CNS and NP: should the roles be merged?

Historically, nursing has adapted to changing environments and patient care needs. For example, the advanced nursing practice roles of clinical nurse specialist (CNS) and nurse practitioner (NP) involved at different times in response to health care delivery needs. Although the current trends in health care reform result from economic constraints, they nonetheless present opportunities for nursing to further develop the advanced practice role. Yet development does not have to mean creating a new role. Indeed, professional fragmentation-such as the separate professional streams for the CNS and NP-is one of the areas that hinders the nursing profession in its participation in and contribution to a restructured health care system. Merging these two roles into one would not only increase the number of nurses with advanced, standardized academic preparation and skills, but would provide a basis for lobbying for a more autonomous role for advanced nursing. As a result, nursing could respond proactively to changing health care needs.