In this article

    Clinical Nurse Specialist (CNS) or Certified Registered Nurse Practitioner (CRNP)?

    FAQ:

    • Is a clinical nurse specialist different than a certified registered nurse practitioner?
      • The difference between a CNS and CRNP are very subtle. NPs practice autonomously and collaboratively with other health care providers. CNSs often work with other providers, have less autonomy, but usually work closely with staff to educate and support through the use of evidence based research.  
    • What is the role of a clinical nurse specialist in a hospital?
      • Manage the care of complex and vulnerable populations,
      • Educate and support interprofessional staff to provide optimal care through the use of evidence based research
      • Facilitate a culture of safety within health care systems.
    • What is the CNS salary? What is the CRNP salary?
      • According to salary.com, the median annual CNS salary as of July 2019 is $104,763 but the range typically falls between $94,720 to $114,754. 
      • According to the Bureau of Labor Statistics, The median pay for nurse practitioners for 2018 was $107,030 with salary ranges from $85,880 to $143,480.
    • Which program takes longer to complete, Clinical Nurse Specialist or Certified Registered Nurse Practitioner?
      • Both programs take roughly the same amount of time. Individuals with a BSN should expect to spend 2-3 years to obtain their advanced practice nursing degree. Some schools will actually include the CNS curriculum in the CRNP program. 
    • Are CRNPs in demand? 
      • According to the U.S. Bureau of Labor Statistics, the need for nurse practitioners is expected to grow by 31% by 2026. This is much faster than the national average of other healthcare-related professions included Registered Nurses. 
    • Are CNS’ in demand?
      • Similar to CRNPs, clinical nurse specialists are highly in demand.

    Are you ready for more autonomy and specialization in your nursing practice? Do you enjoy working directly with patients? Are you ready to start making bigger decisions that will directly impact your 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 Registered Nurse Anesthetist (CRNA)
    • Certified Nurse Midwife (CNM)
    • Clinical Nurse Specialist (CNS)
    • Certified Registered Nurse Practitioner (CRNP)

    If you’ve narrowed down your choices to CNS and CRNP, how do you choose which of these roles is best for you? There are some similarities but they are also grossly different. You’ll be investing significant time and financial resources to achieve your goal, so this decision should not be made lightly. 

    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.

    Clinical Nurse Specialist (CNS)

    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.

    According to the National Association of Clinical Nurse Specialists (NACNS), CNSs provide, 

    • Clinical expertise 
    • Leadership in nursing practice
    • Systems innovation in hospital, community, outpatient, and long-term care settings 

    Their responsibilities may also include, 

    • Diagnosis and treatment 
    • Health promotion and wellness
    • Maintain patient records
    • Conduct research and share findings
    • Research, develop, maintain, and train others in departmental policies, procedures, and patient care standards
    • Order tests and evaluate them
    • Advise other nurses
    • Being a subject matter expert
    • Disease management 
    • Prevention 
    • Risk reduction
    • Prescribe medications

    The CNS role was established more than 60 years ago. According to the 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. 

    Education Requirements for CNS

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

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

    • Pathophysiology
    • Pharmacology
    • Physical Health assessment
    • Epidemiology
    • Practicum 
    • Health Care Policy
    • Nursing Informatics
    • Research 
    • Teaching in Nursing

    CNS Specialization Areas

    CNS specialities 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)

    Clinical Nurse Specialists can specialize in the following areas, 

    • Adult Health
    • Adult Psychiatric and Mental Health
    • Child/Adolescent Psychological and Mental Health
    • Diabetes Management
    • Gerontology
    • Home Health
    • Pediatrics
    • Public and Community Health

    CNS Work Environments

    • Physicians’ offices
    • Hospitals
    • Outpatient care centers
    • Colleges and universities
    • Community centers
    • Laboratories
    • Other health services offices and facilities

    CNS Scope of Practice

    Regulations and administrative rules for nursing practice vary by state for Clinical Nurse Specialists. As of May 2016, CNSs can now practice independently in 28 states and prescribe independently in 19. Additionally, 13 recognize CNSs as Advanced Practice Registered Nurses but require them to have a collaborative practice agreement with a physician. 

    CNS Practice Authority 

    Source: National Association of Clinical Nurse Specialists

    There are also 19 states that require a CNS to have an agreement with a physician to prescribe drugs and durable medical equipment. It’s interesting to note that Maryland has granted independent practice authority only to psychiatric and mental health CNSs.

    CNS Prescriptive Authority

    Source: National Association of Clinical Nurse Specialists

    Visit the National Association of Clinical Nurse Specialists (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 Certification

    National exams for the CNS Core and nine specialty areas are administered by the American Nurses Credentialing Center (ANCC).

    Requirements to take CNS exam:

    • MSN degree or other graduate-level program preparation for the CNS role, which is accredited by the CCNE or ACEN
    • Current RN licensure
    • A minimum of 500 supervised clinical hours in the specialty area
    • Completion core coursework 

    The ANCC requires certification renewal every five years. 1,000 clinical hours during the five-year certification and completion of 150 CEU hours including 25 of pharmacology CEU hours are required. 

    CNS Salary Potential

    According to salary.com, the median annual CNS salary as of July 2019 is $104,763 but the range typically falls between $94,720 and $114,754. Payscale.com reports the range for CNS as $65,584 - $116,550 with a median salary of $88,085. Salaries vary considerably by region, so it’s best to research salaries in your practice area.

    CNS Programs

    Prospective CNS students should research academic programs accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN).

    The National Association of Clinical Nurse Specialists (NACNS) maintains a CNS program directory. Some programs are offered jointly with Nurse Practitioner and Nurse Educator programs.

    Kent State University - Adult-Gerontology CNS

    Loyola University Chicago - Adult-Gerontology Acute Care CNS and Adult-Gerontology CNS

    Old Dominion University - Clinical Nurse Specialist

    University of South Alabama - Adult-Gerontology CNS

    University of Southern Indiana - Adult-Gerontology CNS

    University of Texas Austin - Adult-Gerontology CNS

    University of Virginia - Adult-Gerontology Acute Care CNS 

     

     

    Certified Registered Nurse Practitioner (CRNP)

    Nurse Practitioners deliver advanced care to a variety of patients in the clinical setting. According to the American Association of Nurse Practitioners (AANP), NPs work “autonomously and in collaboration with healthcare professionals and other individuals, to provide a full range of primary, acute, and specialty health care services.”

    CRNP responsibilities include:

    • Order, perform and interpret diagnostic tests
    • Diagnose and treat acute and chronic conditions
    • Record and examine medical history, diagnoses, and symptoms
    • Prescribe medications
    • Manage patients’ overall care
    • Counsel
    • Educate patients and families on disease prevention and plan of care
    • Monitor and operate medical equipment
    • Perform physical examinations and patient observations
    • Collaborate with other healthcare professionals
    • Detect changes in a patient’s health and change the treatment plan if necessary

    CRNPs also provide teaching and supportive counseling and refer patients and families as appropriate. They focus on health education, health promotion, and disease prevention. CRNPs also collaborate with others to provide health care services to individuals, families, and communities. 

    CRNP Education

    Certified nurse practitioners are registered nurses with a Master’s degree in nursing, and may also have post-master’s certification and doctoral degrees.

    Nurse Practitioner students should expect to take the following courses,

    • Clinical Ethics
    • Clinical Research
    • Leadership 
    • Advanced Pharmacology
    • Advanced Pathophysiology
    • Advance Physical Assessment
    • Practicum
    • Healthcare Informatics

    CRNP Certification 

    National exams for the CRNP administered by the American Nurses Credentialing Center (ANCC) and/or the American Association of Nurse Practitioners (AANP).

    Requirements to take CRNP exam:

    • MSN degree from a CCNE or ACEN accredited program
    • Current RN licensure
    • A minimum of 500 supervised clinical hours in the specialty area
    • Completion core coursework 

    The ANCC requires certification renewal every two years. 1,000 clinical hours during the two-year certification and completion of 75 CEU hours including 25 of pharmacology CEU hours are required. 

    CRNP Work Environments

    Nurse Practitioners have a wide range of environments in which they can work, including:

    • Hospitals, acute care or ambulatory care settings
    • Outpatient settings
    • Long-term care facilities and nursing homes
    • Private homes providing health care services
    • Hospice and palliative care services
    • Government and community health agencies
    • Universities and research agencies
    • Healthcare or health industry businesses
    • Private practice

    CRNP Specialization Areas

    Nurse Practitioners can specialize in a variety of areas including, 

    • Family – Primary or Acute
    • Pediatric – Primary or Acute
    • Neonatal
    • Adult-Gerontology – Primary or Acute
    • Trauma
    • Emergency Care
    • Women’s Health/Gender-Related
    • Psychiatric/Mental Health

    CRNP Work Environments

    Nurse Practitioners have a wide range of environments in which they can work, including:

    • Hospitals, acute care or ambulatory care settings
    • Outpatient settings
    • Long-term care facilities and nursing homes
    • Private homes providing health care services
    • Hospice and palliative care services
    • Government and community health agencies
    • Universities and research agencies
    • Healthcare or health industry businesses
    • Private practice

    CRNP Scope of Practice

    In 23 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa. In states with reduced practice (Ohio, Pennsylvania, and Utah) and restricted practice (Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.

    CRNP Salary Potential

    The U.S. Bureau of Labor Statistics (BLS) reported that employment opportunities for all nurse practitioners would grow by 31% between 2016 and 2026. This is much faster than other occupations and a result of increasing demand for healthcare services. Additionally, as the healthcare industry continues to change there will continue to be a need for CRNPs. 

    The median pay for general nurse practitioners as of May 2018 was $107,030. 

    The BLS reports that in May 2018 the highest paying states for nurse practitioners were:

    • California: $133,780
    • Alaska: $122,880
    • Massachusetts: $122,740
    • New Jersey: $122,100
    • New York: $120,970

    The top five states with the highest concentration of jobs and locations for CRNPs include:

    • Mississippi
    • Tennessee
    • Maine
    • Alabama
    • New Hampshire

    The BLS also reported that the top five metropolitan cities for nurse practitioner pay were:

    • New Bedford, Massachusetts: $156,980
    • San Francisco-Oakland-Hayward, California: $150,790
    • Spokane-Spokane Valley, Washington: $148,440
    • Sumter, South Carolina: $145,890
    • Vallejo-Fairfield, California; $145,400

    The top five non-metropolitan cities for nurse practitioner pay, according to the BLS, were:

    • Big Thicket Region of Texas nonmetropolitan area: $143,480
    • Central Louisiana nonmetropolitan area: $141,380
    • Eastern Sierra-Mother Lode Region of California nonmetropolitan area: $128,410
    • Coastal Plains Region of Texas nonmetropolitan area: $127,370
    • Southwest New York nonmetropolitan area: $125,260

    Comparison: CNS vs. CRNP 

    Educational Differences

    • Clinical Nurse Specialist (CNS): MSN or DNP plus certification in speciality
    • Certified Registered Nurse Practitioner (CRNP): MSN or DNP plus certification in speciality

    Main Duties

    • Clinical Nurse Specialist (CNS)
      • Expert consultation
      • Applies evidence-based research 
      • Patient outcome improvements
      • System outcome improvements
      • Develop policies and procedures
      • Educate and train staff
      • Health care administration
    • Certified Registered Nurse Practitioner (CRNP): 
      • Health assessments and diagnostic testing
      • Promote disease prevention
      • Education to patients and families
      • Diagnose and treat
      • Provide referrals to specialists
      • Prescriptive authority 
      • Direct patient care

    Licensing Differences

    • Clinical Nurse Specialist (CNS): Renewal every five years.
    • Certified Registered Nurse Practitioner (CRNP): Renewal every two years.

    Specialities

    • Clinical Nurse Specialist (CNS)
      • Adult-gerontological health
      • Adult-gerontological critical care
      • Adult gerontology
      • Community-public health
      • Home health
      • Pediatric critical care
      • Neonatal
      • Pediatric primary
    • Certified Registered Nurse Practitioner (CRNP)
      • Adult primary
      • Adult-Gerontology acute
      • Adult-Gerontology primary
      • Adult psychiatric-mental health
      • Family primary
      • Gerontology primary
      • Neonatal
      • Pediatric acute
      • Pediatric primary
      • Women’s health

    Successful personality traits

    • Clinical Nurse Specialist (CNS)
      • Strong communication skills
      • Ability to educate 
      • Leadership skills
      • Ability to decipher information
      • Good speaking skills
      • Mental endurance
      • Enthusiasm
      • Creativity
      • Strong clinical knowledge
    • Certified Registered Nurse Practitioner (CRNP)
      • Leadership skills
      • Communication skills
      • Decision making skills
      • Empathy
      • Physical endurance
      • Strong clinical skills
      • Problem-solving skills
      • Integrity
      • Advocate
      • Responsible
      • Delagate
      • Compassionate
      • Attentive to detail
      • Ability to prioritize

    Autonomy differences

    • Clinical Nurse Specialist (CNS): Full autonomy in 29 states. Prescriptive authority in 19 states. No controlled substance authority. 
    • Certified Registered Nurse Practitioner (CRNP): Full autonomy in 23 states. Prescriptive authority in 50 states. Controlled substance authority in 49 states.

    Salary Differences

    • Clinical Nurse Specialist (CNS): Median salary - $104,763. Salary Range - $94,720 to $114,754.
    • Certified Registered Nurse Practitioner (CRNP): Median salary - $107,030. Salary Range - $85,880 to $143,480

    Next Steps To Advance Your Education

    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. 

    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 the 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 health care 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.

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