NP vs. CNS ??

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.

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

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,:balloons:

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.

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

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.