I'm an APRN and This Is Why I Made The Change From CNS to Nurse Practitioner

I’ve had a very colorful and rewarding nursing journey from CNA, to LPN, to ADN, to BSN to MSN initially becoming a Clinical Nurse Specialist and now Nurse Practitioner. When I entered nursing, I knew it would involve lifelong learning as practice, science and technology changed but I had no idea I’d end up as a dual advanced practice registered nurse (APRN). Before I share why and how that happened, let’s discuss the types of APRNs.

There are only four APRN roles: 

• Clinical nurse specialist, 
• Nurse practitioner, 
• Nurse midwife,
• Nurse anesthetist 

All four of the roles listed above are advanced practice registered nurses who've obtained advanced degrees and training in a specialized area of nursing practice. Let’s explore each specific role, 

1. Clinical nurse specialist: An APRN that can work in a variety of health care settings and in highly specialized areas such as population, setting, disease type of care, or type of problem.

Regardless of the specialty area, all clinical nurse specialists are clinical experts at diagnosing and treating illnesses, guide staff on nursing practice, provide education, conduct research, and are clinical leaders and consultants usually with hospital or system wide responsibilities.

2. Nurse practitioner: An APRN whose sole focus lies in treating a particular population or specialty. In many states they are able to operate independently and often act as the primary care provider for patients by diagnosing conditions and treating them without a doctor’s supervision. They see patients on a one-on-one basis, offering care ranging from well check-ups and immunizations to diagnosing illnesses and treating chronic and acute conditions.

3. Certified nurse midwife (CNM): An APRN who provides health care and wellness care to women, which may include family planning, gynecological checkups, and prenatal care. They specialize dealing with pregnancy, labor and delivery, and postpartum concerns.  Although their approach is somewhat different, CNMs in many ways offer similar care to that of an OB/GYN doctor.

4. Certified registered nurse anesthetist (CRNA): An APRN who administers anesthesia and other medications for surgery or other medical procedures. They also monitor patients who are receiving and later recovering from anesthesia. CRNAs focus on providing anesthesia, have completed extensive clinical training, and have passed a certification exam approved by the National Boards of Certification and Recertification of Nurse Anesthetists.

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Why I Became a CNS

After practicing as a nurse for eight years I decided to go back to school for my MSN and selected a dual program in Nursing Education and CNS. I chose this type of program because I wanted to become an APRN, loved teaching and wanted the formal training to teach nurses of all levels in both clinical and academia. 

I continued to work at the bedside in critical care while going to school to obtain my MSN. This proved to be beneficial in a number of ways, 

• I progressively became a preceptor for students and new hires, a charge nurse and a rapid response and code team nurse. 
• Concurrently, I was an active member of my unit practice council and other various hospital task forces and committees. 
• I was able to get real life experience assisting the unit CNS with providing education and in-services, doing research, unit projects and annual skills fairs. 

Outside of the hospital I volunteered with the American Heart Association and was an active member and board member for my local American Association of Critical Care Nurses chapter. Participating in these activities as a bedside nurse helped me to identify the advanced degree program that was best aligned with my gifts, passions and goals.

I finished the two year MSN program and became a board certified cardiac clinical nurse specialist in critical care and adjunct nursing faculty at the local university teaching pre-licensure nursing students in their fundamentals, med/surg and advanced med/surg critical care rotations. 

What I do as a CNS

Fast forward 10 years - I have thoroughly enjoyed working as a CNS in critical care specializing in coronary care, advanced heart failure, heart transplant and even transitioned to include working in the emergency department. As a CNS I’ve had the pleasure of keeping one foot at the bedside and one foot in the boardroom as part of hospital leadership. It’s hard to quantify or summarize everything I do as a CNS but here are a few examples of work I’ve done: 

• Teach new grads and new to specialty nurses in progressive care and critical care internship programs
• Teach ACLS to incoming/rotating medical residents
• Participate in evidenced based projects and international research with medications and devices prior to their FDA approvals
• Model to staff how to care for high risk, low volume devices, procedures and patients real time at the bedside
• Committee work reviewing and creating hospital policies and procedures
• Provide consultations on complex and high risk patients. 

What type of personalities do best in the CNS role? 

Being a CNS requires one to be a clinical expert in a particular specialty or population, and be independent, self-motivated, and proactive with your work schedule. It is a very autonomous role. Every day at work was different for me. While I did have some scheduled meetings and classes to teach, much of what I did was based on providing my clinical expertise to what the patients and staff needed in real-time. 

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Why I Became a Nurse Practitioner

After 10 years in the role, I grew tired of practice barriers.  

In California CNSs do not have the ability to practice independently. They also do not have prescriptive or diagnostic authority. As much of a clinical expert that I am, I still had to get an Medical Doctor (MD) or Nurse Practitioner (NP) to order for things I knew the patient needed. As of today, CNSs can only practice independently in 28 states and prescribe independently in 19 states. 

With those barriers in mind along with my collective nursing experience, I decided to pursue becoming a family nurse practitioner, which would allow me more autonomy,

• Prescriptive and diagnostic authority
• The opportunity to practice independently (depending on the state)

This was an excellent opportunity to complement my critical care knowledge and experience to care for people before they reached ICU or ER by working with them in primary care, which focuses more on wellness and prevention.

How I paid for my APRN degrees

I worked full-time at every leg of my career. Fortunately I worked in clinical areas that complimented what I was learning in school. And because I was working, I was able to utilize my employer tuition reimbursement program, in addition to the scholarships and loans I applied for.

5 Tips for nurses who are considering becoming an APRN

1. For anyone desiring to advance their education and become an APRN, the first, and most important step, is to research all the various roles so you select the profession most aligned with the type of work you’d like to do. 
2. Also review your state’s scope of practice for the role. 
3. Once you select an APRN role, further identify what population or specialty you’d like to work with. 
4. Work in areas that can expose you to the providers and patient population you desire to specialize in if possible to compliment your learning. 
5. Find a mentor in the role you select. Advancing your education and practice has the potential to be stressful and it’s helpful to have someone to guide you during your journey.

Alice Benjamin, APRN, MSN, ACNS-BC, FNP

Nurse Alice is a cardiac clinical nurse specialist and family nurse practitioner with over 23 years of healthcare experience. She is a community health activist, nursing faculty, freelance media health expert and CEO of I Am Nurse Approved. You can follow her at AskNurseAlice.com and on Twitter, Facebook, and Instagram at @AskNurseAlice.