Necessity of Role Separation
Historically the CNS and NP roles developed differently. The CNS role was instituted in 1954 with the vision to offer role modeling for staff, expert patient care, consultation, and evidence based research. The NP role evolved in 1965 in response to the shortage of primary care physicians to focus on direct patient care services outside of the hospital (Ackerman & Mick, 2002). The NP role was further developed to incorporate medical actions in the expanded role of the APN. The CNS role was further developed when the concept of masters preparation of the APN was introduced to increase the knowledge of the CNS and decrease disconnect in patient care. The CNS assists and facilitates the care of a specific population in both direct and indirect care, education, leadership, and consultation but would defer diagnostics to a physician colleague. In contrast, the NP scope encompasses differential diagnostics, testing, treatments, and prescribing medication, all of which are similar to the medical model and are reflected in their legal liability (Ackerman & Mick).
In a comparison of seven studies and surveys, there was a consensus that the NP role included aspects of consultation, research, education, and administration but was mainly concerned with direct care of the patient and family system. The CNS role presented a unique blend of all aspects of direct and indirect patient care creating distinctive domains within the nursing practice. APNs should stop debating the need to merge the CNS and NP roles. Instead, they should work to develop strong identities within these roles which would promote collaboration between APN and physician colleagues and serve to address the needs of the public for responsible and caring healthcare.
A 1992 study by Williams and Valdivieso was completed to gain insight into the current role activities and explore the possibility that there was enough overlap in the positions of the CNS and NP to be combined. It was discovered through the study that while there are many similarities in both positions, the existence of the CNS and the NP roles as unique, distinct entities is supported by the results. Some of the study findings are as follows:
*60% of CNS spent less than 20 hours providing direct patient care with a mean of 17.5 hours in direct patient care. Conversely 85.5% of NPs spent mores than 20 hours of direct patient care with a mean of 30.5 hours in direct patient care.
*NPs ranked direct practice highest out of five roles, education second, and third consultation CNSs
ranked consultation highest, direct care second, and education third. Both NPs and CNSs ranked research
fourth and administration fifth.
*Prescribing medications and physical exams were most strongly identified with NP roles and
initiating/conducting research and support groups were most strongly identified with the CNS roles
*When surveyed, both groups were opposed to being merged stating that while each practice has areas of overlap, there is evidence that both the CNS and the NP are distinct roles that cannot be merged.
*Both the CNS and NP play vital roles in the administration of cost-effective, high quality health care and the roles continue to show distinguishable differences in their focus, setting, and locale (Lincoln, 2000).
The difference in roles and scope of practice is important as these differences serve to defend the position to keep these roles as independent, unique entities. The focus and practice of the CNS and the NP differ greatly and the practice of each fills a much needed niche in today's health care system. The existence of both roles serves to take better care of patients and families and delivers improved health care within existing systems.
