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APRN LACE dialogue for CNSs
Blog is about the changes and updates related to the implementation of the Advanced Practice Registered Nurse Consensus Model for Regulation and the Licensure, Accreditation, Certification and Education changes that will need to take place over the next few years.
Sunday, December 11, 2011
What about the DNP and educational implications to the CNS?
Let me see if I can craft a response to Fiona's questions in her comment on the last blog posting. She has asked many great questions and I will do my best to give my perspective on the situation and the concerns she is voicing.
 
What is the future of CNSs? I personally see a very strong future for CNSs in many many areas of practice. The movement in the US toward Magnet Designation means the the hopsital environment is just waiting for us to flex our skilled muscles in the ability to dialogue, manage programs, collaborate with others and negotiate difficult situations. Also the work of the IHI and IOM mean that there are multiple opportunities to explore and create immense differences in the care of the patients we serve as CNSs.
 
In other countries there is a huge need for CNSs and the skills we carry...it is the CNS in public and community health environments that will make the greatest difference in the care of populations in many developing countries...not the NP who can see one person at a time...the CNS who works and lives with populations. There is a huge future for the work of the CNS. We jsut have to realize it and make it happen.
 
Fiona mentions that CNS programs are closing and the DNP program are opening...that may be true but look at the program. As the DNP was first envisioned it was intended to be "bigger" than just the NP role. It was envisioned to be a degree that would encompass all four of the APRN roles. That has changed somewhat in the individual interpretation of the programs at each university but there is no reason that the DNP should be solely restricted to the NP role...how do you change that if you have only an NP focus in the program near you? Talk to the dean and the faculty...talk to employers in your area and make it clear to them that a DNP prepared as an NP cannot meet their needs for a CNS prepared individual In spite of the common degree there are distinct differences in the programs. If the employer approaches the school and asks for a CNS they will create it...
 
Now...I do not agree that the DNP is a needed next step in the evolution of CNSs...frankly if you look at the curriculum of the quintessential DNP it looks a lot like a CNS curriculum at the Masters level. A CNS can and should be able to be crafted/forged at the Masters level. Does that mean that CNSs should not go back and get a DNP...no...but it does mean in my mind that they should not HAVE to go back unless they feel there is something of benefit to them...knowledge of any kind is a good thing...to have to go back just because it is the latest fad is not.
 
Yes...CNS programs at the DNP level do exist...Oregon Health and Sciences University is a good example of this. There are many that are online but shop around carefully and I do not recommend an entirely online program for someone who is not yet a CNS. Certainly for those who have the skills of the CNS already and who simply want to expand and extend their knowledge. Purdue University Calumet also has a great opportunity for an online program at the Masters level for students that requires a face to face practicum with an experienced faculty member in your state...if you have an expert CNS preceptor and a local person who can act as a local faculty outreach person talk to the folks there and see what they can do for you...there are options!
 
When will the DNP become the terminal degree...the American Association of Colleges of Nursing (AACN) are stating 2015...but it is simply a statement and is not policy that is recognized by anyone other than them and the schools that have agreed with them. It does not necessarily mean that it will come to pass regardless of what folks have said to you. AACN is not a regulatory body and truly they cannot tell schools that they cannot offer a Masters level program and they cannot tell the state boards of nursing to no longer recognize a Masters level preparation. Those decisions are up to your local schools and your local state board of nursing...that is where you come in.
 
Your influence is essential in the process...the CNS will not and cannot disappear into the sands of time (nor should it!) if you are actively voicing your concerns in any venue where you can have influence.
 
What is the impact on people currently in school? EXCELLENT question! The answer is "it depends..." Not a good answer is it? It truly depends on what actions the faculty are taking to make curricular changes that meet the consensus model. Clearly the accrediting bodies, the certifying bodies and the state boards of nursing are moving towards the recommendations in the consensus document...are the educators? Students also take time to complete programs and may have started before all the fury around the APRN consusensus model but will not finish until after it is implemented...how are the faculty addressing those issues and concerns? Perhaps a faculty member will jump on to this discussion and respond?
 
Recommendation regarding going bak to school to become a CNS if no program in your area? Find a good online program...they are out there...but shop carefully and make sure it is the right program with the right curriculum for you...
 
I hope I have answered at least some of your questions Fiona...thank you for being brave enough to respond and ask them. Perhaps you will be joined by other voices as well...
 
 
2/24/2012
Dr. Jo Podjaski said:
I am a CNS with a DNP and I am so glad I went on in my education. I feel so much more confident to "sit at the table" and make a difference through my influence. I am involved in so many projects where a CNS is simply strategic and the only one to bring certain expertise to the discussions. I think more globally since my DNP as well as a variety of issue affecting populations. I support the DNP for the CNS. Also, CNSs cannot afford to come in behind as APNs. Thanks, Jo
12/17/2011
Dr. Kelly A. Goudreau said:
Very good question Fiona. My post was really intended to provide the bigger picture discussion...YOU and your EMPLOYER have a great amount of power in the process. If employers are asking for CNSs they will be produced. That is key. In regards to NACNS...it has an education committee that will be in communication with the schools shortly when they share information with them in regards to the latest education criteria that have been developed in response to the APRN Consensus Paper and general needs to improve the educational process for CNSs. Keep the faith and keep demonstrating excellence and you will be valued by your employer and they will keep asking for more just like you....
12/16/2011
Fiona Winterbottom said:
Thank you for the response. I am well aware of the value of a CNS to an organization. Our CNS team is growing however the pools of available applicants is dwindling because of program closure and low participation in programs. How can NACNS and others help local chapters and schools maintain programs? Fiona
About the Author

Kelly A Goudreau DSN, RN, ACNS-BC
Kelly A Goudreau DSN, RN, ACNS-BC is an Associate Editor for the Clinical Nurse Specialist Journal and has been a participant on behalf of NACNS in the development of the APRN Consensus Model and subsequent discussions about implementation of the LACE entity.

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