Dear Editor:

I am currently completing my MSN as a community health clinical nurse specialist (CNS). I wondered when I began this program why there is a need for CNSs and nurse practitioners (NPs); I mean, why couldn't these two specialties be combined into one? After reading Dr. Lyon's article, "Why the CNS and NP Roles Should Not Be Blended in a Masters Degree Program," however, I realize this option would not be feasible.

NPs have a strong clinical focus. This is great because it provides the client with high quality care at a substantially lower cost than a primary care physician. Community health CNSs, however, are trained to have a broader community focus, especially with resource management in these ever financially-constricting times. The diverse focus of this form of CNS and the primary care focus of an NP would be very difficult to combine into one person. However, I do see where the collaboration of these two highly specialized but equally valuable forms of advanced practice nursing should be seamless.

As an example, an NP sees Joe. Joe needs complex care, some of which the NP can provide but some of which is referred out. The community health CNS can ensure that programs and systems are available to take over from the referral point to ensure Joe gets the special care he needs at the best price. The system should work so well that Joe's only concern should be getting well.

This example shows how having two separate specialties works in the best interest of both the patient and the payor. This type of treatment requires direct patient care and community healthcoordination efforts. It is clear to me these two specialties should not be combined but allowed to work within the system individually and interdependently. Therefore, I agree with Dr. Lyon's article which states in greater detail the reasons against combining these two advanced practice nursing specialties.

Pamela A. Assid, RN, BSN, Lt, USAF
Executive Officer, 90th Medical Group
F E Warren AFB WY

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