Community CNS Careers

This is a guest post by Richard Hemby. Enjoy...

A Clinical Nurse Specialist (CNS) is an nurse of advanced practice who administers nursing services to a specific patient population. These nurses are specialists who may focus on areas such as cardiology, oncology, neonatology, OB/GYN, pediatrics, neurology, and mental health. A CNS may focus on a very specific type of disease, such as diabetes, or they may focus on a specific hospital environment, such as the operating room or the emergency room. They can practice with a variety of different healthcare environments, and may provide simple nursing care for patients while also consulting the nursing staff, influencing the healthcare system, making medical diagnosis, and treating illness or injury.

A CNS takes on many of the responsibilities that used to be assigned to a doctor. They have a very focused set of assessment skills that make them more qualified to care for a specific type of population than even the most expert staff nurse. The CNS is a more central player than a staff nurse, often taking on the role of educator for the staff nurses, patients, and non-nursing members of a hospital team.

Depending their area of expertise, location, and years of practice; a CNS may practice independently or work in a hospital. They could work for a health care agency, or even teach undergraduate and graduate-students at the nursing level. The CNS role is one of much flexibility and is an excellent choice for someone who wishes to be involved in one-on-one patient care while also helping to shape and better the processes that make up health care systems.

Clinical nurse specialist’s salaries range from $60,000 to $80,000, depending on their experience. The median salary for a person within the field of clinical nursing is currently $80,000. That is the average for approximately 14,000 clinical nurse specialists currently practicing in the United States. Due to their specialization and level of expertise, a CNS has the potential to make more than $100,000 a year. Since there is currently a shortage of nurses that is projected to become even more severe in the coming years, the value of a CNS will surely increase accordingly.

To become a CNS, one must first become qualified to practice as a registered nurse. State laws regarding licensing of clinical nurse specialists varies from state to state, but a master’s degree and additional training will be necessary for a registered nurse to become a clinical nurse specialist. The American Nurses Credentialing Center will award a CNS accreditation to people in the field who pass exams in their specialties.

This is a guest post from Richard Hemby, a writer for Online College Guru, an online resouce for online degrees, colleges, and careers. For more information on online nursing degrees and nursing careers visit OCG's comprehensive nursing section.

Loving my New Gig

I cannot fully express how much I LOVE my new job! It's so much better than my last. I guess it takes being in the pits for 13 weeks to actually find and appreciate something that is so much better!

I work in the CCU (which is going to look super good on my resume!) I haven't worked in the CCU officially before, and this is a 3 month stint. It's been good so far, the hospital is fairly isolated in the boonies, so most of the super critical patients we transfer to one of the more high tech hospitals after we stabilize them. In some ways I feel like it's bare bones nursing, but my coworkers are super cool, the manager is the best and the patients aren't above my skill level.

I feel competent and appreciated. I feel like my being there matters and that I'm actually valued as a person. I don't feel dumped on---the assignments are always fair. I love it so much. Best of all, the pay is super good, way better than my last job.

I have no complaints, I only wish that I could stay here longer than 13 weeks...I don't know, I might re-up after my contract is over, that's how good it is.

Vacations

One of the benefits of doing travel nursing is the excellent opportunities for vacations practically year round. I've determined to take a week or two vacation in between each 13 week assignment, sort of like a pat on my own back for making it through.

I spent the last week in Hawaii on the Big Island. My hubby's fam rented this lovely house right on the ocean sea board, away from the 'tourists' and closer to nature. It was absolutely lovely, I sat on the rocks, watched the waves and read all the books in my To Be Read pile. It was nice to get away from rainy, cloudy Portland. And that was my first time in Hawaii so it was very great.

My next trip is planned at the end of this new contract. I'm going to start a CCU position in a community hospital about 30 minutes from my house. The manager showed me around the unit, and I'm actually excited. Tomorrow is D-Day...new agency, new pay, new unit, new field. The scene is set for me to rock out! Hopefully it won't end up the same ungrateful mess my last assignment was. Boy, I'm glad that is over!

So after this assignment, I'm going to Nigeria!! I'm really excited about that. I haven't been back to Nigeria in almost 7 years so it's going to be an experience.

Working Blues

Whoa, I can't believe it's been a month since a posted. That means that I've done 12-15 shifts, but have been too tired to write about it. I'm going through a period of frustration on my job. So much that I'm counting the remaining weeks left on my travel contract. The unit I work on is so disorganized, and the charge nurses make me the doormat on every shift I work.

I won't even go into all the injustices here, but to those that say that "oh you are getting paid more so you shouldn't complain"--get real! The staff nurses are making more than I am AND they get benefits. It's so bad that I actually heave a sigh of relief when I get floated---because the unit that I get floated too always ends up being better than my home unit. Wherever else I'm floated to---they are nicer and more helpful.

I hope that for the rest of the assignment, they float me every chance they get. Especially to the 7th floor---I heart the seventh floor! Even though it's just pure Med Surg, the energy up there is so refreshing and everyone is so helpful and friendly. It really does matter the attitude that your coworkers have.

So I'm buckling in for 2 more nights this week. Wish me luck.

The Norovirus

Our unit got hit with a gastro-enteritis virus last week. One patient had it and then it mysteriously appeared in 2 other patients. It's passed around by droplet transmission, and 15 nurses were out sick with it before it cleared out. The hospital infection control department quarantined our unit, and all patients with the mysterious N-virus were sent to our unit with all other patients being transferred out of it.

We had to be on droplet precautions, from gowns to booties each time we went in a room. Everything was bleached all day long, as that was the only thing that could kill the virus. If it stayed on an inanimate object, it could be transmitted for up to 30 days. Handwashing was amped up as well as bleaching all your stuff, even your shoes. If you caught it, you were sick with vomiting or diarrhea for 12-48 hours but couldn't be at work for 3 days after your last symptoms, to make sure that you didn't pass it on. People showed up at work and got sent home because they were still in the 'incubation' period.

The Norovirus took out our whole unit. But now it's gone. And thank God I didn't catch it.

Floating

As a traveler, I'm used to getting a different assignment everyday. It's rare that I keep the same assignment for all 3 12 hr shifts. However this past week seemed to be a weird trend, all my patients stayed over, and by the third day I was on a cloud, actually looking forward to getting to work. They weren't too complicated and were all reasonably stable and could voice their needs and independently void. What more can a nurse ask for?

At 10pm that night, I got an admission and was running trying to get him settled when the charge nurse told me that she was pulling me to go to another unit. This didn't please me but I sucked it up, finished my rounds, meds and report in 27 minutes flat and huffed it up to Neurovascular to get report on my second set of patients.

It turned out to be a sitter case. And not just any sitter case, a lovely one at that. He had fallen so many times during his stay that he was on 1:1 strictly for being a fall risk. Besides that he was hunky dory. He slept most of the shift and I watched so much crap nighttime tv it was ridiculous. He got abit agitated around 4am and I just whipped out a deck of cards from his table and played a weird version of rummy with him.

All in all it was a great night. I couldn't have asked for anything better. I wish it could be like this everytime I float. I wish.

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Shell Shocked

My patient died a few nights ago. It was the most bizarre experience ever. I had just been in his room, taking his blood pressure (which was fine), drawing his AM labs and talking to him. I walked him to the bathroom and back, then tucked him in his bed, got him a warm blanket and said goodnight.

I went into my next patient's room to hook up his antibiotics. The Monitor tech calls me and tells me my other patient has a junctional rhythm. I rush in there and he's pale and unresponsive, his head crooked over to the side, his dentures halfway out of his mouth. I instantly freaked and started shaking him, then hit the code button (even though he was DNR). I told the other nurses that he was DNR with chemical intervention but his heart had stopped beating and he wasn't even breathing. The doctor pronounced him at a few minutes after 3am.

How can someone be talking to you and then dead the next minute? He was old, in his 80s and had COPD...beyond that, he should have been fine. The family is not going to do an autopsy, so I'll never know what happened but always have questions.

This isn't the first time that my patient died, it's just the first time that it was so unexpected and random. I was the last person that he saw before he passed. I was the last person he spoke to. I'm still shell shocked. The nurses on the unit accepted it cynically, and almost without empathy. I'm dealing with hella emotions at this point, feeling that if I had stayed in the room for just a few more minutes I could have helped him live.

The next night I had a patient in the SAME ROOM. Unfortunately he didn't get much sleep that night because I kept going in to make sure he was still alive. I checked on him almost religiously, freakishly paranoid that this old 80 year old would die on me too.

How do nurses deal with all these emotions? I don't know what to do.

Cardiac Jitters

I've just started a new job at this super advanced hospital. It's the largest tertiary cardiac hospital in the WHOLE state, and has a reputation of sterling gold. I'm learning so much on this unit, which is great because at my old job I was getting kinda stagnant. It's a cardiac telemetry unit, and when I say cardiac, I mean CARDIAC. They are hardcore about the cardiac ish.

I'm worried about working this week because now that I'm off orientation I'm expected to fly on my own. It's a ratio of 5 patients per night, which isn't hard except I'm still new and figuring everything out. Hopefully they go easy on me the first few days, it would suck if I couldn't hang.

The whole hospital is computerized to the next level, everything is computerized. It reminds me of my old job in Maryland, and the ease that technology adds to everything does make up for the 'fish out of water' feeling that I have. I love the fact that I can do all my charting on my patients on the computer in less than 15 minutes!

It actually gives more time to spend with the patients. I'm doing 12 hour nights, and they have me on 3 in a rows, so hopefully I will stay on top of my game and the Super Nurse will find her wings again.

Wish me luck!

Hello

Hey peoples,

Do I really post that infrequent that noone knows I've been out? Dayum! New Year Resolution, post more often.

I was sick in the hospital since the 5th, not a cool way to start the year but it has been my modus operandi as of the last few years.

Anyway, there is alot to do and say, but first I must catch up on all you blogging freaks out there.

Oh, and although I'm hella late,

HAPPY NEW YEAR!!!

By the way, my new job starts on the 14th, I'm going to be a travel nurse...can I get a hells yeah?

How to Reach 50 Years Together

I was talking to my patient and his wife today, a couple that are still so sweet and loving even after 48 years of marriage. "So what's the magic formula to keep things strong?" I asked. Yes, it might seem a redundant question but her response was one that really tugged chords with me.

"Commitment. There is no out clause for us. We vowed forever and we will do everything in our power to keep that vow." She told me that they had been through some rough times, and there are moments that even she would want to pull his hair out. But she always reminded herself that she "went into this with my eyes wide open and will stay in it with my eyes wide open."

It just got me reflecting on how our generation is so ready to call it quits as soon as the relationship hits the skids or calamity strikes. We have become a generation of fast food relationships, where friends, family and loves are casually tossed aside when they no longer fulfill our needs or something better comes along.

Alot of my patients went through the depression, and they hold on to everything from a shoe string to a piece of tissue paper. What we view as waste, they store and keep for when it will be needed. But I'm getting off topic here...

Oh yeah, so the formula to a long lasting relationship by my lady in room 17;

• Commitment
  
• Good Communication--talk about everything, your thoughts, your actions, your motives etc. This will help you see where the other person is coming from.
  
• Never going to bed mad--and always have sex even if you are fighting. This shifts the energy of the argument and reconnects you.
  
• Don't be afraid to seek counseling or professional help

Oh, and if your guy is sick in the hospital, come with a cheery attitude, some good food and a smile. It will do wonders for his health.

Musing

This weekend was one of those days that if I hadn't handed in my resignation letter already, I would have had to resign all over again. However, it's over and I have today off to recuperate and rejuvenate so I'm not even going to dwell on the torrid parts, but instead, will focus on the goodness.

My coworkers are the greatest! I was so frustrated that I hadn't taken lunch and it was an hour to report. The Charge Nurse practically ordered me to take a break and when I came back everything was done---and I mean everything from my last meds passed, foleys emptied and documented and fingersticks done and insulin given. They even helped me document some of my new patient paperwork and the only thing I had to come back to do was to finish charting and give report. Talk about teamwork. In 30 minutes they had pulled together and finished what would have taken me the rest of the shift to finish.

Man...I hate the fact that I'm leaving. And I think they do too. As the day draws nigh, I start hearing more and more how everyone is going to miss me when I'm gone. It's nice to feel valued, even if I was just on the unit for 6 months, I feel like I really bonded and made some great friends. I really am going to miss not being here anymore.

When I left my first job in 2005, I thought I would never find another place that I adored my coworkers as much, but my crew of 2007 have proven me wrong. I guess it doesn't matter where you go in the US, if you are a genuine person you will make genuine connections.

Happy holidays to everyone.
7 more days till Portland baby!

Doubling

Doubles are so hard to do. The first couple of hours are a breeze but then come 2 o'clock you are still hustling, my body feels like it's shutting down to "rest and relaxation" mode. I just did a slew of doubles last week and can't wait to see how fat my check is gonna be on the 28th.

Sorry, I'm kinda out of it.

What's up with you all?

The Blues

Okay, even as a nurse with an iron stomach, some things totally make me squeamish. It's weird, I can deal with lots of poop and vomit, but let me have a patient that needs regular suctioning and I'll be inwardly cringing. There is something about the Crrrrr sound of suctioning that gets my grout and flips me out. RT's like suctioning, and I know alot of nurses that dig it, but that shit is not my cup of tea at all. Ewwwww!

Luckily in med surg, you rarely run into a frequent suctioning case so it's not something I have to deal with much.

I'm getting to my last couple of weeks on the job and I'm trying to rack up the OT like crazy. I plan to work hard for the next three weeks, bank up that holiday money and take a week vacation between my present job and my new one. I hope that everything works out in my mind like I've planned.

As you can see, I don't have much to say today, but I'm glad that I'm a nurse, even though we are so underpaid for the ish we put up with, the good times for me are far more than the bad. Sorry for the blathering, I'm kinda tired after pulling a double last night but too wired to sleep.

Hugs to the nurses out there.

7 Random Things

I've been tagged by Nocturnal RN and I'm supposed to share 7 random/weird things about myself. I have alot of weird things about me, and I've done this several times on my other blogs, but for the sake of this blog, I'll stick to 7 weird things about me in nursing, to keep it fresh.

1. At work, I hydrate by drinking a gallon of water mixed with 3% lemonade or lemon juice. I can drink this more than just straight water, and it actually makes me feel like I'm staying hydrated.
2. Since the very first day out of nursing school and on the floor, I've taken report the same way, folding an A4 paper into four and sticking it in my pocket for reference. Everything is on there, but if I lose it I can still function because the art of writing the stuff makes it stick in my brain.
3. I coordinate everything about my scrubs. I even coordinate my shoes, socks and hair clips. My watch is coordinated as well as most of my 'nursing' stuff. Getting dressed for work is a ritual for me, it puts me in the mindset of going to work. It's like my supernurse outfit...and TaDa!, I'm ready to hit the floor running as soon as I clock in. Most of my scrubs and outfits are red, pink, green or variations of blue.
4. I always chart at the end of the shift, in the last hour after I&Os and everything is done. I just want to get a complete feeling when I'm done charting, so charting twice irritates the hell out of me. I'll work straight through the shift with minimal breaks and get my patients tucked in by 10 so that I can compose my report and chart in the last hour. That's essential to me.
5. I HATE the pagers...I think everyone does. When mine goes off and it's not my patient, I get very irritated when the nurse covering doesn't seem to care or doesn't deal with the issue. I'm the one that's going, "Are you doing something about your patients' HR of 140?" It's not because I care that much, I just hate my pager going off!! Sometimes I want to slam it against the wall. Almost every shift in fact.
6. I make rounds on my patients' every hour and tell them this when I introduce myself. This is more for me than them, I want to poke my head in, see their chest rise and ask if they need anything. Usually I find my patients end up using the call bell less, because they know I'll be around soon.
7. At the end of the day as I'm clocking out, I give myself a mental pat on the back and say, "Good job Vixen you supernurse you!"

Okay, totally weird but then again, they did ask for weird things. So I'm sending this back out with a twist. Nurses, what are the weird things you do?

The Thanksgiving Weekend From Hell...

Whoa...the last 2 days were bad. So bad that I just couldn't bring myself to wade into poop and mess another day in a row. For some reason, my Manager is always complaining about the budget...so this weekend, he understaffed ALL three shifts, leaving no CNAs on the floor at all, nurses having 5-6 tele patients and a patient load that rivalled a nursing home/post op unit. Only the sickest patients were still in the hospital this Thanksgiving weekend, and everyone was stressed to the max.

Tempers were short, mistakes were happening and we had 4 incident reports in 2 days and 3 falls on Friday. There is only so much you can do and only so many places you can be at one time, at the end something starts to suffer.

Luckily the only aspects my patients suffered in was that they didn't get dinner until 8pm both nights...which is about 2.5 hours late but as soon as I could get to it. In addition, I had 2 patients to feed, which left me charting after midnight on the clock. Night shift actually begged me to stay for a few hours to help them out (they were at 6 patients each) but my tired, bedraggled body could barely make it down the stairs home.

As soon as I got home, I was assailed by sickle cell pain and knew that once again I had over done it. I had to call out today just to get the pain under control and as I'm writing this I'm still dealing with the aftershocks. The whole staff is mutiny with the Management and I have a feeling that this will be one of the main discussions on Tuesdays staff meeting.

Ode to Patients

To my favorite patients of the week,

Mr. 32A, for having a smile for me when I walked through the door. For calling me pretty lady and holding my hand. For making your wife blush at your banter. For being cheery even though it seemed like you'd been sick for a while and not getting better. For working hard with physical therapy when your body was wanting to quit. For being patient for 3 days waiting for a private room. For brushing your teeth at night.

Mr. 21, for coming into the hospital the first time in 20 years. For all the wide eyed innocence and simple questions. For not ringing your bell incessantly but grouping all your needs. For introducing me to your whole family as if we were family. For not worrying and trusting me when I said everything was going to be okay. For taking all your pills. For not complaining over all the times we were sticking you. For drinking that cup of coffee like it was better than Starbucks.

Thank you both.

xoxoxo
Your nurse

Thought...

nursing is such a conflicting job sometimes.
we are expected to be human and sensitive so we can take better care of our patients by feeling what they are going through, for their sake.
and yet, we are also expected to detach ourselves from our emotions so we can take care of our patients and make intelligent decisions, also for their sake.

From May's blog: About a Nurse

The Needle Less System

I love whoever created the Luer Lock system. My current hospital doesn't use Luer locks, they have a weird soft rubber system that you have to add a plastic blunt catheter to be able to puncture the rubber part. I think it's tedious and time consuming, and I can't wait to switch to Luer Locks again.

I was trying to explain to my man how effective the needle-less system is, and how good it is that you can retract a needle if you do use one with the one touch method. He has such a huge fear that I might get stuck one day and I was trying to reassure him. I don't know how much it helped explaining the system, but it's another thing I have to thank God for.

Can you imagine nursing 10, 15 or even 20 years before such systems came into effect? How careful you had to be to dispose of the needle properly and how scared one would be all day long under this cloud. It's hard enough working in a health-ruining environment and that's not even thinking about needle sticks.

Good luck to all the nurses out there who work out and do their best whatever situations they find themselves. Stay safe peoples.

Hey!

Okay, I'm back from across the great divide. Wow, I can't believe that you guys still check in. Thanks! I'm doing much better...believe it or not, I got out of the hospital on Friday, had the weekend to convalesce and then had to hit the floor running back to work by Monday. Because I'm 'new', HR pretty much told me that I would lose all my benefits if I don't return to work in 30 days. So back to work I go.

It was rough...I was super tired, but I'm happy to report that I survived, and the attack of nerves I had on the way to work faded away as soon as I got there. It's a good thing I love my job, if not, I would have really had it worse than it was.

On Monday, I was the lunch/break relief nurse, which pretty means I was the scut worker. I think it was apt for my first day back, no patients, no assignment, just pitching in to help everyone out. Tuesday I did get an assignment, but by then, my mojo was back. Nursing is truly like riding a bike...lol.