Clinical Nurse Specialist (CNS) vs Nurse Practitioner (NP)
If you’re deciding between becoming a Clinical Nurse Specialist (CNS) or a Nurse Practitioner (NP), you may be wondering how to choose which of these roles is best for you. There are some similarities, but they are also very different.
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.
| CNS | NP | |
| Salary | $115,923 per year | $121,230 per year |
| Education | MSN or DNP plus certification in a specialty | MSN or DNP plus certification in a specialty |
| Job Duties |
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| License | Renewal every five years | Renewal every two years |
| Specialties |
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| Skills |
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| Autonomy | Full autonomy in 34 states. Prescriptive authority in 19 states. No controlled substance authority. | Full autonomy in 28 states. Prescriptive authority in 50 states. Controlled substance authority in 49 states. |
What is a Clinical Nurse Specialist?
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 prevention and management
- 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.
What is a Nurse Practitioner (NP)?
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.”
NP 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
- Educate and counsel 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
NPs 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 healthcare services to individuals, families, and communities.
CNS Salary
According to salary.com, the average annual CNS salary, as of May 2023, is $115,923, but the range typically falls between $104,819 to $126,981. Payscale.com reports the range for CNS as $74,000- $124,000, with an average salary of $97,000. Salaries vary considerably by region, so it’s best to research salaries in your practice area.
CRNP Salary
According to the U.S. Bureau of Labor Statistics (BLS), the median pay for general nurse practitioners is $121,610 (May 2022).
The BLS reports that in May 2022, the highest-paying states for nurse practitioners were:
- California: $158,130
- New Jersey – $143,250
- Massachusetts – $138,700
- Oregon- $136,250
- Nevada – $136,230
CNS Education
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
NP Education
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
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
NP 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
CNS Work Environments
- Physicians’ offices
- Hospitals
- Outpatient care centers
- Colleges and universities
- Community centers
- Laboratories
- Other health services offices and facilities
NP 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
CNS Scope of Practice
Regulations and administrative rules for nursing practice vary by state for Clinical Nurse Specialists. As of June 2023, CNSs can practice independently in 34 states and prescribe independently in 22. Additionally, 46 recognize CNSs as Advanced Practice Registered Nurses but 11 require them to have a collaborative practice agreement with a physician.
CNS Practice Authority
There are also 18 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
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.
CRNP Scope of Practice
In 28 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor.
Full practice authority 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.
CNS Certification
National exams for the CNS Core and nine specialty areas are administered by the American Nurses Credentialing Center (ANCC) or the American Association of Critical-Care Nurses (AACN).
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.
NP Certification
National exams for the CRNP are 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 five years. 1,000 clinical hours during the two-year certification and completion of 75 CEU hours including 25 of pharmacology CEU hours are required.
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.
>> Related: Top Clinical Nurse Specialist Programs
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.
