NP vs. CNS ??

  1. Can someone please explain to me the differences between a Nurse Practitioner and a Clinical Nurse Specialist?

    Thanks
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  2. 12 Comments

  3. by   sirI
    Quote from CapeCoralNurse2be
    Can someone please explain to me the differences between a Nurse Practitioner and a Clinical Nurse Specialist?

    Thanks
    Hello, CapeCoralNurse2be,

    The differences are so verly slight. Most of the time the tracks do overlap. There are even programs for the CNS/NP combination.

    Clinical nurse specialists and Nurse Practitioners are advanced practice nurses who are experts in the diagnosis and treatment of illness and the promotion of wellness in the presence or absence of disease in addition to assisting the physician with disease management. They use theory and research to guide and improve nursing care.

    I usually find the CNS is more research oriented and the NP is more primary care oriented.

    Both can have prescription privileges.
  4. by   CapeCoralNurse2be
    Thank you, I was just contemplating which track to go for eventually, and I couldn't really find any info on the differences between the two professionals.
  5. by   llg
    In my experience (over 20 years in CNS and similar roles), the roles are often VERY different. Historically, the NP role was created as a "physician extender" role -- to provide primary care in outpatient settings when a physician was either not available or not needed. While the role has evolved greatly since those early days to include more of a holistic nursing focus, the focus is still frequently on primary care in outpatient settings.

    The CNS role has a different history. Most early CNS's were employed by hospitals to provide advanced, specialized services for specific groups of patients. Sometimes it makes sense to have 1 person or a small group of people develop expertise and provide a specialized service than to expect every staff nurse to be an expert in everything. Early CNS's also focused on staff education, project management, and research. Again, while the role has evolved over the years, only a few CNS's focus on primary care in outpatient settings.

    While that may not seem like a big difference, it really is. Who hires you ... who supervises you ... inpatient or outpatient .... primary care vs specialty inpatient care ...general population vs specialty population .... etc. these are really big differences. That's why the "combined NP/CNS role" that was proposed several years ago did not become commonplace. Most people find that they prefer one role over the other -- and most employers need the skills of one or the other.

    I would recommend looking closely at the roles before you choose to be sure that your long term job prospects are what you want them to be.

    llg
  6. by   sirI
    Quote from llg
    In my experience (over 20 years in CNS and similar roles), the roles are often VERY different. Historically, the NP role was created as a "physician extender" role -- to provide primary care in outpatient settings when a physician was either not available or not needed. While the role has evolved greatly since those early days to include more of a holistic nursing focus, the focus is still frequently on primary care in outpatient settings.

    The CNS role has a different history. Most early CNS's were employed by hospitals to provide advanced, specialized services for specific groups of patients. Sometimes it makes sense to have 1 person or a small group of people develop expertise and provide a specialized service than to expect every staff nurse to be an expert in everything. Early CNS's also focused on staff education, project management, and research. Again, while the role has evolved over the years, only a few CNS's focus on primary care in outpatient settings.

    While that may not seem like a big difference, it really is. Who hires you ... who supervises you ... inpatient or outpatient .... primary care vs specialty inpatient care ...general population vs specialty population .... etc. these are really big differences. That's why the "combined NP/CNS role" that was proposed several years ago did not become commonplace. Most people find that they prefer one role over the other -- and most employers need the skills of one or the other.

    I would recommend looking closely at the roles before you choose to be sure that your long term job prospects are what you want them to be.

    llg
    Hello, llg,

    I agree with you that in the beginning the roles were very different, but, the role of CNS has evolved and changed so much in the past few years, it is now so very close to the role of NP. Both are capable of delivering primary health care although many CNS will still stay within a hospital setting. Many CNS seeks the opportunity to conduct research and that is one reason this role is so attractive to the individual.

    But, initially, the roles were very far apart in their philosophies.
  7. by   CapeCoralNurse2be
    This has been helpful.

    Part of my confusion comes from different Doctor's Offices I've been to. I've seen both and been cared for personally by both the CNS and the NP in the primary care setting, so I didn't understand the differences. Eventually I think I'd want to work in a clinic or primary care type of setting, so I'm assuming NP would probably be the way to go over CNS.

    I did look at the specialty options for both and interestingly a lot of the areas do offer a degree similar for both CNS and NP. For instance you can get either CNS or NP in areas such as Family, acute care, occupational, women's health, psych, peds, neonate...and several others..... And then there are some specialty areas where it looks like you need the CNS, for instance, Rehab, cardiac care, infectious Disease, Med/Surg, etc.. So while a large portion of the specialty options do seem to overlap, there are a number of areas of specialty that seem to be CNS only.
  8. by   OH RN,BSN
    It's been interesting to read your post... I also am debating CNS or FNP. I'm currently an ED nurse and love it... but looking for that perfect job where I can have more autonomy. My understanding is that CNS areas were more for if you wanted something in the Acute care setting, or education. FNP more for outpt settings like a Dr's office. I've been debating doing fnp with a leaning more towards coronary... but I'm still not convinced of what to do. I plan on starting in the FNP track this year and hopefully will be in tune with which way to go before it's too late. An obvious goal would be to make a bit more than I am now... which may be difficult looking at other postings?? I told an instuctor of mine... if I could create my own position (that obviously doesn't exist) I would love to do some sort of rounds for a physician in the acute care setting from 9-5 M-F....I know I'm dreaming. Any suggestions by anyone for the correct route to go?
  9. by   pattchez
    There is a difference between NP and CNS careers. NP is focused on individual patient issues via thorough assessment and diagnostic skills. The CNS looks at patient populations -- groups of patients -- and it not focused necessarily on a specific patient. Education coursework is a component of a CNS program because teaching is an important aspect of this role. I agree that research is an important component of the CNS role and should be taught in the CNS program -- doing a thesis. Both roles are important in the health care system but each have different focuses.
  10. by   GeeBeeRN
    I'm glad I found this post as I too am contemplating which route to take. I hope this question doesn't sound dumb but is there a high demand for NPs? Also, my sister-in-law told me that her friend couldn't find a position as a Nurse Practioner so she is back to working on the floor as a staff nurse. She also said that the jobs her friend found weren't paying her much more if not the same as what she got paid as a staff nurse. This made me feel a little discouraged as I will be spending a fortune to go back to school and will be making a complete makeover on my life w/ my husband and new baby boy. Anyway, my concern lies more with if there are many job opportunities for NPs. I just want to know that after the many years of schooling, I want to know that there will be opportunities for work once I graduate. (I looked at my current employer's job board and there's usually only 1 or 2 postings for Nurse Practitioners vs gazillions for staff nurses).
    Thanks in advance for any input and comments.
  11. by   texas-rn-fnp
    In my experience CNS are typically case managers that review complex/difficult patients that have so many things going on in different directions. They coordinate care and sort things out. They sometimes work like a social worker too. It has not been my experience that they act like an NP. The NP has been more like a physician extension or a primary care provider, acting just like a doc. Pay is usually better for the NP, greater scope of practice, greater authority, but typically outpatient. NP follow inpatients too although most commonly a doc admits.
  12. by   llg
    Job availability varies for both roles in different areas of the country. In some places (particularly those close to schools that graduate large numbers of nurse practitioners) there is an over supply of nurse practitioners. In those places, yes, NP jobs are hard to find. However, that's not true in other areas of the country.

    CNS graduates tend to be a little more flexible in their job choices -- a little prepared for case management, staff development, nursing school faculty, management, etc. roles. If they can't find a pure "CNS" job, they can often find some job that utilizes their general clinical expertise and knowledge. It may not be the exact job they want, but it is a workable solution until they can find a better fit. NP's can make those compromises too and find a job less-than-perfect-fit job, but there are usually fewer choices that include the primary care component that NP's need to maintain their certification.

    Of course, in some areas of the country, there is a great need for NP's. So, you need to find out about your region of the country in particular.

    llg
  13. by   texas-rn-fnp
    It all depends on where you are willing to live and work and what you are looking for. CRNA is obviously a great job, but not in San Antonio. Only government facilities ther use CRNAs. All civilian anesthesia is controlled by Anesthesiologist groups. If you are willing to go to houston or Corpus Christi there is big money waiting for you. The same holds true for NPs. I agree with the previous post. If you live in a rural community near to an FP school, the market may be saturated. Look on the internet. There are so many jobs, you can't imagine. My wife wants me to change practice to cosmetic surgery in a resort are such as SU Virgin Island or Hawaii. You can do whatever you want, wherever you want. Being near civilization helps. Definitely more positions to fill.
  14. by   traumaRUs
    I'm in a CNS (adult health) and am interviewing with a renal/nephrology group and have interviewed with a hospital for a clinical educator roles. I have found it interesting how different places use the different roles. For many positions, it is the billability for services that is the precursor to employment. In other words, if the practice or hospital can bill for the APN's services, that is what they are going with.

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