Nurse Practitioner (NP) vs. Clinical Nurse Specialist (CNS) vs. Clinical Nurse Leader (CNL)

There are many different types of nurses, each with its own specific focus and training. Three advanced roles include nurse practitioner (NP), clinical nurse specialist (CNS), and clinical nurse leader (CNL). All of these nurses have completed additional training beyond what is required to become registered nurses (RNs). However, the focus of this additional training can be quite different, and the duties and roles vary widely. 

However, all three jobs have in common that they must first be registered nurses and then complete a master’s degree or higher.

Both nurse practitioners and clinical nurse specialists are advanced practice registered nurses with a high degree of responsibility in their practice. They can diagnose diseases, provide treatment, and even prescribe medications. The level of autonomy they have will vary by state.

On the other hand, clinical nurse leaders do not have additional practice authority but are registered nurses with advanced administrative training and can coordinate staffing and patient care. 

What is a Nurse Practitioner (NP)?

A nurse practitioner has completed a graduate-level program and passed a national certification exam. Nurse practitioners provide many of the same services as physicians, including diagnosing and treating illnesses, ordering and interpreting tests, and prescribing medication. They may also provide wellness care, such as immunizations and health screenings. 

In some states, nurse practitioners must be supervised by a physician, while in others, they have full autonomy to practice. Nurse practitioners can choose a specialty, including pediatrics, gerontology, neonatal, psychiatry, and women’s health. 

NP Education

All nurse practitioners must hold a master of science in nursing or a doctor of nursing practice degree. Some states also require nurse practitioners to complete a postgraduate clinical fellowship. The education completed will be in a chosen specialty, such as family practice, pediatrics, psychiatry, or women’s health

The program should be accredited by the Commission on Collegiate Nursing Education (CCNE, the Accreditation Commission for Education in Nursing (ACEN), or the Accreditation Commission for Midwifery Education (ACME), as this is required for national certification and by many state licensing boards. 

NP Certification and Licensing

There are several national certifications nurse practitioners can earn. The primary certifying agencies are:

  • American Academy of Nurse Practitioners (AANP)
  • American Nurses Credentialing Center (ANCC)
  • American Association of Critical-Care Nurses (AACN)
  • National Certification Corporation (NCC)
  • Pediatric Nursing Certification Board (PNCB)
  • American Midwifery Certification Board (AMCB)
  • Dermatology Nursing Certification Board (DNCB)
  • Nephrology Nursing Certification Commission (NNCC)
  • Orthopaedic Nurses Certification Board (ONCB)
  • Oncology Nursing Certification Corporation (ONCC) 

Requirements for certification will vary by agency, but will typically include completing an accredited graduate degree or post-master certificate in that specialty, having a required number of experience hours, and passing an exam. 

Nurse practitioners must also hold a license issued by their state’s nursing board to care for patients. Requirements to obtain a license will vary by state. The most common requirements are:

  • Complete a graduate degree in nursing or a post-master’s certificate from an accredited program
  • Pass a national certification exam and, in some jurisdictions, a jurisprudence exam
  • Have a clear background check and drug screening
  • A current unencumbered registered nurse license

What is a Clinical Nurse Specialist (CNS)?

Clinical nurse specialists are advanced practice registered nurses who are expert clinicians and work in specific areas of nursing. The main focus of a CNS is to improve patient care through clinical practice, research, and education. They often work with other healthcare professionals, such as doctors and pharmacists, to develop evidence-based treatment plans. In addition, CNSs provide direct patient care, depending on their area of specialty. For example, they may work with patients who have chronic conditions or are recovering from surgery. 

CNS Education

To work as a CNS, a registered nurse needs to have an accredited master’s of science in nursing or a doctor of nursing practice degree with a specialty in clinical nurse specialization. Alternatively, some CNSs who have already completed a master’s may earn a post-master’s certificate in clinical nurse specialization.

 It is essential that the program be accredited by the Commission on Collegiate Nursing Education (CCNE),  the Accreditation Commission for Education in Nursing (ACEN), or the National League for Nursing (NLN) Commission for Nursing Education Accreditation (CNEA) as this is required for certification. In addition, the program must include a minimum of 500 -supervised clinical hours. 

CNS Certification and Licensing

To be eligible for certification as a CNS, nurses must have completed an accredited nursing program and earned at least a master’s of science in nursing. In addition, they must pass the Adult-Gerontology Clinical Nurse Specialist Certification (AGCNS-BC) specialty examination through the American Nurses Credentialing Center (ANCC). The eligibility requirements include:

  • A current, active, and unencumbered RN license
  • An accredited master’s, post-graduate certificate, or doctor of nursing practice degree from an adult-gerontology clinical nurse specialist (AGCNS) program 
  • Three separate, comprehensive graduate-level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology
  • Completed course content in health promotion and/or maintenance and differential diagnosis and disease management

Clinical nurse leaders must also be licensed as advanced practice registered nurses by their state’s nursing board. Requirements will vary by state but typically include:

  • Complete a graduate-level nursing degree in their chosen specialty
  • Pass a national certification exam
  • A current, active, and unencumbered RN license
  • A clear background check 
  • Pass a drug screening

What is a Clinical Nurse Leader (CNL)?

Clinical nurse leaders are registered nurses who work in various settings, including hospitals, clinics, long-term care facilities, research centers, academia, and home health agencies. Their responsibilities vary depending on their place of employment but generally include coordinating patient care, developing and implementing policies and procedures related to patient care, providing mentorship to nurses and other healthcare professionals, and collaborating with other members of the healthcare team to provide quality patient care.

CNL Education

To work as a clinical nurse leader, registered nurses must complete a master’s of science in nursing, doctor or nursing practice, or a post-master’s certificate in clinical nurse leadership.  

Students should ensure the program they complete is accredited by a nursing accrediting agency recognized by the U.S. Secretary of Education that meets the AACN’s Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. This program must include 300 hours of practice as a CNL and at least 400 clinical hours in total.

CNL Certification and Licensing

The Clinical Nurse Leader (CNL) certification through the Commission on Nurse Certification (CNC) is the primary certification for this field. This certification demonstrates competency in care coordination, transitions of care, risk assessment, outcome measurement, quality improvement, and best practices implementation. To be eligible for this certification student must either be a graduate of or in the last term of an accredited clinical nurse leader master’s or post-master’s program and pass the certification exam. 

All clinical nurse leaders must be licensed registered nurses in the state where they practice. While requirements will vary by state, the most state expect the following qualifications:

  • Complete an accredited education nursing program 
  • Pass the National Council Licensure Examination- Registered Nurse (NCLEX-RN) exam
  • Have a clear background check and drug screening
Kimmy Gustafson

Kimmy Gustafson


Among her many diverse writing endeavors, Kimmy Gustafson has also lent her expertise to since 2020, providing insightful and engaging content about the significant role of education in shaping our future generations of nurse practitioners. Many of her pieces include interviewing experts on timely topics such as healthcare workplace violence and moral distress.

Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.