NP vs. CNS: What’s the Difference?

Keith Carlson, RN, NC-BC
Updated April 22, 2024
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Can't decide between a career as an NP or CNS? Use this guide to compare educational and certification requirements, skills, salaries, and practice settings.
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The difference between a clinical nurse specialist (CNS) and a nurse practitioner (NP) can be difficult to understand when trying to choose the right career path as an advanced practice registered nurse (APRN).

Find out the many similarities and differences between a CNS vs. an NP, including education and certification, duties and responsibilities, salary, and the overall job outlook. Use this guide to determine the best career choice for you.

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NP and CNS Key Similarities and Differences

An NP and a CNS are APRNs with specialized training and certification. Each role requires earning either a master of science in nursing (MSN) or a (DNP), and both have similarities and differences in their daily work responsibilities. Understanding these roles is key to choosing the right career path.

What is an NP?

A nurse practitioner is an APRN who provides specialized care for certain patient populations based on their specific training and certification. NPs can work in acute or primary care and are licensed to assess, diagnose, and treat many conditions and illnesses.

What is a CNS?

A clinical nurse specialist is an APRN with extensive training and expertise. A central role of a CNS is to serve as a consultant and educator to other nurses and clinicians, either on a specific unit or facility-wide. A CNS can design and implement educational programs to increase staff nurses’ competency. They precept nursing students and new nurse staff members, design or lead evidence-based research, and counsel and educate patients and their families.

Clinical nurse specialists frequently serve as resident experts, providing consultation services in the care of medically complex patients rather than assuming full responsibility for each patient.

NP vs. CNS Comparison
Points to ConsiderNPCNS
Degree RequiredMSN or DNPMSN or DNP
Certification OptionsThe American Nurses Credentialing Center and the American Academy of Nurse Practitioners offer specialty certifications for NPs.The American Nurses Credentialing Center administers CNS certifications. Not all specialties have their certification exam.
Duties and Responsibilities
  • Assess and treat acute and chronic illnesses, diagnose medical conditions
  • Provide acute or primary care
  • Order medical tests
  • Prescribe medications
  • Make referrals for specialized care
  • Counsel and educate patients and their families
  • Lead nursing departments or teams
  • Supervise other clinical staff
  • Promote community and population health
  • Facilitate interprofessional collaboration
  • Lead implementing changes to improved evidence-based care
  • Collaborate with other nursing personnel
  • Educate nurses and other clinical staff
  • Lead evidence-based practice projects
  • Precept nursing students
  • Conduct or assist with research
  • Train nurses on new technology, best practices, or equipment
  • Consult with nurses about how to provide the best care for patients
Average Annual Salary$128,490$100,390

Duties and Responsibilities

Even though the duties and responsibilities of a CNS vs. an NP overlap, the differences are significant enough to make each role distinct and require a different educational and certification pathway. Understanding what NPs and CNSs do during their work day can help you choose which role is a better fit for you.

What Does an NP Do?

NPs often provide primary care to help fill the need due to a physician shortage. Depending on their certification area, the populations they serve, and the state in which they are licensed, NP roles and responsibilities include:

  • Providing direct patient care
  • Assessing, diagnosing, and treating medical conditions
  • Ordering diagnostic tests
  • Prescribing medications depending on their state’s prescriptive authority
  • Making referrals for specialized treatment

NPs occupy leadership roles, supervising and collaborating with clinical staff. They may work with patients, families, and community partners to provide education and promote disease prevention.

Most NPs hold certifications in family care, pediatric care, adult-gerontology primary care, psychiatric mental health, adult-gerontology acute care, and women’s health. NPs find employment in almost every healthcare environment, but most work in outpatient settings or private practice.

While NPs in some states must work under physician supervision, many grant NPs full practice authority and professional autonomy.

What Does a CNS Do?

Clinical nurse specialists play a key role as clinical leaders in the acute care setting. They can serve as expert consultants on complex patient cases and may also be a clinical educator for the nursing staff. Most CNSs find employment in acute care hospitals.

A CNS may collaborate with an interdisciplinary patient care team, including physical therapists, social workers, physicians, nurses, and case managers.

This role includes:

  • Supporting evidence-based practice and a culture of safety
  • Being the clinical educator or preceptor for nurses and nursing students
  • Conducting or assisting in clinical research
  • Serving as an expert consultant or leader for the interdisciplinary patient care team
  • Leading changes in evidence-based practice
  • Facilitating interprofessional collaboration

Education and Certification

When comparing NP vs. CNS, the educational path for both nursing roles takes 6-8 years. Both need a bachelor of science in nursing (BSN) degree and at least one year of independent clinical experience before applying to an MSN or DNP program.

NP classes focus on providing direct patient care, such as assessing and diagnosing patients. CNS classes emphasize management, education, and research.

State nursing boards generally require these advanced practice nurses to hold certifications in their specialty before they apply for licensure. Certifications require passing exams in specialty areas after graduate training.

NPs and CNSs must fulfill continuing education requirements to maintain their certifications.

How to Become an NP

The education for nurse practitioners includes an MSN or a DNP from an accredited NP program. NP specialty education includes adult-gerontology (acute or primary care), women’s health, psychiatric mental health, pediatrics, neonatal, and family practice.

All NP students learn to assess, diagnose, and treat various illnesses and conditions related to their specialty. Their education includes pathophysiology, anatomy, pharmacology, informatics, research, statistics, and related specialty courses. Clinical experiences shadowing and learning from working NPs are important to all programs.

NP certification and exams are offered by several organizations, including the following:

Certification requirements and exam eligibility vary based on the certifying body and the specific certification. Common eligibility requirements include a current professional nursing license in good standing and official or unofficial transcripts with documentation of the degree awarded from an accredited institution of higher education.

How to Become a CNS

CNS training emphasizes evidence-based research, management, teaching, and policy analysis. Becoming a CNS requires an MSN or a DNP from an accredited clinical nurse specialist program, CNS certification, and state licensure. Other practice requirements vary by state.

State licensure for CNS candidates requires passing the CNS certification exam in the specialty area aligned with their graduate training.

The American Nurses Credentialing Center and the American Association of Critical-Care Nurses administer CNS certification exams. Nurses can choose to specialize in pediatric care, adult- gerontology care, or neonatal care.

Exam requirements include a valid and unrestricted RN license, an MSN or DNP degree from an accredited program, and 500 supervised clinical hours. A CNS must renew their license every five years.

Salary and Career Outlook

With NPs being the fastest growing occupation in the country for several consecutive years, projections for job growth, salaries, and overall career outlook for APRNs and NPs remain positive.

NP Salary and Career Outlook

NPs currently enjoy an average annual salary of $128,490, an average hourly wage of $59.94, based on BLS data from May 2023. With the bottom 10% of NPs earning $94,530 and the 90th percentile making $168,030 the overall salary range for NPs is highly competitive. Multiple factors, including a growing physician shortage, drive demand for NPs. BLS job growth projections for NPs and APRNs stand at 38%, compared to physician job growth at only 3%. With the addition of expanding professional autonomy for NPs around the country, the next decade looks positive for the NP career path.

CNS Salary and Career Outlook

CNS salaries are generally lower than that of an NP. However, a CNS can still earn a competitive wage, with an average salary of $100,390, according to Payscale data from March 2024. The bottom 10% of CNS salaries reported were $75,000, while the top 90% of earners made $130,000 annually.

Skills, experience, and location can all affect CNS salary. Clinical nurse specialists with skills in cardiology, operating room, and acute care earn higher than average salaries, according to Payscale data from March 2024. CNSs with 1-4 years of experience earn an average of $93,000 annually, while CNSs with more than 10 years of experience earn $101,000 per year. Cities with higher living costs, such as San Francisco, California; Los Angeles, California; and Seattle, Washington, also pay CNSs higher than average salaries.

NP vs. CNS: Which Career is Right For Me?

When deciding between an NP vs. a CNS career, there are multiple factors to consider.

A CNS is responsible for serving as a consultant and an educator. This could be a gratifying aspect of the job for those who enjoy teaching and supporting other nurses. The additional CNS duty of serving as an expert consultant to the interprofessional team could be equally intellectually stimulating for those who enjoy multidisciplinary collaboration, critical thinking, and clinical problem-solving.

The NP role in primary care often involves the now common 15-minute patient visit, a frequent source of frustration for providers and patients. For those interested in a career as an NP, an acute care track might be preferable if the structure of primary care is less attractive. And while both paths pay well, NPs earn more than CNSs on average.

In terms of education, NPs and CNSs can choose between pursuing an MSN or continuing on to earn a DNP. NP and CNS students learn many of the same subjects, with CNS students focusing additionally on evidence-based research, management, teaching, and policy analysis.

Each career path offers the potential for a satisfying, fascinating, and well-paid career with excellent job growth projections and career potential.

Page last reviewed on March 25, 2024

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