Advanced practice in nursing: conceptual issues

The issue of defining advanced practice nursing roles is increasingly a subject of national discussion and debate. Central to this discussion has been the issue of merging nurse practitioner (NP) and clinical nurse specialist (CNS) roles and the tendency for the term "nurse practitioner" to replace that of "clinical nurse specialist" in denotation of these roles. The authors note the lack of any attempt to use a broader conceptual approach in these discussions. In this article, the development of each role is reviewed, and the strengths and weaknesses of each role in current practice and education are evaluated. The authors conclude that inadequate justification exists for continuing both roles, but that the answer is not in simply replacing the CNS with the NP. Ongoing careful and thoughtful dialogue should be used to guide the merging of these two roles.