Advanced practice models: a comparison of clinical nurse specialist and nurse practitioner activities

The purposes of this article are to present advanced practice nursing models, explore similarities and differences in roles of clinical nurse specialists (CNSs) and nurse practitioners (NPs) in South Carolina, and relate findings to the advanced practice nursing models. A questionnaire was mailed to advanced practice nurses (APNs) listed with the board of nursing, which yielded a convenience sample of 228 nurses; sixty-two percent were classified as CNSs and 30% as NPs. CNSs spent significantly less time in direct practice and more time in education, consultation, research, and administration than did NPs. Satisfaction was high for both CNSs and NPs and was related to the quality of perceived support for the role and to relationships with key staff. Respondents were engaged in a variety of revenue-generating activities and provided additional suggestions for ways in which APNs could generate additional revenue. Results support previous literature suggesting greater ambiguity in the CNS role as compared with the NP, but also suggest that differences in role are primarily related to relative emphasis on direct practice. Findings tend to support viewing CNS and NP roles as dual pathways to advanced practice or as overlapping roles, with areas of shared and unique activity.