Understanding the Subtle but Important Differences Between the Clinical Nurse Specialist (CNS) and Nurse Practitioner

Clinical nurse specialist, nurse practitioner—both of these advanced practice registered nursing professionals are educated at the master’s or doctoral level and both hold national certification and state licensure in their chosen practice role and specialty. While the other APRN roles—certified nurse-midwives and nurse anesthetists—have clearly defined scopes of practice, the difference between clinical nurse specialists and nurse practitioners isn’t always as clear, leaving many to wonder exactly what makes these roles distinct.

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In the simplest terms, these two APRN roles can be best distinguished by their position within the healthcare system:

  • Nurse practitioners are on the frontlines, providing healthcare to specific patient populations in acute or primary care settings.
  • Clinical nurse specialists, on the other hand, are the behind-the-scenes experts who analyze the entire process behind the delivery of care to optimize it and produce the best possible patient outcomes.

Both roles are focused on disease management/prevention and health promotion. But while nurse practitioners are focused on the diagnosis and management of acute and chronic diseases, clinical nurse specialists are instead focused on the prevention of specific illnesses, considering things like risk factors and behaviors among individuals, families, groups, and communities.

The nurse practitioner is the autonomous provider of healthcare, while the clinical nurse specialist provides the support needed to ensure outstanding patient outcomes for complex and vulnerable populations.

The nurse practitioner asks: “What can I do to improve the health of each patient I treat?” while the clinical nurse specialist asks: “What can I do to improve the healthcare outcomes of a specific (complex and/or vulnerable) population?”

For example, in a skilled nursing facility, nurse practitioners provide direct care to the patients, which includes diagnosing, assessing, ordering tests, and prescribing meds and treatments. Clinical nurse specialists in the same setting are instead working in a support capacity that includes implementing and improving plans of care and providing support and guidance for the nursing staff and other members of the interdisciplinary healthcare team.

Nurse Practitioners: Frontline Healthcare Providers

Nurse practitioners occupy the most popular and widespread APRN role (more than 290,000 in the U.S. and growing). NPs are most often recognized as being an autonomous provider of healthcare across the wellness-illness continuum. The national certification and state license they hold permits them to work with one (or more) of six populations in acute or primary care settings. The largest number of NPs are certified to work with families (55%) and seniors (22%).

All 50 states recognize nurse practitioners as autonomous and collaborative healthcare providers and, as of 2020, 28 states and Washington D.C. allow them to practice independently, without any form of physician oversight or collaboration. The remaining states require NPs to work under some type of physician oversight for the duration of their career. NPs have become vital to the nation’s healthcare system in recent years, as physician numbers dwindle and the number of insured Americans increases. In many areas of the country (usually in rural or low socio-economic areas), NPs have become the sole providers of care for millions of Americans.

National certification options include:

American Academy of Nurse Practitioners National Certification Board (AANPCB)

  • Family Nurse Practitioner (FNP)
  • Adult-Gerontology Primary Care Nurse Practitioner Certification (A-GNP)
  • Emergency Nurse Practitioner (ENP)

The American Nurses Credentialing Center Certification Program (ANCC)

  • Adult Nurse Practitioner Certification (ANP-BC)
  • Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC)
  • Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC)
  • Adult Psychiatric-Mental Health Nurse Practitioner Certification (PMHNP-BC)
  • Advanced Diabetes Management Certification (ADM-BC)
  • Emergency Nurse Practitioner Certification (ENP-BC)
  • Family Nurse Practitioner Certification (FNP-BC)
  • Gerontological Nurse Practitioner Certification (GNP-BC)
  • Pediatric Primary Care Nurse Practitioner Certification (PPCNP-BC)
  • Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC)
  • School Nurse Practitioner Certification (SNP-BC)

American Association of Critical-Care Nurses Certification Corporation (AACN)

  • Acute Care Nurse Practitioner Certification Adult-Gerontology (ACNPC-AG)
  • Acute Care Nurse Practitioner (ACNPC)

Pediatric Nursing Certification Board (PNCB)

  • Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC)
  • Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC)

National Certification Corporation

  • Neonatal Nurse Practitioner Certification (NNP-BC)
  • Women’s Health Care Nurse Practitioner Certification (WHNP-BC)

Clinical Nurse Specialists: Experts in Healthcare Leadership, Consulting, and Design Innovations

The clinical nurse specialist role was first created in 1954 to address specific needs in acute and mental health care settings. Clinical nurse specialists are educated and trained to integrate care across the continuum and across three “spheres of influence”: patient, nurse, system.

While these APRNs also provide direct care, their role is most often focused on providing support within healthcare systems, which is why these pros are often referred to as the “nurse’s nurse.” Usually practicing in a less autonomous role, CNSs educate and support an interdisciplinary staff using evidence-based research to ensure the best care for specific complex and vulnerable populations.

In many cases, independent practice among CNSs is not as clearly defined as it is for their NP peers. As of 2020, CNSs enjoy independent practice authority in 28 states. Of these states, 19 allow CNSs to prescribe independently. The remaining states either require CNSs to maintain a collaborative physician agreement to practice and/or prescribe drugs and other interventions, or otherwise do not recognize the CNS role for APRN licensing purposes.

Clinical nurse specialists can specialize by population, a setting, or a disease (e.g., oncology, cardiac, psychiatric, critical care, neonatal, obstetric/gynecological, pediatric care, etc.). The vast majority of CNSs (76%) specialized in adult health/gerontology, as of 2019, according to the National Association of Clinical Nurse Specialists.

They are experts in the design of nursing assessments, diagnoses, interventions, and innovations to achieve specific health goals. They work with other nurses and the members of the interdisciplinary healthcare team to improve outcomes and effect system-wide changes to improve programs of care. They are practice specialists, expert consultants, and leaders and collaborators of the interprofessional team, and they promote improvements in healthcare delivery and healthcare team competencies.

National certification options include:

American Association of Critical-Care Nurses (AACN)

  • Clinical Nurse Specialist: Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
  • Clinical Nurse Specialist: Wellness through Acute Care (Pediatric) (ACCNS-P)
  • Clinical Nurse Specialist: Wellness through Acute Care (Neonatal) (ACCNS-N)

American Nurses Credentialing Center (ANCC)

  • Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
  • Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
  • Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
  • Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
  • Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
  • Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
  • Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
  • Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC)

Salary Differences Between Nurse Practitioners and Clinical Nurse Specialists

According to recent salary statistics, both nurse practitioners and clinical nurse specialists enjoyed salaries in the six figures, in most cases.

According to a 2019 Medscape APRN Compensation Report, nurse practitioners earned an average gross income of $108,000, while clinical nurse specialists earned an average gross income of $102,000 during the same period.

The report also found that the average salary for NPs during this time was $109,000, while for CNSs, it was $106,000.

The average salary for CNSs with a doctorate degree was $104,000, compared with $102,000 for those with a master’s degree. NPs with a doctorate also earned more than their master’s-prepared counterparts: $114,000 vs. $107,000.