Qualitative distinctions and similarities in the practice of clinical nurse specialists and nurse practitioners

Current debate over whether clinical nurse specialist (CNS) and nurse practitioner (NP) roles should be combined or remain separate are largely theoretical. Minimal research has been conducted comparing these roles. Most studies to date consist of graduate follow-up surveys and comparisons of curricula. Interpretive results of Fenton's investigation of the practice of CNSs and Brykczynski's study describing the practice of NPs were compared to highlight the commonalities and distinctions between the two roles. This comparison is significant in that it explores the actual practice of CNSs and NPs. Both studies were modeled after Benner's research exploring the development of clinical expertise and produced adaptations of Benner's domains and competencies of nursing practice specifically for CNSs and NPs. Participant observations and small group interviews were the data-gathering methods used in these interpretive research studies. The interpretive approach is described as a situational, contextual, or narrative research method for understanding the knowledge and meanings in everyday (naturalistic) settings. Comparative analysis of results of the CNS and NP studies showed a shared core of advanced practice competencies as well as distinct differences between the practice roles. These findings have implications for curriculum development in advanced nursing practice.