There are no "NP schools" or "CNS schools," there are only MSN programs in clinical specialties that prepare you for the clinical role and certification. All CNS certifications now require an MSN, although there are some folks around who got grandfathered in from the old "certificate" days (the same is true of NPs). I am a child psych CS, and my jobs have all been direct patient care (outpatient as well as inpatient settings), although I have done some policy and program development and staff education as part of my job (certainly not the focus). I am currently working as a mental health consultant for my state (which is still about direct patient care, now that I think about it). Most of the other CNSs I have known (in many specialties) have also worked in direct patient care. There's a reason why the generic term is
clinical nurse specialist!
There is a great deal of variety out there, and what options are available to you depends on employers (and what they are willing to pay you to do!

) as much as anything.
There's plenty of literature out there about the differences between CNSs and NPs, so I won't bother getting into it. A lot of the differences have to do with the different origins of the two roles, which is an interesting read. Both roles have grown and evolved in recent years, but nurse practitioners were originally developed to be physician extenders in primary care settings (analagous, if you will, to family practice or GP docs) and CNSs were originally developed to be clinical experts in one specific specialty area (analagous to specialist docs). Best wishes with whatever you decide --
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