Clinical nurse specialists (CNSs) belong under the umbrella of advanced practice registered nurses (APRNs). APRNs comprise highly trained nurses with a master’s or doctoral degree and specialty expertise. These professionals command high salaries and ample job opportunities.
CNSs provide patient care in a specialty area, including adult-gerontology, family practice, neonatal, pediatrics, psychiatric mental health, and women’s health. They collaborate with other nurses and medical staff, serving largely in leadership roles such as nurse educators, researchers, advisors, and policy advocates.
CNSs often perform the following responsibilities:
More than a third of CNSs work in hospitals with acute care patients, nearly 30% find employment in academic health centers, and 10% choose nursing education in academia. The list below highlights typical roles and responsibilities.
CNSs direct patient care, manage acute care and improvement, and supervise and educate nursing staff.
CNSs provide acute care consultation, implement evidence-based practice, and evaluate nursing students.
CNSs lecture and instruct courses, design curriculum, and conduct research on best practices.
While their duties may overlap, the differences between CNSs and nurse practitioners (NPs) lie in their practice focuses. Generally, NPs work on teams of healthcare providers to perform advanced nursing care. CNSs manage, educate, and facilitate safe and optimal practices within healthcare systems.
The steps listed below outline the CNS process. Although a master of science in nursing (MSN) is the current minimum degree, the National Association of Clinical Nurse Specialists (NACNS) endorses a shift to the DNP by 2030.
PayScale lists the average base salary for CNSs as $91,300 per year. Bonuses and other benefits, if offered, bring the total pay amount to $60,000-$125,000. The U.S. Bureau of Labor Statistics reports a median annual salary of $117,670 for APRNs and references CNSs as being equivalent to APRNs. A 2018 National Sample Survey of registered nurses shows a median clinical nurse specialist salary of $95,720.
Location impacts salaries. According to PayScale, CNSs in Los Angeles earn 33% more than the U.S. average, followed by New York City (27%) and Seattle (20%). However, Milwaukee CNSs make 8% less than the national average.
Find State-Specific Salary Data HereThe NACNS position statement endorses the DNP as the minimum degree needed to become a CNS. The NACNS cites the future direction of nursing practice and increasingly complex patient needs as its reasons to advocate for doctoral-level advanced practice nurse training.
According to NACNS, adult health/gerontology is the most popular certification specialty, with more than 75% of CNSs opting for this credential. The remaining specialties include pediatrics (9%), family practice (5%), psychiatric/mental health (4%), women’s health/gender specific (4%), and neonatal (3%).
State laws determine whether and how CNSs can prescribe medication. A number of states allow independent prescriptive authority, but some only permit psychiatric CNSs to prescribe independently. Many states require supervision by or a collaborative agreement with a physician; others do not allow CNSs to prescribe at all.
The Accreditation Commission for Education in Nursing and the Commission on Collegiate Nursing Education are the primary organizations that regularly evaluate CNS training curriculums to ensure they provide a high-quality education that complies with licensing and certification standards. State licensure and certification boards along with many employers require degrees from accredited programs.
NACNS hosts a national conference, posts news briefs and job listings, provides insurance discounts, and publishes an online journal and newsletter for its CNS membership. Nursing students can join at a discounted rate. Other membership levels include practicing CNS, retiree, and associate.
NACNS' toolkit serves as a business guide for CNSs, offering strategies for implementing cost-analysis tools to quantify and describe the contributions CNSs make to healthcare improvement. The guide includes a cost-analysis process checklist, a comprehensive literature review, resources, and frequently asked questions.
AACN offers certification in several areas for the adult, adult-gerontology, pediatric, and neonatal patient populations, including acute/critical care nursing, acute/critical care knowledge professional, progressive care nursing, and CNS wellness through acute care. It also offers credentials in TeleICU acute/critical care nursing and adult cardiac medicine and cardiac surgery.
ANCC's certification options for all nurses include an adult-gerontology clinical nurse specialist credential. Candidates with an RN license, a graduate nursing degree from an accredited adult-gerontology CNS program with 500 supervised clinical hours, and listed prerequisite coursework can apply to take the 3.5-hour exam.
Deborah Weatherspoon, Ph.D., RN, CRNA is an advanced practice nurse. Weatherspoon graduated with a Ph.D. from the University of Tennessee in Knoxville. She is currently a university nursing educator and has authored multiple publications, presenting at national and international levels about medical and leadership issues. She enjoys walking, reading, traveling to new places, and spending time with her family.
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