Deconstructing the myth of the advanced practice blended role: support for role divergence

Since the early 1980s, there has been discussion about combining the clinical nurse specialist (CNS) and nurse practitioner (NP) roles. Examination of recent nursing literature reveals renewed interest in differentiating, rather than combining, these 2 advanced practice roles. Research has shown that although the 2 roles share similarities, these advanced practice pursuits are more different than alike, both philosophically and practically. Despite curricular attempts at "blending" CNS and NP philosophies of nursing care and their distinctive domains of practice in master's level degree programs, the uniqueness of these roles in actual practice demands a continuation of educational differentiation in preparation. Both roles are important and address varied systems requirements. Each role has been shaped by population needs, education, market, and legal forces that transform with time. The differing ideologies of CNS and NP practice lead to diverse patient and system outcomes and reveal different researchable questions.