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March 29, 2017

Clinical Nurse Specialist (CNS) or Certified Nurse Practitioner (CNP)?

By Anne Devine, MA, BSN

Are you ready for more autonomy and specialization in your nursing practice? Do you enjoy working directly with patients? It may be that you’re ready to pursue an advanced practice registered nurse (APRN) role. 

According to the Consensus Model for APRN Regulation, these roles include: 

  • Certified Nurse  Anesthetist (CNA)
  • Certified Nurse Midwife (CNM)
  • Certified Nurse Specialist (CNS)
  • Certified Nurse Practitioner (CNP)

If you’ve narrowed down your choices to CNS and CNP, how do you choose which of these roles is best for you? You’ll be investing significant time and financial resources to achieve your goal, so this is an important decision. 

So how do you ensure that your career choice will be professionally fulfilling and financially rewarding in the long run? 

The information below can get you started on your fact-seeking journey. Learning more about your local healthcare milieu can open your eyes to potentially new opportunities.

Clinical Nurse Specialists (CNSs) 

Clinical nurse specialists provide an advanced level of care in hospitals and other clinical locations. They strive to improve healthcare through evidence-based practice at the individual patient and systems levels.

CNSs provide clinical expertise, leadership in nursing practice, and systems innovation in hospital, community, outpatient, and long-term care settings. Their responsibilities may also include diagnosis and treatment, health promotion, disease management, prevention, and risk reduction.

The CNS role was established more than 60 years ago. According to the National Association of Clinical Nurse Specialists (NACNS) studies show that CNS involvement results in the following: 

  • Reduced hospital costs and length of stay
  • Reduced frequency of emergency room visits
  • Improved pain management practices
  • Increased patient satisfaction with nursing care
  • Reduced medical complications in hospitalized patients. 

Required Educational Preparation and Certification for the CNS Role

Clinical nurse specialists are registered nurses with a graduate degree in nursing at the Master’s or Doctorate level. 

In addition to training in their specialty area, CNSs complete advanced coursework in:

  • Physiology
  • Pharmacology
  • Physical assessment
  • CNSs also must meet the licensure/certification requirements their state requires.

CNS Clinical Practice Areas

  • CNS specialties are defined by
  • Patient population (e.g., adult/gerontology or pediatrics)
  • Setting (such as intensive care unit or specialty clinic)
  • Disease or medical subspecialty (e.g., diabetes)
  • Type of care (such as rehabilitation, post-partum)
  • Type of problem (e.g., wound care, pain)

CNS Scope of Practice

As mentioned earlier, regulations and administrative rules for nursing practice can still vary by state. CNSs can now practice independently in 28 states and prescribe independently in 19. 

Visit the National Association of Clinical Nurse Specialists (NACNS) (NACNS) website to learn more about CNS scope of practice and prescriptive authority state by state. Check with your state licensing board to ensure you have the most up-to-date information.

CNS Salary Potential

According to salary.com, the median annual CNS salary in January 2017 was $98,997 with a range of $89,522 to $108,428. As salaries vary considerably by region, so it’s best to research salary the actual potential in your practice area.

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Certified Nurse Practitioners (CNPs)

The American Association of Nurse Practitioners (AANP) defines nurse practitioners as “licensed, independent practitioners who practice in ambulatory, acute, and long-term care as primary and/or specialty care providers.” 

Decades of research confirms that Nurse practitioners provide safe, high-quality care. CNP responsibilities include:

  • Taking health histories
  • Performing physical examinations
  • Diagnosing and treating acute and chronic illnesses
  • Prescribing and managing medications and durable medical equipment
  • Ordering and interpreting diagnostic tests.

CNPs also provide teaching and supportive counseling, and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention. CNPs also collaborate with others to provide healthcare services to individuals, families, and communities. The importance of CNPs to the provision of primary care services cannot be overstated. 

Required Educational Preparation and Certification for the CNP Role

Certified nurse practitioners are registered nurses with a Master’s degree in nursing, and may also have post-master’s certification and doctoral degrees. Competency is ensured by national education program accreditation requirements as well as competency-based standards. Licensure requirements for CNPs vary by state. Visit Nursing Licensure.org for your state’s specific requirements.

CNP Clinical Practice Areas

CNPs enjoy much diversity in clinical practice areas, which include:

  • Acute care
  • Adult
  • Family practice
  • Gerontology
  • Neonatal
  • Pediatric
  • Psychiatric/mental health
  • Women’s health

CNP Scope of Practice

Scope of practice for nurse practitioners varies by state, with 19 states and DC allowing full practice, 19 reduced practice (a formal, written agreement with a physician is required) and 12 states further restrict NP practice. 

CNP Salary Potential

The Bureau of Labor Statistics, states that in 2015, median annual income for nurse practitioners, nurse anesthetists, and nurse midwives was $104,740 per year. Again, since salaries vary considerably by region, be sure to check out current ranges for your region. 

Do Your Research about CNS and CNP Roles 

Be aware of recent and ongoing developments in advanced nursing practice.

Although the Consensus Model for APRN Regulation mentioned above defines advanced practice nursing roles, and the goal for its implementation was 2015, nursing regulations can still vary by state.

Seek out state-specific information about scope of practice, licensure, and certification requirements.

For example, if prescriptive authority and independent practice are important to you, be sure that your state includes these functions as part of your preferred APRN role. Also consider your preferred practice setting and which patient population(s) you enjoy most. Thinking these things through and supporting your decision with accurate data will help you avoid disappointing and expensive choices.

Research the healthcare needs of the population in your city, state, or region.

Which of the APRN roles are most needed to meet these needs? Check out job postings with local healthcare organizations, and decide if you are willing to relocate for a new position. Determine if the role you choose will be flexible should you/your spouse/partner relocate. Research salary ranges for APRN roles in your region to obtain a realistic measure of salary potential. 

Tap into your network!

Talk with others to learn what they like/do not like about their current role as CNS or CNP. Use your professional and social media connections to request brief informational interviews with those currently working as CNSs or CNPs. Ask questions! Your network can help you uncover details about the work culture of potential employers and how they support nurses through benefits and training opportunities.

Next Steps

After researching the above information, your sleuthing skills will be honed, and you can start the exciting process of deciding on an educational program. Choosing a new career path is an educational experience unto itself – before you’re even admitted to your graduate program.

Information in this article is provided as general information. Be sure to carefully assess your own goals and needs, and to research educational programs, demand in your geographic area, your state’s scope of practice regulations and certification requirements, and potential opportunities before embarking on your individual career path. 

How Can You Advance Your Nursing Career?

High-paying nursing opportunities abound. As an RN, you are in control of your career. Check out the best jobs from coast to coast on our job board. Get the pay and career path you deserve.

Click here to see today’s best nursing opportunities.

Anne Devine, MA, BSN, started her nursing career in trauma and orthopedic nursing before finding her true passion in public health. She has more than 15 years of experience as a healthcare writer helping patients and providers tell their stories. She has an MA in Community Health Nursing from the UW in Seattle.

Also Read: 15 Highest Paying Nursing Specialties

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