In my practice, we have nurse practitioner (NP) students all year round who come for their clinical rotations. I have had the opportunity to precept NP students from several universities. Therefore, I am familiar with their course objectives and understand the clinical knowledge base according to the semester where they are in the program.
This semester, I had an opportunity to precept a student from the clinical nurse specialist (CNS) area. This was my first time mentoring a student for advanced practice nursing outside of the NP program. At first, I wasn’t quite sure of her objectives. I wasn’t sure if I was the right mentor or preceptor for her. But once we reviewed the course objectives, I understood her learning goals and how I could guide her to meet those requirements. She said she had waited two and a half years for this clinical rotation placement. I could see her eagerness and enthusiasm to learn. She first shadowed me for a few days, and she knew the basics of the NP role and the nature of the workflow in the clinical setting.
Unlike NP students, she communicated her goals to me throughout the learning process. She proactively searched different topics referring to evidence-based practices. We had engaging discussions around several health conditions, referring to basic science and doing more research. She evaluated herself intermittently, where she was along the learning curve, and would tell me in what area she needed more practice before going to the next step. This made my precepting process easier. I could provide the learning she needed and knew she was benefiting from my preceptorship.
Toward the end of her clinical rotation, she was able to accomplish the following:
- Background for practice in sciences and humanities
- Prevent and improve population health
- Translate and integrate scholarship into practice
- Interprofessional collaboration for better health outcomes
- Understand advanced nursing practice from NP lens
As a clinical preceptor, this interaction allowed me to educate myself in a different area of advanced practice nursing. Advanced practice registered nurses are licensed independent practitioners educated and trained to practice within the standards established by the licensing body. There are four advanced practice registered nurse roles: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). There are differences in the NP and CNS practices depending on education, training, accreditation, and state regulations. Because both trajectories are advanced practice nursing, their methods may look similar on the surface but are distinctively different in the delivery of patient care. The following table illustrates the differences between the two advanced practice roles.
| Clinical Nurse Specialist | Certified Nurse Practitioner |
| Integrate care through three spheres of influence: patient, nurse, and system. | Deliver direct patient care in primary and acute care settings along the wellness-illness continuum. |
| Create an environment through system changes and mentorship that empowers nurses to develop evidence-based practices to eliminate patient distress and support ethical decision-making and diversity. | Practice autonomously in diverse areas such as family practice, pediatrics, internal medicine, geriatrics, and women’s healthcare. |
| Prepared to develop clinical practice guidelines based on best practices and conduct periodic reviews and modifications as necessary. | Prepared to diagnose and treat patients. They provide initial, ongoing, and comprehensive care. This includes ordering, performing, supervising, and interpreting laboratory and imaging studies. NPs prescribe medications and durable medical equipment and make necessary referrals. |
Traditionally, NPs were clinic-based, and CNSs were hospital-based. However, in recent years these roles have been seen in various areas of healthcare, working in collaboration. I learned how inter-collaboration between advanced practice registered nurses could help better understand and address the needs of the patients to improve health outcomes.
Kunta Gautam, MSN, MPH, CPNP-PC, is a pediatric nurse practitioner at Texas Children’s Urgent Care in Houston, Texas, USA. She is a member of Sigma’s Beta Beta Chapter (Houston).