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.
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What Does a Clinical Nurse Specialist Do?
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:
- Providing or assisting with direct patient care
- Teaching nurses and staff
- Leading evidence-based practice projects
- Educating patients and their families and community members
- Precepting nursing students
- Conducting or assisting with research
- Attention to detail
- Communication and critical thinking skills
Where Do Clinical Nurse Specialists Work?
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.
- Hospital – Acute Care
- CNSs direct patient care, manage acute care and improvement, and supervise and educate nursing staff.
- Academic Health Center – Acute Care
- CNSs provide acute care consultation, implement evidence-based practice, and evaluate nursing students.
- Nursing Education – Academia
- CNSs lecture and instruct courses, design curriculum, and conduct research on best practices.
What Is the Difference Between a Clinical Nurse Specialist and a Nurse Practitioner?
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.
Clinical Nurse Specialist
- Practice defined by care or problem type, medical specialty, and patient population
- Requires a master’s or doctor of nursing practice (DNP)
- Earns an average annual salary of $91,300
- Duties include expert consultation, evidence-based practice application, healthcare administration, system and patient outcome improvement, and teaching
- Practice defined by patient population
- Requires a master’s or DNP
- Earns an average annual salary of $114,510
- Duties include direct patient care, primary care diagnoses, health assessments, and treatment, prescribing medications (if state law permits), promoting disease prevention and education, and diagnostic testing
How to Become a Clinical Nurse Specialist
The steps listed below outline the process to become a CNS. 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.
Graduate with a bachelor of science in nursing (BSN).
A BSN qualifies nurses
to sit for the National Council Licensure Examination for RNs (NCLEX-RN) and earn their RN license. Most programs take four years to complete, but some students may qualify for accelerated options.
Pass the NCLEX-RN Exam to receive RN licensure.
Nursing school graduates typically take the NCLEX-RN
about a month after completing their program. RN licensure allows nurses to obtain entry-level clinical work experience.
Apply to an accredited CNS program.
Graduate school is the time to select a clinical specialty area. Admission generally requires an RN license with a year of clinical experience, a BSN, and program-specific prerequisite coursework.
Graduate with an MSN or a DNP.
Students can complete their MSN in two years. MSN-holders in a DNP program would take an additional 1-2 years, while BSN-holders would take closer to six years. RN-to-DNP bridge programs offer streamlined options for qualified learners. Graduates apply with their state nursing boards for licensure as APRNs.
Apply for certification from the American Association of Critical-Care Nurses or the American Nurses Credentialing Center.
Many state nursing boards and employers require CNSs to hold certification in their specialty area. Certification areas align with patient populations, such as adult-gerontology, pediatrics, and neonatal.
How Much Do Clinical Nurse Specialists Make?
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 Here
Frequently Asked Questions
Why should clinical nurse specialists earn a DNP?
The 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.
What are the most popular certifications for clinical nurse specialists?
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%).
Can clinical nurse specialists prescribe medication?
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.
Where do NNPs work?
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.
Resources for Clinical Nurse Specialists
National Association of Clinical Nurse Specialists
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 Cost Analysis Toolkit
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.
American Association of Critical-Care Nurses Certifications
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.
American Nurses Credentialing Center Certification
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
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.