Comparing Nurse Practitioners and Clinical Nurse Specialists in Canada

This report provides a comprehensive comparison of the roles of Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) in the Canadian healthcare system, focusing on the Saskatchewan Nursing Advanced Practice (SNAP) Model. The analysis covers five key domains: direct comprehensive c...Read More

Running Head: COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE
SPECIALISTS IN CANADA (SNAP MODEL)
Comparing Nurse Practitioners and Clinical Nurse Specialists in Canada (SNAP Model)
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COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
Abstract
The Canadian Nursing Association under the Advanced Nursing Practice guidelines cuts
out the different roles of CNSs and NPs. These roles can be summed up under the 5 main
domains of nursing practice according the SNAP Model. In regard to comprehensive care, the
CNSs has no autonomy while NPs have the autonomy to diagnose and treat ailments and even
order and interpret medical test. They are all however, professional leaders, educators and
advancers of evidence-based nursing practice in their areas of specialty. This discussion outlines
the comparison and contrast of the roles of the two entities in the Canadian Advanced Nursing
Practice setting.

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
Introduction
Despite the fact that NPs and CNSs in Canada are both highly experienced and educated
in clinical practice, each of them have a different role. It is important that in order to identify the
main differences existing between them so that an individual aspiring to be an advanced practice
nurse can decide the role that suits their skills and/or personality. According to the Canadian
Nursing Association, CNSs offer expert nursing care while playing the lead role in developing
clinical guidelines and/or protocols (Canadian Health Services Research Foundation, 2011).
They also promote evidence-based practice, offer support, consultancy to stakeholders in the
healthcare sphere in order to facilitate system change. CNSs are Registered Nurses that have
advanced skills in nursing to make complex decisions. A CNS must have a master’s and/or
doctoral degree in the field of nursing and expertise in any clinical nursing specialty (Fulton et
al, 2014). They are agents of change bringing value to their clients, organizations and practice
settings. They thus improve safety in healthcare, promote health outcomes that are positive and
reduce healthcare costs (Gardenier, 2012). On the other hand, the Canadian Nursing Association
indicates that NPs offer direct care to clients and focuses on health promotion, illness treatment
and their management. NPs have a more expanded practicing scope where the can diagnose,
order and even interpret necessary diagnostic tests. They have the authority to prescribe
medication unlike the CNSs. NPs have graduate education and also experience in clinical
practice. For one to be an NP, they must be Registered Nurses with working experience. While
there are several similarities between their roles, NPs and CNSs usually work in differing
environments. Most NPs operate in private practice of in office setting while CNSs find
themselves in acute care facilities including hospitals (Hoyt & Proehl, 2011). The roles of CNSs
and NPs can be distinguished based on the Saskatchewan Nursing Advanced Practice (SNAP)

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
Model which emphasizes on the 5 major domains of practice which include; direct
comprehensive care; evidenced-informed practice, educative practice, support systems, and
professional leadership.
a. Direct Comprehensive Care
Clinical Nurse Specialist
The CNSs has both consistent and broad influence in regard to the provision of direct
comprehensive care within the Canadian provinces where they have been posted. They
epitomize their knowledge, abilities, skills and attributes in generating relevant research
questions within clinical practice (Lamarche & MacKenzie, 2015). Where necessary, CNSs form
part multidisciplinary research teams, contributing as senior members. Their skills and abilities
enable them to recruit patients as respondents and obtain informed consent where research on
direct comprehensive care is required (Gardenier, 2012). They have great documentation and/or
communication skills which enable them to be resourceful to research teams. They take
responsibility for any independent nursing decision (Hoyt & Proehl, 2011). More often, CNSs
only engage in agreed upon independent direct practice within the supervision of the doctors
and/or the senior management team. The CNSs usually influences all nursing practices
predominately within the clinic and/or ward setting, being a senior member of the research team.
Nurse Practitioner
Unlike the CNSs who cannot directly engage in independent direct comprehensive care
without supervision, NPs can conduct comprehensive and/or systematic nursing assessment of
patients. They provide comprehensive, effective and safe evidence-based nursing care in order to
attain identified individual and/or group health outcomes (Hoyt & Proehl, 2011). It is also there
direct role to develop, maintain and conclude therapeutic relationships with their patients in

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
appropriate terms. In regard to collaboration, the NPs work with the rest of the interdisciplinary
healthcare team in order to provide clients with comprehensive nursing care directly. The NPs
take part in formulating nursing plans for patients in collaboration with RNs, the patients and
their caretakers. They also manage the nursing care within their scope as NPs while ensuring that
they promote individual and/or group security, integrity and safety while under care (Lamarche
& MacKenzie, 2015). Further, the NPs offer support and care to either individuals or groups
within their scope of practice in the quest to maintain quality direct comprehensive care
b. Support of Systems
Clinical Nurse Specialist
CNSs make crucial contributions to both local and national clinical guidelines within
their specific areas of specialty area. They can contribute to peer review publications which they
submit to national and/or international journals in their areas of specialty. Where local clinical
guidelines require reviews, the Clinical Nurse Specialists take part in the review process. Their
knowledge, skills and attributes enable them to take part in such processes with efficiency and
effectiveness (Carter et al, 2010). They contribute to different processes aimed at supporting
clinical research. For instance, they form part of the ethics committees by representing nursing.
They also represent their areas of specialty when there are reviews of organizational processes
within the settings they could be working in. Clinical Nurse Specialists also recognize the
contributions of any research endeavors in the clinical environment while actively advocating
increased awareness among nurses of what conducting a good research constitutes. Further in
supporting systems, CNSs model expert skills and/or behaviors that guide interactions with
different patients and their families.

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
Nurse Practitioners
In supporting systems, Nurse Practitioners operate as a consultant to different entities in
the healthcare system and also refer or accept referrals of patients from different health-care
providers, allied community agencies and professionals. They offer client advocacy in regard to
therapeutic interventions, access to healthcare and decision making on health. They also support
the system through collaborating with healthcare team members in the provision and promotion
of inter-professional care that is client-centered both at system and individual levels. Nurse
Practitioners also collaborate with healthcare team members in promoting and guiding initiatives
related to quality improvement at system, organizational and individual levels. They apply
advanced knowledge and abilities in terms of communication, analysis, coalition building,
negotiation, management of change and even conflict-resolution. This is important in facilitating
systemic functions in health sector. It is however important to note that NPs do not participate
directly in policy and/or protocol development reviews as is the case for Clinical Nurse
Specialists.
c. Educative Practice
Clinical Nurse Specialist
Clinical Nurse Specialists take part in different local and national health education
programs. They also work with their junior nursing colleagues in developing their capabilities in
their specialty areas and this improves their competencies while setting their role limits. More
particularly, CNSs provide specialized education including nursing knowledge and skills in their
own clinical specialty areas to the members of different multidisciplinary teams, patients and
their families formats (Fulton et al, 2014). They advise on methodologies, procedures, research
programs, special protocols and guidelines in line with their specialty areas. CNSs have skills in

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
communication, documentation and research which they use to carry out health promotion
through planning and executing health education activities within their areas of jurisdiction in the
Canadian provinces. They are mentors to the nurses within the organizations they work in as they
also help each other in professional development and growth.
Nurse Practitioner
Nurse Practitioners are mainly preceptors to nurses that are less experienced and these
can include graduate and/or undergraduate nurses. In this regard, NPs play an important role in
facilitating ongoing individual and group professional development of themselves and others. As
an educationist in their specialty area, NPs accept accountability and responsibility for their own
individual actions within the nursing practice. In their educative practice, they lead or collaborate
with healthcare teams in staging community initiatives on health promotion. This is aimed at
reducing risks to complications, injuries and illnesses for individuals, groups and the whole
population(Carter et al, 2010). A Nurse Practitioner has the skills to carry out the assessment,
identification and critical analysis of information from various sources in order to determine
patient or population trends and patterns. They then initiate and take part in developing strategies
which can be used to address some of the identified implications.
d. Evidence Based Practice
Clinical Nurse Specialists
CNSs actively take part in generating new evidence and knowledge since they take part
in different research initiatives that aim at improving both patient care and their profession. They
can also be associate investigators in different projects concerning the improvement of health
outcomes within the population and in the nursing practice (Canadian Institute for Health
Information, 2015). The CNS has skills necessary to develop, implement, analyses and

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
disseminate new audit and research projects which are aimed at optimizing healthcare in their
specialty areas. They also take part in protocol development during research projects and their
high level skills in documentation and ability to maintain Case Record Files facilitates them to
offer evidence-based practice (Lamarche & MacKenzie, 2015). They use their knowledge and
skills in obtaining information on latest appropriate nursing practice and they implement them on
their patients or impart the knowledge to the members of healthcare teams. CNS understands
that it is their responsibility to offer patients and groups evidence-based healthcare services.
They therefore strive to use their skills in using and/or contributing knowledge to evidence-based
nursing practice platforms for them and others to rely on while offering comprehensive care. The
information they retrieve of add to such platforms include latest guidelines, new knowledge,
procedures and protocols on nursing practice in different care settings.
Nurse Practitioner
Nurse Practitioners just like the rest of Registered Nurses in Canada are required to
practice within the evidence-based framework. In this regard, they seek for new knowledge on
different platforms in order to inform their decision making in the direct diagnosis of patient
illnesses, their treatment and how nursing plans should be drawn for different disease conditions
(Lamarche & MacKenzie, 2015). Nursing Practitioners also need to establish therapeutic
relationships with their patients and this needs evidence-based practice especially in managing
special conditions among patients with mental problems. The Nurse Practitioners thus assess
and review the latest evidence based practice materials, guidelines and protocols some of which
are developed by CNSs, to inform their nursing decisions. The NPs identify and implement
research-based innovations to improve the care of patients individually, organizationally and
systemically (Canadian Institute for Health Information, 2015). They especially, identify, collect

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
and evaluate data on nursing practice outcomes for their clients and for the benefit of improving
the healthcare system. They also act as agents of change through translating and disseminating
new knowledge in platforms such as formal presentations, discussions, and publications.
e. Professional Leadership
CNSs
A CNS provides professional leadership, advice and consultancy in nursing and in their
specialty areas. This is done at individual/group level of clients, healthcare providers and
organizational management. As professional leaders, Clinical Nurse Specialists increase the
efficiency of patient care processes and the effectiveness delivering such services through
leading and establishing various quality improvement projects (Carter et al, 2010). This is also
possible where CNSs are able to facilitate the creation and maintenance of special frameworks
for both policy and education in their area of jurisdiction (Canadian Nurses Association, 2008).
The CNSs in Canada play an important role in contributing to the development of provincial and
territorial healthcare policies. They also play an important leadership role in advanced nursing
practice as members of different research teams as well as in multidisciplinary nursing teams.
CNSs while taking part in research projects advocate for the rights of patients and families
involved in order to ensure ethical considerations are taken care of by the research teams (Fulton
et al, 2014). They are positive role models to their junior colleagues as they work towards
developing themselves and others in the nursing environment. As leaders, CNSs carry out their
activities in line with relevant legislation, procedures and policies which affect nursing practice.
Further, their professional leadership is seen when they conduct nursing practice in ethically
justified ways.

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
Nurse Practitioner
A Nurse Practitioner also practices professional leadership as is the case for Clinical
Nurse Specialists. NPs offer special leadership in managing of clinical care as they are not only
resource persons but also educators and role models. They are preceptors, mentors and coaches
to their colleague nurses, health-care team members and student nurses within their areas of
practice. As leaders, Nursing Practitioners articulate and promote their role to patients,
healthcare providers, the public, policy makers and to the social and/or public service sectors
(Canadian Nurses Association, 2008). They also advocate for and participate in the creation of
organizational environments which support safe client-care, professional growth and
collaborative practice. Further, Nurse Practitioners guide, initiate and provide professional
leadership in establishing and implementing standards, guidelines for practice, quality assurance,
education and relevant important research initiatives.
Conclusion
In conclusion, the discussion above provides a clear definition of the roles of the CNSs
and the NPs in Canada according to the Canadian Nursing Association. While the roles differ in
regard to autonomy in offering comprehensive care and specifics in the provision of direct care;
they all play major roles as professional leaders, educators and promoters of evidence-based
nursing practice. Their common ground is that they must first be Registered Nurses bound to a
common code of ethics, who are leaders, consultants, educators and advancers of evidence based
practice. The discussion thus outlines their specific differences and similarities in line with the
SNAP conceptual framework.

COMPARING NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS IN
CANADA (SNAP MODEL)
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