Deciding to become a Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP)? Here is what you need to know.
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I get a lot of questions about which route to take, post-bachelors degree in nursing. The possibilities are endless and nursing education is confusing, to say the least. However, through the right online and in-person research, I am confident that every grad student can uncover her/his ideal path. The reason I am starting to write more informative posts on nursing education vs. lifestyle posts is because I have noticed the amount of inaccurate information online regarding these topics.
I want to clarify that I am a dual board certified Acute Care Nurse Practitioner and Clinical Nurse Specialist. I practice as a Nurse Practitioner but have completed the educational requirements and certification exam to be a Clinical Nurse Specialist as well. I also want to clarify that I am writing this to the best of my knowledge and experiences. It will be important for you to shadow professionals in the states and institutions where you want to work because practice laws and roles might vary.
What is a Clinical Nurse Specialist?
The definition of a Clinical Nurse Specialist (CNS) from the National Association of Clinical Nurse Specialists website is as follows:
“The clinical nurse specialist has been a part of the health care industrial complex in the United States for more than 60 years. Through the decades, the profession has become widely accepted in the healthcare system as a standardized, licensed, and fully regulated health care occupation, and one that significantly impacts the nation’s economy by providing safe, low-cost, and effective evidence-based health care services.
Clinical nurse specialists are advanced practice registered nurses who have graduate preparation (Master’s or Doctorate) in nursing. Like other advanced practice registered nurses, they are trained in physiology, pharmacology and physical assessment in addition to their particular areas of specialty.”
In other words, CNSs are expert clinicians. They know the system and their area of practice inside and out. The best CNSs I have worked with have extensive experience in their area of practice, whether it is Cardiac Surgery ICU, Trauma, Emergency Department, or Med-Surg. They are the go-to communicators between the nursing staff, management, and administration.
In my opinion, the most effective CNSs are well liked, passionate, and extremely knowledgeable. They are expert teachers and motivators. They are skilled at translating evidence into practice within their own institution and have been proven to decrease costs and improve quality within their settings. They are self-starters. CNSs identify problems and create solutions – they are priceless members of the healthcare team.
In my current setting of Cardiac Surgery Intensive Care, the CNSs are responsible for training new nurses, physicians, and advanced practice providers on the ins and outs of ECMO. They also host a number of other classes on topics like EKGs, Centrimag, LVADs, and Impellas. They are the first contact for the bedside nurses, advanced practice providers, and physicians. They also are vectors of change to improve practice and have authored countless research studies. Not only that, but they also serve as points of contact and consultation for many committees throughout the hospital system. Once again, a motivated CNS is absolutely priceless to any institution, in my opinion.
Can Clinical Nurse Specialists Prescribe Medication?
In some states and institutions, yes they can. In others, however, they cannot. It is important to check your state and institutional laws before making assumptions. And once again, it is important to shadow several people in the roles you hope to achieve before finalizing your decision of which path to pursue.
What Qualifications Does a CNS Need To Sit For The Board Exam?
To be board certified, a CNS needs a Masters or a Doctorate degree and must have successfully completed an accredited CNS program and clinical hours. Exact details to sit for the exam through the AACN can be found here. Of note, CNSs can be certified in Adult-Gerontology, Pediatrics, or Neonatal specialties.
What Are Some Resources to Explore the Role of the CNS?
My two favorite CNS textbooks are The Clinical Nurse Specialist Handbook by Zuzelo and the Clinical Nurse Specialist Toolkit by Duffy, Dresser, and Fulton. The National Association of Clinical Nurse Specialists is a great online resource to familiarize yourself with the role and competencies as well. Also, my favorite CNS with an online presence is Nicole Kupchik. She has been very successful in her consulting business, creating education for nurses, and public speaking. You can follow her on Instagram @nicolekupchik or check out her website here. Finally, understanding the APRN Consensus Model is a must when learning your role as an advanced practice nurse.
What is a Nurse Practitioner?
The definition of a Nurse Practitioner (NP), from the official website, is as follows:
“As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective and personal touch to health care. All NPs must complete a master’s or doctoral degree program, and have advanced clinical training beyond their initial professional registered nurse preparation. Didactic and clinical courses prepare nurses with specialized knowledge and clinical competency to practice in primary care, acute care and long-term health care setting.”
In other words, NPs are particularly skilled in holistically managing patients. In my personal experience, I note that NPs can expertly manage the traditional skills of a licensed independent practitioner through assessment, diagnosis, development, and implementation of treatment plans and evaluation. If trained within an institution, NPs can perform some procedures, such as central line placement, arterial line placement, intubation, bronchoscopies, bone marrow biopsies, lumbar punctures, and many more. Their standout qualities include expert communication, providing individualized patient care, preventative medicine, and transitional care.
The foundation of an NP’s practice is nursing, and the foundation of nursing is caring. Meaning, even if you are the most knowledgeable practitioner, if you lack the ability to truly care, then your knowledge cannot be appropriately applied. This theory is why I love being an NP because I am taught to wholeheartedly care about my patients both individually and holistically.
Can an NP Prescribe Medications?
Yes. Laws vary by state and institutions regarding which medications NPs can prescribe. In general, however, NPs can prescribe most medications relevant to their areas of practice. There is special training required in many states for NPs to prescribe medications like suboxone and methadone. Be sure to check your state and institutional laws prior to prescribing.
What Qualifications Does an NP Need To Sit For The Board Exam?
To be board certified, an NP must have a Masters or Doctorate degree and must have successfully completed an accredited NP program in their chosen specialty, including the required clinical hours. Specific requirements to sit for the certification exam can be found here.
If you’re getting ready to sit for an NP certification exam, one of the review resources I used to study for my acute care nurse practitioner exam is BoardVitals. They provide high-quality online question banks for several NP specialties, and you can even earn CEs on select banks. You can find my study schedule here.
Is Bedside Nursing Experience a Requirement to become an NP?
The short answer to this question is no. Some NP programs are accepting nurses without bedside experience. It is my belief that nurses are being funneled away from the bedside to graduate school without experience for various reasons:
A bedside nurse position is very hard to sustain in many institutions without mandated staffing ratios, and nurses are simply looking for a way out
Schools are offering new grads direct admission to their programs right after graduating with their BSNs. Although no school would ever directly state this, I’m sure this offer is a great way for the school to make money
While I do believe there are exceptions to every rule and that every nurse has a different path, I still have the opinion that nurses should work at least two years at the bedside before going back to graduate school to become an NP. Most of the top institutions require bedside experience before admission to graduate school and many of the top tier NP jobs require bedside experience as well.
If I were applying to grad school all over again, I would be very skeptical of any school that would admit graduates directly into grad school with zero work experience.
What Are Some Resources to Explore the Role of the NP?
As for the NP, understanding the APRN Consensus Model is a must when learning your role as an advanced practice nurse. The American Association of Nurse Practitioners is another website to familiarize yourself with the role. If you would like to see the life of an NP through Instagram, some NPs I follow are @thekatieduke and @seanpdent. They are both full-time NPs; Katie works in Cardiology and Sean works in an ICU.
I hope this article has given you a clearer idea of the difference between an NP and a CNS. Both are great jobs where there is ample opportunity to make a difference in the field of nursing. Best of luck to you all on your journey!
