The NP vs. the CNS

By definition, nurse practitioners (NP) and clinical nurse specialists (CNS) are unique subsets of advanced practice registered nurses. In general, a CNS works more in administration, education, and research, and NPs focus more on direct patient care and clinical leadership. In practice, however, the two overlap routinely—both essential to nursing’s role at the front lines of the COVID-19 battle, for instance. In fact, in an assessment of NP vs. CNS, the “vs.” should probably be replaced by an ampersand. Where one stops or rests, the other steps up.

The mission for both: ensuring better health outcomes for patients in primary and acute care settings. Both have the training to focus in direct care, administration, and leadership. COVID has called for even more shared responsibility.

Michelle Patch, PhD, MSN, APRN-CNS, described her CNS role this way: “The focus was on leading COVID-related operational efforts, communicating rapid changes in clinical practice, advocating for staff needs, and informing organizational-level planning and decision-making.”

“The [NP] is an integral part of the COVID response team at Johns Hopkins,” explains Jason Farley, PhD, MSN, MPH, FAAN, “from the incident command center to the intensive care unit to the trenches of primary care or in leadership of large research protocols.”

Both CNSs and NPs take medical histories, conduct physical exams, and analyze patient data to develop medical care plans. Both administer medications, monitor patient well-being, and modify patient care plans as needed over time. Both can also assume leadership and educational roles in medical and academic settings. One difference is how often they perform particular skills. For NPs, prescribing and adjusting medications, conducting physical exams, and ordering and interpreting lab tests are everyday tasks. In contrast, a CNS would likely identify patient advocacy, evidence-based research, and collaborating with interdisciplinary teams as critical responsibilities of the job.

Either specialty offers nurses good pay and an unmatched level of training and autonomy. Find a side-by-side comparison and learn where you fit best at