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I think it helps to consider the history of the two roles. While neither role "looks" exactly as it looked when it was first created, understanding their origin helps explain the differences.
NP roles were originally designed to provide "physician extenders" to patients who had limited access to physicians. The original NP's were educated to provide primary care to outpatients by doing assessments and proscribing treatments that had previously required a doctor's order. Those roles were very similar to Physician Assistant roles and the NP's practice had to be supervised by a physician.
CNS roles were designed to augment the nursing care received by patients in hospitals (and some community health settings). The original CNS roles emphasized the coordination of inpatient care, the development of new procedures and policies, staff education, research, etc. CNS's were not educated to write perscriptions or do other things that typically require a physician's order. No special license was even considered as they did nothing that anyone with an RN couldn't do. CNS's were the expert nurses -- and did not cross over into medical diagnosis or treatment.
Over time, some CNS's wanted prescriptive authority, which meant special licensure would be required and a change in the educational requirements. Other CNS's have not wanted the role to change in that way. Also, more NP's are working in hospitals coordinating the care of certain patient populations. And some people have experimented with trying to combine the 2 roles into one "advanced practice" role. The lines between the two roles has blurred. That makes it confusing for everyone.
In some specialties, it makes sense to combine the two roles. But in other specialties and other situations, it makes no sense to do that because the provision of medical diagnosis and treatment and nursing expertise are not synonamous. Unfortunately, most people tend to think that what works best for their particular situation will work for everyone. So the confusion continues as each state board and each hospital and each specialty nursing organization and each school tries to advance its vision of the roles and make it the national standard for everyone.
I've been a CNS since 1979 and have seen many different people try to advance different political agendas in shaping the role. I admit to being a little tired of the battles and wish that the nursing profession would get its act together and stop changing the definitions so often.
llg couldn't have said it better! I'm an adult health CNS in an NP role. I prescribe meds, treatments, order tests, interpret results, just like my fellow FNPs and PAs. In the practice where I work, we are all equal with the same job description! How is that for confusing?
Before I became a CNS, I had done ER case management in a level one trauma center for two years. I absolutely loved that job! However, expanding the role to be one of an APN wasn't possible, so I left. Personally, the ACNP or FNP education and role probably would have suited me better.
However, I must add that before you commit to grad school:
1. Look at your state practice act. Do you want to prescribe meds? Make sure you are in a state that allows that.
2. What type of jobs are available in the area you want to work. My experience is ER and ICU. However, in my geographic area, there are no positions period. The ICU's are closed to APNs at the hospitals where I work as are ERs here. So...I had to consider what I could do.
3. Geographically, who gets hired? Do FNPs work in your ERs or do PAs? Do CNS' work in the hospitals, while NPs work in clinics?
4. Do your homework BEFORE you get to grad school.
Also would like to chime in that if you notice, there are direct-entry NP programs available but you'll be hard pressed to find a direct-entry CNS program. I think this boils down to the historical distinction between the 2 roles. A CNS is looked at as an "expert nurse" - someone who has worked in their specialty for a considerable amount of time and have obtained advanced education on evaluating, interpreting, and dissemintaing the latest evidenced-based nursing practice specific to the specialty of their training. It is hard to assume the role of a CNS and and have the credibility with little nursing experience to back you up. On the other hand, because the NP role is closely-tied with concepts from the medical model, many schools feel that certain individuals can be fast-tracked into the role even with little nursing experience. Although many NP's disagree with this practice, many schools have been successfully producing new NP's in this manner.
As a CNS I was not particularly fond of the traditional hospital role, and so I branched out, with a physician friend of mine, into Primary Care. It was there that I found the excitement and fulfillment that I have so longed for in the Advanced nursing profession. You can truely go anywhere or do anything at this level, just don't box yourself in somewhere and say this is it,because there is always more.