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Nurses interested in shaping the future of the profession can do so either as a clinical nurse leader (CNL) or a clinical nursing specialist (CNS). These two positions lead implementing and evaluating nursing practices that improve the patient care effectiveness and efficiency.
While the roles are similar in their goals, the two positions are distinct when bringing nursing deeper into the 21st century. This guide details the differences between these similar-sounding roles. Continue reading to learn more about the specific responsibilities of a CNL and CNS.
CNL and CNS Key Similarities and Differences
What is a CNL?
The American Association of Colleges of Nursing (AACN) created the CNL position to address the need to improve patient outcomes and increase the quality of care. CNLs tend to work in care coordination, transitions of care, risk assessment, and quality improvement.
What is a CNS?
CNSs are considered expert clinicians who have advanced education and training in specialized areas of nursing such as pediatrics, women’s health, geriatrics, psychiatry, oncology, or pain management.
CNLs and CNSs are both advanced clinicians who earned a master of science in nursing (MSN). Nurses in both roles can choose to work in a variety of practice settings with diverse populations.
CNLs are classified as generalists who keep the big picture in mind. They focus on implementation of new and best practices to help as many patients as possible. Conversely, CNSs focus on a specific specialty. As such, CNSs sometimes work directly with patients in a clinical capacity.
Duties and Responsibilities
CNLs and CNSs both have vital roles within the healthcare community. While their responsibilities differ, they share a goal. Their objective is to provide nurses insight into the newest and best medical practices, while making sure they deliver care in a safe, efficient, and effective manner. They incorporate research-based techniques to help the medical community provide the most advanced services.
What Does a CNL Do?
As generalists, CNLs often work within a research capacity, following a cohort of patients while analyzing and implementing evidence-based best practices in the areas of quality, safety, risk assessment, and cost-efficiency.
CNLs can work with all patient populations within a variety of practice settings. Some CNLs operate under the title of nurse manager of a nursing unit. Overall, some of the major responsibilities of a CNL include the following:
- Design, implement, and evaluate the delivery of patient care plans
- Incorporate data from evaluations to update procedures and practices
- Collaborate with physicians and other providers to discuss and develop care plans for patients
- Incorporate information systems and technology to improve healthcare outcomes
- Anticipate and assess risks to patient care to ensure safety protocols are in place and effective
What Does a CNS Do?
The primary focus of a CNS is to improve the healthcare system from within the medical community. CNSs do this by making sure nurses can safely and efficiently take care of their patients. They evaluate programs and facilities to identify ways nurses can positively influence the delivery of care. Overall, some of the major responsibilities of a CNS include the following:
- Provide consultation services, monitor care, and evaluate general delivery of healthcare
- Optimize patient care by working directly with the nursing staff
- Evaluate procedures and review alternatives while educating staff on new practices
- Provide expertise and support to the nursing staff
- Educate patients and their families on the best ways to manage medical conditions
Education and Certification
The paths to earning either a CNS or CNL certification are similar. Individuals must already hold a bachelor of science in nursing (BSN), be licensed to practice as a registered nurse (RN), and possess at least 2 years of experience in their chosen specialty. Both are also required to complete advanced study in their respective area while passing the appropriate certification exams.
How to Become a CNL
Becoming a CNL begins with earning a BSN and obtaining an RN license. RNs must then enroll in an MSN program with a CNL specialization accredited by the AACN. Nurses with an associate degree in nursing (ADN) need to earn their BSN before enrolling in an MSN program, or complete an RN-to-MSN program for CNLs.
Upon completion of their graduate program, RNs must pass the certification exam offered by ACCN's Commission on Nursing Certification to qualify for certification. The content of the exam focuses on clinical outcomes management, care environment management, and leadership. Once they have earned their certification, CNLs must renew their license every five years.
How to Become a CNS
To become a CNS, nurses must first become an RN through the completion of a BSN program. CNS programs are offered at the graduate level and require nurses with an ADN to earn their BSN before being accepted into a CNS program. Prospective CNS should also have at least 2 years of experience in their desired specialty to be eligible for most CNS programs.
Interested nurses should apply to programs accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). Once in the program, nurses can choose from a variety of specialties including intensive care, acute care, medical-surgical, oncology, psychiatric and mental health, gerontology, or pediatrics.
Upon completing an MSN program and accumulating 500 faculty-supervised clinical hours, graduates are eligible to take the CNS certification exam administered by the ANCC. The content of the exam differs based upon the nurse's chosen specialty. Once they have earned their certification, CNSs must renew their license every five years.
Salary and Career Outlook
Both CNLs and CNSs have a variety of professional opportunities available amongst several different populations in a variety of settings, all of which influence their pay. As a generalist, CNLs should expect an annual wage higher than the average RN salary. CNSs can anticipate an even higher annual wage with a projected growth rate nearing 50% between now and 2030.
Average Annual CNL Salary
Average Annual CNS Salary
CNL Salary and Career Outlook
According to Payscale, an average annual CNL salary comes to $83,460 per year; however, base earnings can range between $65,000 and $109,000 depending on experience, practice setting, and location.
States such as California, New York, and Massachusetts provide some of the highest-paying positions, while the need for CNLs in long-term care facilities and home health agencies also offer higher wages.
CNLs are currently in high demand, especially due to the increased dependency on data and the evolution of medical technology. While the Bureau of Labor and Statistics (BLS) does not track CNLs specifically, they project a 9% employment increase for RNs through 2030.
CNS Salary and Career Outlook
According to PayScale, the average yearly salary for a CNS is $93,930 with a base salary that can range from $70,000 to $121,000 depending on the nurse's specialty. The top CNS specialties that net nurses some of the highest wages include working in intensive care, acute care, or medical-surgical care. Geographically, CNSs who work in larger cities tend to earn higher salaries than those in small communities.
As advanced practice registered nurses (APRNs), CNLs are generally in high demand. While the BLS does not track CNLs specifically, they project a 45% employment increase for APRNs through 2030.
CNL vs. CNS: Which Career is Right For Me?
While there are some similarities between a CNL and CNS, each role provides nurses with different opportunities. According to the AACN, both the CNL and CNS deliver care in a variety of settings, develop a comprehensive view of patients, advocate for everyone involved in making healthcare decisions, and develop new and effective ways to increase the standard of care.
The CNL functions as a generalist who supervises nurses. At times, they will work directly with patients. They are often in charge of managing the entire nursing staff, making sure they are up-to-date on the most effective and efficient standard of care.
CNS may also be responsible for onboarding new staff, managing nurse schedules, ensuring safe staffing levels, and other important managerial responsibilities. Conversely, the CNS serves as a clinical professional with expertise in a specific area of medicine. They are the ones who often provide the CNL with information regarding best practices.
Ultimately, each position's responsibilities can help nurses determine which role works best for them. Becoming a CNS is ideal for those interested in data and research that impacts nursing strategies. Those who are more interested in working more directly with patients and overseeing a nursing staff would do well as a CNL.
Page last reviewed: April 8, 2022
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- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. (2022). Registered Nurses.
- What is a CNS? (2022).
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