How to Become a Clinical Nurse Specialist

NurseJournal Staff
Updated April 30, 2024
Clinical nurse specialists are in high demand. Learn how to become a clinical nurse and how to choose the right CNS specialization for you.
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Clinical nurse specialists are advanced practice nurses (APRNs) who specialize in a particular field of practice or patient population, such as cardiology or pediatrics.

Clinical nurses are in high demand, like all APRN nurses; earn an above-average annual salary; and can choose from a wide variety of specializations. If this sounds interesting to you, find out how to become a clinical nurse.

Clinical Nurse Specialist Overview

Clinical nursing specialties can include cardiology, diabetes, pediatrics, mental health, wound care or emergency department care, to name a few. They work in a variety of settings, depending on their specialties, but most often in hospitals. Like all APRNs, they have greater professional autonomy than RNs and can diagnose conditions and prescribe treatments. However, unlike other APRN specialities, they focus on consolation, education, leadership, rather than direct patient care.

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Steps to Becoming a Clinical Nurse Specialist

To become a clinical nurse specialist, you must become an APRN by earning an MSN from an accredited program and pass a certification examination in a general area, either adult/gerontology, pediatrics, or neonatal. After this, most employers will require additional certifications, based on your department.

Earn a Bachelor’s Degree in Nursing (BSN)

First, you will need a BSN degree (or if you have an ADN, enroll in an RN-to-MSN bridge program). This typically takes four years. Requirements vary by school, but usually require at least a 3.0 GPA and passing grades in biology and math.

Pass the NCLEX-RN Exam to Receive RN License

Once you graduate from nursing school, you will need to pass the NCLEX-RN examination, a multi-hour multiple choice examination. You will also need to apply to your state for an RN license and pass a background check. Certain criminal convictions may prevent you from being licensed; check your state regulations.

Gain Experience as a Registered Nurse

Most MSN programs require or strongly prefer at least two years of full-time experience (or the part-time equivalent) as an RN. This also helps you identify your preferred specialty and make sure that it’s a good fit, and an opportunity to find mentors and build your professional network.

Earn a Master’s Degree in Nursing (MSN)

The next step in becoming a CNS nurse is earning an MSN or DNP from an accredited program. This typically takes two years for an MSN and at least three for a DNP, studying full-time. Most MSN programs require at least a 3.0 GPA and strong references, as well as RN experience.

Apply for CNS Certification in Your Desired Specialty

You will need to pass the CNS certification examination from the American Association of Critical-Care Nurses (AACN)’s Certification Corporation in either adult/gerontology, pediatric, or neonatal clinical nursing. Most employers also require or prefer other specialty certifications, which also require examinations. The National Association of Clinical Nurse Specialists (NACNS) has more information on certification.

Clinical Nurse Specialist Education

When reviewing programs to find the right one for you, consider factors such as cost and financial aid, location or online options, admissions requirements, board examination pass rates, and reviews and recommendations.

Bachelor of Science in Nursing

For most CNS nurses, earning a BSN is the first step in their education. There are a variety of online, hybrid, and on-campus programs. Online and hybrid programs offer the same degree as on-campus programs. It’s vital to choose an accredited school, since most MSN programs only accept students from accredited programs and most employers will only consider graduates of accredited programs.

  • Admission Requirements: High school diploma or GED
  • Program Curriculum: Science, anatomy, disease and injury treatment and prevention, nursing practices, communications, public health, legal and ethical aspects.
  • Time to Complete: Typically four years.
  • Skills Learned: Administering medications, taking vital signs and conducting medical tests, performing procedures such as wound cleansing and treatment, intubation, and using medical equipment.

Master of Science in Nursing

You must have an MSN or DNP to become a CNS. If you don’t have a BSN but do have an ADN or a bachelor’s in another field, many schools offer bridge programs. These usually take less time and disruption than completing a BSN program. Again, an accredited program is vital to your success.

  • Admission Requirements: BSN or ADN, RN, at least a 3.0 GPA
  • Program Curriculum: Advanced topics in disease and injury treatment and prevention, pharmacology, nursing education, research, leadership.
  • Time to Complete: Typically two years of full-time study.
  • Skills Learned: Diagnosing and treating conditions, prescribing medications, leading healthcare teams, educating nurses, researching evidence-based practices.

Choosing a CNS Specialization

To become a CNS, you will choose a primary population specialization of either adult/gerontology, pediatric, or neonatal nursing and must pass the certification examination for your chosen area. However, many hospitals or health systems, especially the larger ones, may require or strongly prefer additional specialty certifications, such as cardiology nursing.

Which population specialization you choose will depend on your interests and goals. While adult/gerontology serves the widest variety of patients, demand is high for all three specialties.

Adult-Gerontology Clinical Nurse Specialist

These CNSs educate and consult with nurses who treat adult patients, from older teenagers to seniors, in a variety of settings. The ANCC and AACN both certify this specialty.

Pediatric Acute Care Clinical Nurse Specialist

Pediatric CNSs consult with and educate pediatric nurses who care for young children, from infants through early teens. They most often work in hospitals or private practices. The AACN certifies this specialty.

Neonatal Acute Care Clinical Nurse Specialist

Neonatal CNSs consult with and educate NICU nurses who provide care for newborn infants, typically in hospitals or birthing centers. The AACN certifies this specialization.

Clinical Nurse Specialist Licensure

To become a CNS, you must first earn your RN license, pass your certification examination, and gain RN experience. Then, you can earn an MSN and pass your board certification exam to earn CNS licensure. You apply for your licenses with your state board of nursing, while examinations are administered by private organizations.

To earn an RN license, you must graduate from an ADN or BSN program and pass the NCLEX-RN examination, a multi-hour multiple choice examination. To maintain your license, you must participate in accredited continuing education, such as attending conferences, classes, or webinars, or reading and passing an examination on professional literature articles.

Once you graduate from your MSN program, you will need to apply for CNS licensure. Be aware that your practice authority as a CNS will vary from state to state. Some states allow CNSs to diagnose and treat patients and prescribe medications independently, but many require CNSs to collaborate with a physician. Like other nursing credentials, you will maintain your license through continuing education.

Working as a Clinical Nurse Specialist

Once you’ve received your license, you can start work as a clinical nurse specialist. Use your professional and alumni networks and take advantage of professional association job boards to post your resume and find openings.

Clinical nurses work in a variety of settings, including hospitals and health systems, private practices, clinics, and government facilities. Their work involves precepting (teaching and mentoring) students, consulting with nurses, working on evidence-based projects to improve nursing, helping facilitate interprofessional collaboration, and leading the implementation of changes in nursing best practices. The BLS projects 45% growth for all APRNs, and CNS nurse jobs are likely to grow at approximately the same rate. Also like all APRNs, you can expect to earn an above-average salary, though the specifics will vary by location and experience.

Frequently Asked Questions About Becoming a Clinical Nurse Specialist

How long does it take to become a clinical nurse specialist?

It typically takes at least six years, four years for a BSN and two for an MSN. If you already have an ADN, you may be able to enroll in an RN to MSN program, which will take three years. If you study part-time or want to earn a DNP, you will need longer.

What qualifications do I need to be a clinical nurse specialist?

To become a clinical nurse specialist, you will need an MSN or DNP from an accredited program and must pass the specialty board certification examination and earn your state license. Most MSN programs require at least a 3.0 GPA. Some employers may require or strongly prefer additional specialty certifications.

Can clinical nurse specialists prescribe medication?

The specific rules vary state by state, but most states do not allow CNSs to prescribe medication without physician involvement. In 19 states, CNSs can prescribe medication, though some states may require additional education. In 23 states CNSs have full-practice authority. In reduced or restricted practice authority states, you may need a physician’s supervision to prescribe medications or may not be able to.

What is the difference between CNS and NP?

The difference between a CNS and a nurse practitioner is where each role fits into the care team and their typical responsibilities. Both are APRNs, but NPs usually engage in more direct nursing than clinical nurse specialists and often serve as primary care providers. Clinical nurse specialists spend more time on precepting students, consulting with nurses, and improving evidence-based practices.

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Reviewed by:

Portrait of Shrilekha Deshaies, MSN, CCRN, RN

Shrilekha Deshaies, MSN, CCRN, RN

Shri Deshaies is a nurse educator with over 20 years of experience teaching in hospital, nursing school, and community settings. Deshaies’ clinical area of expertise is critical care nursing and she is a certified critical care nurse. She has worked in various surgical ICUs throughout her career, including cardiovascular, trauma, and neurosurgery.

Shri Deshaies is a paid member of our Healthcare Review Partner Network. Learn more about our review partners here.

Page last reviewed November 12, 2021


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