We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. Respondents ( = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs ( < 0.001) and SNs ( < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership ( < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement. Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.