Clinical Nurse Specialist and Nurse Practitioner: Distinct Advanced Practice Roles                                   


Refutation of the blending of the CNS and NP roles 

Six benefits or problems resolved by the combining of the roles were outlined as cost effectiveness for universities, similarities in core courses, increase in numbers increasing power, similarities existing in both roles, a united front, and practice settings which overlap at times. It has been said that confusion in the titles APN, CNS, APRN, ARNP, and NP would be eliminated by choosing a more recognizable title such as blended CNS/NP since the NP currently holds a high level of name recognition (Grudner, 2003). These arguments have been debated for years yet, it has been discovered through much research that there are differences in the roles and they need to remain separate. The benefits do not outweigh the potential loss of care for many individuals.

With the changing face of today's health care system many hospitals have renewed interest in the role of the CNS.  The argument is made that traditionally the CNS role had more of an emphasis on educating others and facilitating changes whereas the NP role included more treatment, diagnostic, and prescription functions and the combination of the roles would increase patient satisfaction (Sperhac & Strodtbeck, 2001). It would be ideal if the CNS and the NP could learn to employ the skills of one another in health care delivery but the saying; ‘a jack of all trades is a master of none’ rings true in this situation. It would be wonderful if one role could embody each scope of practice; advanced clinical expertise, professional and patient education, consultation, research, analyzing health care systems, assessment and treatment, and direct patient care but this is not a realistic expectation of one health care provider. There is a need in today's health care system to work as an interdisciplinary team and therefore maintain roles that focus solely on mastery of some of these scopes of practice. Naturally a provider should strive to incorporate as many of these characteristics into daily practice as possible, but one individual will be unable to embody all of the different scopes of practice. Since one person is unable to care for all aspects of an individual's care, the preservation of both of these roles as separate entities is vital.

Financial restraints and cost containment can preclude the hiring of both an NP and CNS creating the need for a blended role. It has been said with the current emphasis on cost containment, the advantages of moving toward a new integrated role may increase marketability. One should be cautioned not to allow cost containment to be the sole driving forces for change; it is a viable factor, yet one needs to look to the needs of the patient population. If needs are not being met, cost containment will not be an issue since individuals will not continue to employ a health care provider who they do not feel meets their needs. In order to maintain the quality of care given to patients we must make sure the titling of APN indicates the same level of education, regulation, and credentialing across the continuum of APNs not just combine these roles.