthy. Being involved as a volunteer is one of the most important ways to grow professionally. 

2. Can you share insights on the current trends and challenges in the field of clinical nurse specialist practice?

A current trend in the CNS practice is a movement towards more CNSs gaining prescriptive privileges and/or authority. CNSs need to function at the full scope of practice and be writing orders as needed at the point of care to make the biggest impact and show CNS value in direct care.

One challenge CNSs are facing is the barriers to the full scope of practice imposed by healthcare systems, i.e., professional inequity towards CNSs. Other challenges are when CNSs focus too little on the direct care role, moving them further and further away from patient care and having more difficulty showing value as APRNs.

3. What resources or initiatives does NACNS provide to help CNS professionals stay updated on the latest advancements in healthcare?

I think attending our conference in person or virtually is one of the best ways to stay updated. I think the networking opportunities among members are another excellent and underutilized resource. Here at NACNS, we have a wealth of expertise, and I know CNSs are willing to share their expertise with others. I think being on committees as a volunteer or a taskforce to meet others is also an invaluable opportunity for networking and creating new partnerships among CNSs.

4. How does NACNS advocate for the role of clinical nurse specialists at both the state and national levels? 

There is a saying: “If you are not at the table, you are on the menu.” Your membership dollars help us to stay at the table. We are currently on major APRN groups and attending major conferences of importance to make sure the CNS role is visible. We just started that practice a year ago and want to continue it.

We are also focused on growing enrollments in CNS programs and public awareness of the role. We are now having booths at conferences we know can attract nurses to the role, like the National Student Nurses Association’s annual conference. We just launched a new user-friendly and updated CNS Program Directory to facilitate getting interested nurses in the role in front of program directors faster. We also started a new CNS Program Directors Council this year so NACNS can better support our CNS programs to grow the numbers of CNSs.

Position statements are also important. We work hard on them every year to help CNSs in practice advocacy efforts. We recently passed the Clinical Nurse Specialist (CNS) Full Practice Authority position statement and the Title Protection for CNSs PositionStatement will be available for public comment in early 2024.

These are just a few of the many, many activities NACNS does to support CNS practice nationwide. Make sure to subscribe to our newsletter to stay updated on all the exciting things we are up to!


Ask Mitzi Anything: Different Types of CNSs & More

Hello readers! In this edition continue reading to learn about the process for becoming a CNS, CNSs in the operating room, if there are primary care pediatric CNSs and more! 

Q: What is the process for becoming a CNS? What qualifications are required for a CNS?

A CNS is an advanced practice registered nurses who have graduate preparation (Master’s or Doctorate) in nursing. Like other advanced practice registered nurses, they are trained in advanced physiology, pharmacology and physical assessment in addition to their particular areas of specialty. They can diagnose, treat, prescribe and bill like other APRNs as allowed by their state regulations. For a comprehensive document with recommendations for becoming a CNS, please see our Entry for Practice Position Statement and our CNS Program Directory for a lists of schools that offer CNS education. 

Q: Is there such a thing as CNS for operating rooms/surgery?

Yes, a CNS can work in any setting or specialty population. The role goes anywhere there are complex patients and the surgery setting is always complex. 

Q: What is the pathway for an Oregon Nurse-Attorney (BSN/JD) to become a CNS solely for the purpose of providing advanced care planning and assisting clients with the completion of advance directives? No prescriptive authority is desired?

That is not the role of the CNS. You do not need a CNS to do that but if you feel you need the credentials to be able to advise at that level, then the CNS is a good one but you would be prepared well beyond that small piece of what a CNS can do. 

Q: Are there both primary care and acute care certifications for pediatric CNSs like there are for nurse practitioners?

No, just one and CNSs are not primary care providers. The only exam is the acute care exam through the American Association of Critical Care Nurses (AACN). You can download the test plan on their website. 

For more information, feel free to reach out to Mitzi at (734) 355-2792. 

 


Ask Mitzi Anything: How to Create a CNS Dashboard & More

Hello readers! This edition read on to hear Mitzi discuss how to create a CNS dashboard, career path advice, if a CNS is considered a nurse practitioner, and more! 

Q: Do you have any specific recommendations for how to create a CNS dashboard?

Yes, start with what you know as baseline data. Know your exact product of CNS intervention. Is it patient satisfaction, nurse satisfaction, reducing length of stay, reducing readmission rates in complex patients, prescribing medications to decrease inefficiencies in care, completion of major projects as project lead, etc.? What are your products? Get the data from the last 12 months (LTM). Put it in a table. Then, start recording data every month on the same day. Your interventions should be clearly listed out as well. That way, over the months, you will know which interventions work the best and which are not moving the dial to the better (pivot time). Dashboards are critical and every CNS regardless of role or title should be using them and updating them every month. 

Q: As a current LVN in California taking psychology online for my bachelor’s, what would recommend I do next? Whether I’m able to start now or after achieving my degree?

I assume LVN stands for Licensed Vocational Nurse. You would need your RN at minimum to enter a graduate nursing program. The minimum level is BSN but some programs allow an RN (non-BSN) to MSN bridge in that a gap analysis is undertaken to see if you have completed enough courses or work experience in research, leadership, and community based nursing. Those are key components that differentiate the bachelor’s and non-bachelor’s degree in nursing. You will need to first address the BSN component and qualifications. It can be done but will take some work on your part to meet with a CNS program director to figure it out. See our CNS program directory for assistance in locating an all online program or a face-to-face program near you. 

Q: Is a CNS still considered a nurse practitioner?

No, a CNS is not considered a nurse practitioner (NP) and an NP is not a CNS. The two are unique APRN roles and titles. However, the CNS can do the advanced direct care role much the same as the NP as training in CNS programs is similar in that way. 

Q: Are affiliates permitted to accept non-CNSs (i.e. other APRN roles) into their affiliate group meetings?

That all depends on the affiliate’s definition of membership in their Bylaws. I suggest you get a copy of the Bylaws and go from there. Next, talk to the President of the affiliate about any concerns you have. You mention “meetings” – that is a big “it depends” and up to the leadership to decide who attends meetings and again, based on the Bylaws. 

For more information, feel free to reach out to Mitzi at (734) 355-2792. 

 


Ask Mitzi Anything: How to Become a CNS & More

Hello readers! Our Ask Phee Phee blog series has now transitioned to the Ask Mitzi Anything series with the recent election of Mitzi Saunders, Ph.D., APRN, ACNS-BC, to president. This edition read on to hear Mitzi discuss CNS specialty roles, how to become a CNS and more. 

Q: Is there a CNS palliative care role that exists? What would that job description look like and how do I build the business case for it? 

Yes! There is a specialty CNS role for everything. You could build the case by having nursing experience in working with patients in symptom management and quality of life, and by having a passion and seeing the need for change that would improved patients’ lives. You could build the case by showing a gap in services that you could fill. You could make the case for prescription too by showing how you would fill gaps in patient care. It is all about access to care and improving patient and family outcomes.  

A job description would have you in the patient/family care role everyday consulting on patients through a palliative care consult system, ideally. Then, you would meet directly with patients and families meeting their needs. It would be best to have privileges to prescribe cares, so teaming up with a physician or two would be best. Then, you provide the other two spheres in your job description with nursing support to carry out the treatment plan and time for system level improvement too when you see inefficiencies in meeting the needs of patients with palliative care needs. The three spheres should be in your job description but the most important is the patient sphere and having a caseload of patients you see everyday. Be careful to record your outcomes for a quarterly report to the CNO. 

Q: I am a certified pediatric nurse practitioner by licence and certified pediatric hematology oncology nurse and have been working as a pediatric hematology/oncology CNS for the past 12 years. My institution is hoping to apply for magnet and is requesting that I have official CNS certification. Can you advise the best route for me to take? 

You will need a post-graduate certificate from a pediatric CNS program. You would likely transfer in two of the three Ps and maybe all 3 depending on the program (the three Ps are advanced physical assessment, advanced pathophysiology, and advanced pharmacology). Then, you would take the pediatric CNS courses and 500 clinical hours. I know that sounds tough as you are already in the role, but it would be over in three semesters at best (that is the case for my program but it is an adult-gero post grad certificate). Check out our CNS directory for a program. Lynn Mohr would also be an excellent resource; she has a pediatric program in Chicago and would be happy to help you.

Q: Does NACNS not recognize me as a CNS, since I do not have the three Ps? I graduated from an accredited CNS (MSN) program in 2009. I graduated with a DNP in 2017. 

Yes, you are a CNS. Having the three Ps will be necessary if you are seeking prescriptive authority or privileges to prescribe; but, yes, you are definitely a CNS. 

Q: I hold an MSN in Nursing Education and I am a board certified Advance Diabetes Manager. What are your recommendations for obtaining CNS licensure?

You will need to obtain a post-graduate certificate from one of our very fine programs for post-grad certificate CNSs. But, do check your state board of nursing rules on CNS licensure. Most states protect the title, but a few do not. 

For more information, feel free to reach out to Mitzi at (734) 355-2792. 


Ask Phee Phee Anything: CNSI Advocates/CNS Job Growth

Hello Readers!  This month we have two questions to answer for you.  Check them out below.

Ask Phee Phee Anything: CNSI Advocates

Q. Did NACNS members get a GIVING TUESDAY request from CNSI? Did not see it.

On Giving Tuesday we promoted and encouraged donating to CNSI on Facebook, Twitter and Linkedin.  Our position is that any day is a “Giving Tuesday” and CNSI is doing wonderful work and worthy of your donation at any time of year. NACNS’s partnership and advocacy with CNSI is important and will continue as we promote the role of the CNS.  To donate click here. Your donation will directly impact the future of our CNS practice and will help contribute to the mission of the CNS Institute; serve to develop and promote the charitable, educational, innovative clinical practice, and scientific goals of NACNS.

Ask Phee Phee Anything:  CNS Job Growth

Q. Are clinical nurse specialist in demand, what is the job outlook?

Is the CNS a growing profession? Heck, Yes!

The NACNS Job Board has 336 open positions listed. Your hospital may have CNS job postings as well.  According to Recruiter.com the growth in CNS jobs has surpassed 13% annually since 2012.  Between now and 2029 there will be 332,190 CNS jobs needing to be filled.  Do we need more CNSs?

Yes, indeed!

The top ten hospitals in the country employ many CNSs and, like many other organizations, they understand the value of CNS. However, there’s rich opportunity for those organizations who are not familiar with CNSs for you to advocate for the role and pitch it to the organization.  We have resources on our website on how to do that. Call it “making the case for a CNS” or a “business plan for CNSs”.

I had a discussion with one NACNS member just this week talking about “growing your own” CNS. This organization identifies nurse interested in becoming a CNS. It has a program to support the nurse as she is going to school to get education certification and for the transition period into the new position.  There are other innovative programs out there.  Speak up and ask about these types of innovative programs.  If your organization doesn’t have one, let’s make one! Contact me at pwhitehead@nacns.org.


Ask Phee Phee Anything: Things a CNS Should Care About: ICAN Legislation

Hi readers, and welcome to the October edition of Ask Phee Phee. This month, I wanted to talk about a topic that I am passionate about, which directly goes with my presidency’s theme: unstoppable advocacy. As stated on the ANA website, “the Improving Care and Access to Nurses Act (ICAN), H.R. 8812, promotes patient access to health care services delivered by the provider of their choice by removing outdated Medicare and Medicaid barriers on advanced practice registered nurses (APRNs).” Because the ICAN Act was recently released, some of you may have a lot of questions. I want to answer those questions and explain why the ICAN Act is so important for CNSs. 

1. Why is the ICAN Act important to all CNSs?

This is a great example of how CNSs can advocate for themselves. This legislation is geared toward advanced practice nurses (APRNs) and takes away a lot of the limitations APRNS have previously faced. This act ensures that APRNS get fair payment and get the proper reimbursement for what they need for their patients. ICAN advances the advanced practice domain for all APRNs, but specifically CNSs. This act goes directly with the APP Hospice CTI Survey that was created in April 2022. This survey is not yet public, but it directly correlates with hospice end-of-life services and CNSs access to the proper care tools. This survey had large participation from CNSs, which further shows how important the ICAN Act is for all CNSs.

2. What are some good ICAN Act resources?

Some of the best resources can be found on the NACNS website as the legislation continues to move forward. To write to your legislator, follow this link on the NACNS website. This legislation is everywhere, you can find more information with a simple google search, or on the ANA website. Check out the NACNS news page for more updates as they come!

3. What can CNSs do today to help pass ICAN?

The most important step is to contact your legislator using the link above. The next most important action to take is to add your voice on social media with the ICAN photo as I did here. Pass along this photo to your fellow nurses and tell them to join the conversation. The most important part of this legislation is to keep the conversation going until it is approved. Never stop advocating!


Ask Phee Phee Anything: What a CNS Should Bring to Work

Hello and happy CNS Week, Day 5! What a great week it’s been already, and to close this week’s special Ask Phee Phee blog series, I want to talk about the tools a CNS needs at work, and how to always come prepared for any situation that may arise.

Being a CNS means, one needs to be prepared for anything with their patients, and every day is different. A large part of being a CNS entails simply being present and available for whatever your patients need, physically, mentally, or emotionally.

Below is my list of the tools that a CNS should always bring to work to best serve our patients and communities. 

  1. A sense of humor
    A sense of humor is one of the most important things anyone in a health care role can bring to work. Between the long hours and emotionally/mentally draining work, being able to laugh and have a sense of humor can be extremely valuable in tense situations.
  2. Trust
    This tool goes two ways; you need your colleagues to be able to trust you as well as your patients. Being able to be someone that others trust should be a top priority for all health care workers.
  3. Reliability
    Stemming off being someone that people can trust, being reliable, and speaking up when others aren’t comfortable, is extremely important. Always being visible and transparent in your practice allows you to be a reliable person in the healthcare field.
  4. Teamwork
    Be open and be able to collaborate and communicate with those on a team. You can’t take yourself too seriously, but you need to be able to relate to and validate others’ feelings and situations in order to be the best CNS you can be.
  5. Empathy
    Always carry tissues, for the nurses, families, and patients. This is an emotional role and can carry a lot of stress for yourself and those around you. Be in tune with the situations around you and provide as much support as you can.
  6. Advocacy
    Set boundaries, and advocate for yourself as much as you advocate for others. Say no when you disagree with something or are put in an uncomfortable situation.
  7. Change
    Be a change advocate for nursing and your individual organizations as well as your own advanced practice. When our 3 spheres of impact are broken apart, other nurses can do one of the spheres, but we are unique when we practice all 3 spheres, in order to continue to demonstrate our value and impact as advanced practice registered nurses. We need to be able to push and expand our practice to continue to grow in healthcare.

Something I learned when I was a girl scout was to always “do a good turn daily,” and to always be prepared. As CNS, we need to not only do good deeds, but hold ourselves accountable to make sure that we are advancing our education and our practice, and most importantly have unstoppable advocacy.


Ask Phee Phee Anything: Diversity as a CNS

Hello to all my Ask Phee Phee readers, and happy day three of CNS Week! On this special Ask Phee Phee blog, as we celebrate CNS Week, we are going to be talking about the importance of diversity in the CNS role. The NACNS board recognizes that change is needed and is actively educating themselves and others through our initiatives this year and moving forward to create a more equitable workplace for all. 

What diversity initiatives does NACNS have in place for 2022-2023?

In 2022, NACNS has ramped up our DEI committee. This was initiated as a task force, and it has since grown and become more focused on making sure that nursing (specifically CNSs) is representative of the communities we serve. The DEI committee is making sure that members have equal opportunities within their role as a CNS. We released a DEI survey to hear from our members on diversity. 

The DEI committee’s first task identified with the survey was to investigate education, and training for diversity, equity, and inclusion, as well as how to make the CNS role more diverse. Starting with members on the DEI committee, we are going to not only be more aware but actively trained to address the situation. DEI Committee Board Liaison Jerithea (Jeri) Tidwell, PhD, RN, PNP-BC, PCNS-BC, FCNSI, Chair Monica Coles, DNP, RN-BC, APRN, ACNS-BC, CDP, and co-chair Beckie Kronebusch, MSN, APRN/CNS are all helping immensely in their efforts to spread awareness and grow the committee to its full potential. 

Advocacy and Diversity

However, our goal isn’t to “form” and then not follow through. We have a commitment to change, a commitment to move forward and advocate for diversity. . Advocacy is so important at every level. Continuing to advance in our advocacy is reflective of how we take care of our patients.

Like most CNSs, I am not a member of a minority group, but I will continue to educate myself to better understand those who are and the challenges they could face becoming a CNS. If those in positions of power advocate for more diversity, then we can make a difference.  We can move beyond talking about diversity and (soon) see results.

For more on diversity, and how NACNS is actively making a change, make sure to register now for the 2022 Fall Summit on Oct. 18-19. The closing keynote on diversity and racism in nursing will be given by Marcus Henderson, MSN, RN, PhD Student.