Karajoy, I don't think your alone in trying to distinguish the difference between NP and CNS. I was educated in California so much I know about the CNS role is based on the function here. CNS practice varies from state-to-state ... in certain states CNS have prescriptive authority and function as NPs where they see patients in clinic and/or in the hospital setting. In other states, CNS's do not have prescriptive authority and are largely dependent in the institution to what their role would be.
Our board here in California defines fairly well what a NP and CNS are
. But perhaps the best way someone explained it to me is this: 1) An NP takes care of one patient at a time 2) A CNS is a clinician who takes care of a great number of patients all at once. While crude, it does help distinguish the focus of a CNS. A CNS CAN (based on the state or institution) see patients they also do many more things such as clinical consultation, education, research analysis and policy review. As such, some of our clinical experiences diverge from NP, in that we might participate in a research project which counts as clinical hours. For NP, these experiences do NOT count towards the clinical hour requirement.
To illustrate on how CNSs are used, I'll highlight two university academic institutions say university X and university Y. At university X, CNS's as utilized as expert clinicians, educators and supporting the nursing staff. A typical day would be spent talking to nurses on the unit, providing clinical guidance and expertise and attending leadership meetings on how to best improve nursing practice. This usage of CNS is usually termed unit-based, meaning a CNS responsibility is for a particular unit in the hospital. While at university Y, CNS's are used in two different capacities, unit-based and service-line. Unit-based are CNS's that are assigned to a specific nursing inpatient unit or area - such as an ED or ICU. They oversee nursing practice for a particular unit, consult and collaborate with staff. Whereas, a service-line CNS works directly for a medical service such as neurosurgery, interventional cardiology or palliative care. In this role, they function as NPs performing H&Ps, start/stop/modify prescriptive drug therapy and treatment in both inpatient and outpatient settings.
When I was assigned to the interventional cardiology CNS, she saw patients and would do their H&P and would recommend if they should be taken to the cath lab. A few times we would see patient in the pre-procedural holding area prior to taking the patient back for a cardiac catherization. The difference between her role and the NP role is that a MD was required to "sign-off" on all her orders. The MDs would sign-off her orders but would rarely see the patient together, she would discuss the case with the MD in passing if there were any questions. Bottom line, for the most part the MDs would just sign-off since they were seeing their own patients.
Your follow-up question might be ... well how do CNS's get away with writing orders if they are determined not to have prescriptive authority in California? The best I can explain it to you is that the facility makes that determination. In the case here, University Y has determined that service-line CNS go thru credentialing and have prescriptive authority in there institution so that there supervising physician cosigns their orders. That is still in compliance of the nurse practice act. But I will tell you, this is very uncommon among hospitals in California - most hospitals do not permit CNS's to see and treat patients here in California.
As far as my program and comparing it to the NP program, I did a critical care CNS program so I took many courses along side our ACNP cohorts. Aside from a few courses, we took many of our courses together. In fact, our school offers a post-masters certificate to NPs and the only difference is that we have to do that NP clinical component and maybe one or two NP-specific courses. Many programs will actually offer the CNS and NP together where you will be eligible to sit for both NP and CNS boards.
But bottom line I agree with traumaRUs, in that if you can't bill for your services - your job will always be considered "eliminate-able" - the best thing to ensure career longevity is to be able to bring in money for the institution. CNS's are often seen as an "expense" and NOT as income generation.