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NP vs. CNS: What’s the Difference?

NurseJournal Staff
Updated March 23, 2023
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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 demand for advanced practice registered nurses (APRNs) has never been greater. As APRNs, nurse practitioners (NPs) and clinical nurse specialists (CNSs) rank among the most highly trained and highly paid registered nurses.

While both types of nurses require a master’s or doctoral degree and specialty training for certification, their roles and responsibilities differ.

Learn more about each of these nursing roles, including education and certification requirements, salary prospects, and work environments.

NP and CNS Key Similarities and Differences

Like most APRNs, NPs and CNSs must hold graduate degrees, state licenses, and certification to practice. Both careers offer expanding employment opportunities and higher-than-average nursing salaries.

NPs provide direct patient care, practicing autonomously in place of primary care physicians, or under the supervision of other healthcare providers.

They may diagnose and treat medical conditions, order laboratory tests, make referrals, prescribe medications, and perform other procedures, depending on state authorization.

Clinical nurse specialists manage patient care. They collaborate with other nurses and medical professionals on health promotion and disease prevention. CNSs focus on complex cases and vulnerable populations.

Both types of nurses aim to improve healthcare delivery. NPs work with patients directly to assess and treat chronic and acute conditions, either supervised or independently.

While CNSs have less autonomy, they collaborate with teams of healthcare professionals, focusing their efforts on education and support using evidence-based research.

Similarities and Differences
Points to ConsiderNPCNS
Degree RequiredMaster of science in nursing (MSN) or doctor of nursing practice (DNP)An MSN 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 own certification exam.
Duties and Responsibilities
  • Assess and treat acute and chronic illnesses, diagnose medical conditions, act as primary care medical provider
  • 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
  • Direct, provide, or assist with patient care in specialty areas
  • Counsel and educate patients and their families
  • Collaborate with other nursing personnel
  • Educate nurses and other clinical staff
  • Lead evidence-based practice projects
  • Precept nursing students
  • Conduct or assist with research
Average Annual Salary$118,040$93,927

Duties and Responsibilities

While both NP and CNS roles require at least a master’s degree and APRN licensure, aspiring nurses should understand the differences before choosing a career path.

NPs deliver direct primary care. They often practice autonomously or with healthcare providers. CNSs tend to hold less practice autonomy, but have considerable input in managing patient care. CNSs provide leadership to nurses and other staff members.

CNSs work closely with medical personnel, consulting, educating, and supporting with the intention of improving nursing care.

What Does a NP Do?

NPs often provide primary care in place of physicians. Depending on their certification area, the populations they serve, and the state in which they are licensed, roles and responsibilities include:

  • Providing direct patient care, assessing, diagnosing, and treating medical conditions
  • Ordering diagnostic tests
  • Prescribing medications (with state authorization)
  • Making referrals for specialized treatment.

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

NP specializations map to one of five certifications: family, neonatal, pediatric, women’s health, and adult-gerontology. NPs find employment in almost every type of healthcare environment, most often in outpatient and inpatient settings or in private practices.

Rising healthcare costs and physician shortages drive demand for NPs. While NPs in some states must work under physician supervision, a growing number of states grant these nurses full practice authority and professional autonomy.

What Does a CNS Do?

Like the NP, the CNS uses advanced nursing training to provide patient care. However, specific duties depend on certification specialty. Duties include administrative, consulting, and research roles.

Common CNS roles and responsibilities include:

  • Supervising and collaborating with other nurses and medical staff
  • Conducting evidence-based projects and research
  • Consulting on system and patient outcome improvement
  • Teaching and advising nurses-in-training

A CNS often seeks certification in adult-gerontology, psychiatric-mental health, pediatrics, family practice, women’s health, and community health.

Hospitals and academic healthcare centers rank among the major CNS employers, followed by community health centers, mental health facilities, and educational institutions.

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Education and Certification

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

While NP graduate classes focus on primary care, and CNS classes emphasize management and research, most graduate programs share content.

State nursing boards generally require these advanced practice nurses to hold certifications. 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 a NP

Like most APRNs, NPs must earn a BSN, an appropriate graduate degree, and state licensure. NP graduate training focuses on direct patient care, diagnosis, and treatment.

After completing an MSN or DNP with a patient population focus, NPs take the national certification exam in the population specialty aligned with their graduate training. The American Nurses Credentialing Center, among others, administers these exams.

Minimum exam eligibility includes an MSN from an accredited program, a minimum of 500 supervised clinical hours, and completion of core coursework.

Some state nursing boards set additional requirements for APRN licensure. Once NPs receive state licensure, they must renew their certification, often every five years.

How to Become a CNS

CNS training emphasizes evidence-based research, management, teaching, and policy analysis. CNSs must hold an accredited clinical nurse specialist MSN or DNP, and state licensure. Other practice requirements vary per state.

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

Both the American Nurses Credentialing Center and the American Association of Critical-Care Nurses administer CNS certification exams.

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

Salary and Career Outlook

APRNs, including NPs and CNS, can expect a promising job outlook and high salaries throughout the next decade. The U.S. Bureau of Labor Statistics (BLS) projects that jobs for all APRNs will grow by 45% from 2020 to 2030, much faster than average for all other occupations.

While nurses in CNS roles earn slightly less than NPs, both kinds of nursing careers can offer six figure salaries. Compensation varies by type of employer, years of experience, and geographic location.

NP Salary and Career Outlook

NPs earn a median salary over $118,000 per year, with the lowest-paid 10% making $70,000 annually, and the top 10% receiving over $163,000.

Employment prospects for these nurses continue to grow, primarily due to increasing emphasis on preventive care and heightened demand for healthcare services from the aging population.

Factors like location and specialty impact salary and employment. Job growth tends to mirror population growth, especially in states with older populations.

Arizona, with its large retiree population, projects a 50.9% increase in NP positions between 2018 and 2028. The top-paying NP specialty, psychiatric-mental health, offers a median salary of $125,000. Family NPs, the most popular specialty, earn the lowest average salary, at $107,000.

CNS Salary and Career Outlook

Salary.com reports CNS salaries in the United States range from $91,000 to $132,000, with the average annual salary at $111,697. Nurses in CNS roles can expect widening employment opportunities as healthcare organizations seek out specialists.

CNSs can help to reduce costs, length of patient stays, and complications. The need for CNS specialists corresponds to the national spike in patients with chronic conditions like diabetes and heart disease, and the growing demand for nurses trained in critical care.

Geography significantly impacts CNS salaries. According to May 2022 Payscale data, CNSs in San Francisco earn 55% more than the U.S. average. In contrast, Milwaukee CNSs make 10.6% less than the U.S. average.

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

Successful NP and CNSs both must possess the “hard” skills acquired through their training, and “soft” skills like good communication and problem-solving. While they share a mission to improve patient care, each of these nursing roles requires specific kinds of skills to deliver the best possible healthcare outcomes.

NPs, especially those with full practice authority, often work autonomously, diagnosing and treating acute and chronic diseases. They may work directly with the same patients for many years and manage large caseloads.

These NPs need good communication, organizational, decision-making, and problem-solving skills. They also need to develop empathy to build a trust-based rapport with their patients and their families.

CNSs are more likely to work with groups and communities, focusing on illness prevention. They spend much of their time collaborating with teams of healthcare professionals, improving outcomes for vulnerable patient populations or in complicated cases. A CNS may also engage in research, teaching, and supervisory roles.

In these busy and stressful workplace settings, the successful CNS must develop an aptitude and appreciation for teamwork, the ability to work well with diverse groups, the organizational skills to keep track of several ongoing cases and projects, and the analytical and leadership skills to achieve results.

While both roles emphasize health promotion and positive patient outcomes, prospective nurses should consider how their own preferences, training, and talents fit within the work environments and responsibilities associated with each of these nursing careers.

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Page Last Reviewed May 1, 2022

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