Question: What is the difference between a Clinical Nurse Specialist (CNS) and a Nurse Practitioner (NP)? How do their responsibilities and role on a larger medical team differ?

Answer: Many similarities exist between the CNS and the NP roles, in that they receive similar training, can specialize in certain patient populations, and provide direct care to patients. However, in general, CNSs tend to work more in healthcare administration, while NPs tend to concentrate more on direct patient care. In addition, NPs and CNSs have different certification examinations; while NPs earn certification through the ANCC, AANPCP, PNCB, AACN, or NCC, depending on their specialization, CNSs earn national certification through the ANCC or the AACN only.

Nurse practitioners (NPs) and clinical nurse specialists (CNSs) are two types of advanced practice registered nurses (APRNs) who provide direct care to patients and also have the training and expertise to lead teams of health care professionals, conduct medical research, and educate staff in medical and academic settings.

Nurse practitioners are specialized health care providers who evaluate patient health, formulate plans of care, provide direct care services, and coordinate patient care. NPs tend to specialize in either primary or acute care, and generally focus on a particular patient demographic, such as pediatric patients, geriatric patients, or women of reproductive age. NPs may serve as the primary care provider for their patients, and in some states they have full practice authority, which means that they have the ability to prescribe medications and practice medicine independently of a physician.

NPs are trained at the MSN and/or DNP level, and obtain national certification as advanced practice providers through one of the following certifying bodies, depending on their professional focus:

  • The American Nurses Credentialing Center (ANCC)
  • The American Academy of Nurse Practitioners Certification Program (AANPCP)
  • The American Association of Critical Care Nurses (AACN)
  • The Pediatric Nursing Certification Board (PNCB)
  • The National Certification Corporation (NCC)

In addition to national certification, NPs must obtain licensure as APRNs through their state’s board of nursing. Each state has its own licensure requirements for nurse practitioners, so individuals should check with their state’s board of nursing for the specific requirements to earn the appropriate credentials to practice as an NP.

Clinical nurse specialists, like nurse practitioners, receive graduate-level nursing training at the MSN and/or DNP level, and are licensed to practice advanced nursing responsibilities. Like NPs, CNSs conduct physical examinations and medical histories for patients, provide direct medical care, and coordinate the care of patients in collaboration with a larger medical team. CNSs can also teach in medical and academic settings, conduct research, and manage teams of medical professionals who work towards improving overall systems of care. As with NPs, some states may allow CNSs prescriptive authority. Clinical nurse specialists can work in a wide variety of specialties, including but not limited to geriatrics, pediatrics, adult health, critical care, psychiatric/mental health, and community health. Clinical nurse specialists obtain national certification through the ANCC or the AACN, and like NPs, must obtain state licensure as APRNs through their state’s board of nursing.

The Overlaps in Responsibilities Between NP and CNS Roles

According to a recent study conducted by the National Council of State Boards of Nursing, Inc. (NCSBN), significant overlap exists between the roles of the nurse practitioner and the clinical nurse specialist. The NCSBN surveyed 1,526 NPs and 1,344 CNSs, and their findings indicated that both roles share key responsibilities in the medical setting. Both CNSs and NPs noted that taking patient medical histories, conducting physical examinations, and analyzing patient data to develop medical care plans were important parts of their jobs. Both NPs and CNSs also administer medications and other types of treatments (including patient counseling and non-pharmacological interventions), monitor patient well-being, and modify patient care plans as needed over time. Both NPs and CNSs can also assume leadership and educational roles in medical and academic settings.

The Differences Between the CNS and the NP Roles: Professional Focus

While many of their core responsibilities and medical training are very similar, the NCSBN found that the emphasis of the clinical nurse specialist role tends to be administrative, research, and/or program development-oriented, while nurse practitioners tend to focus more on direct patient care. They also discovered a noticeable difference in the frequency with which both nurse practitioners and clinical nurse specialists completed certain tasks. For example, the nurse practitioners surveyed noted that prescribing and adjusting medications, conducting physical examinations, and ordering and interpreting laboratory tests were crucial tasks in their daily work. In contrast, CNSs identified patient advocacy, evidence-based research, and collaborating with interdisciplinary teams as critical responsibilities of their job.

Despite these differences, the core mission of nurse practitioners and clinical nurse specialists is the same: ensuring better health outcomes for patients in both primary and acute care settings by evaluating patient health statuses, developing patient care plans, and improving systems of care at the individual and the group levels. Furthermore, while the NCSBN’s study found that CNSs tend to work more in administration, education, and research, and NPs focus more on direct patient care and clinical leadership, one should note that the differences that the NCSBN survey found illustrate trends rather than rules. There are many NPs who focus significantly more on administration, research, and improving systems of care, rather than on direct clinical care. Furthermore, there are numerous CNSs who provide direct care services to patients as the main element of their job. Both nurse practitioners and clinical nurse specialists have the training to focus in direct care, administration and leadership, or both, and depending on their work experience, areas of professional interest, professional connections, and academic focus in graduate school, NPs and CNSs generally have the opportunity to shape their careers as they see fit.

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