What is a Clinical Nurse Specialist?

Are you an RN who has dreamed of getting a graduate-level education in a challenging and rewarding area of medicine? One of the most dynamic careers you can have is that of Clinical Nurse Specialist. Read on to find out more.

What is a clinical nurse specialist?

One of the graduate-level registered nursing specialties is that of a clinical nurse specialist or CNS. Not only does a CNS have a master’s degree in nursing (MSN), but also has a certification in this interesting and challenging specialty niche area of nursing.

What does a clinical nurse specialist do?

Clinical nurse specialists typically focus on education or research. They often tend to be consultants as well. However, clinical nurse specialists can fulfill traditional nursing roles, such as ordering medical tests, patient exams, diagnosing illnesses, providing medical treatments and treating disease. Clinical nurse specialists may also perform the following roles within a healthcare organization:

• Promote wellness through education
• Conduct research in a specialized area
• Provide policies and procedures and standards of care based on evidence-based research
• Provide clinical expertise
• Utilize medical record data to improve health care services
• Review and revise treatment plans
• Educate and mentor other nurses
• Fulfill supervisory or managerial roles

If you are looking for more regular business hours, CNS nurses tend to work a normal business day, but depending on the healthcare setting you work in, you might work occasional evenings, weekends or holidays, particularly if you are working in a hospital setting.

You can work in direct patient care roles, but many CNS nurses work in research, consulting, or administrative or supervisory positions that do not involve direct patient care. With this career, you will definitely have a wide variety of choices.

Why is a clinical nurse specialist so important?

Clinical nurse specialists serve important roles as nurse educators and mentors. They tend to work in healthcare organizations to promote change based on current evidence-based research and information. A CNS will often educate other nurses regarding the best health care delivery strategies. In short, these nurses apply their vast experience in patient care to improve policies and practices within healthcare organizations.

A CNS uses a problem-solving approach and incorporates the best evidence to date from patient data, published studies and physician and nurse expertise to make a comprehensive decision regarding how to improve patient care. CNS nurses are integral to clinical decision-making.

The CNS role has been an integral part of healthcare for more than six decades and is recognized as a licensed professional healthcare occupation that contributes evidence toward the best health care service trends.

How to become a clinical nurse specialist

Education Requirements and Training

A clinical nurse specialist is one specialization available to Advanced Practice Registered Nurses (APRN). These specialty nurses have additional responsibilities above those of a registered nurse (RN). The APRN group includes not only the CNS specialty, but also Certified Nurse Practitioners (NP), Certified Registered Nurse Anesthetists (CRNA), Clinical Nurse Specialists (CNS), or Certified Nurse Midwives (CNM).

A CNS must complete a master’s program in nursing. Many actually go on to obtain a doctoral degree (Doctoral Nursing Program or DNP), particularly if research is their desired focus.

The first step is to obtain a bachelor’s degree in nursing (BSN) from an accredited program. Common accrediting programs are the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). If you are an RN but don’t have a BSN, the RN-to-BSN programs generally take two years to complete, but there are accelerated options as well. There are even BSN programs offered for those who already have a bachelor’s degree in a non-nursing field. You must take the NCLEX-RN exam to become licensed as an RN and maintain the license in good standing while you pursue an advanced education.

An MSN generally takes two years to complete when a BSN is your starting point. If you want to focus on research, it is generally recommended that you continue on with your education by obtaining a DNP. BSN-to-DNP programs are available and take about four years to complete. The traditional MSN-to-DNP takes one to two years.

These days, nursing students have many educational options, including traditional in-classroom settings as well as clinical nurse specialist programs online and hybrid programs. Research your desired schools to see what they offer. Many schools offer certain specialty tracks for a CNS, including pediatrics, gerontology, mental health, community health, women’s health and other specialties. It is important to note that not all schools offer all specialty tracks, so do your research.

Most CNS degree programs cover areas like advanced pathophysiology and health assessment, detailed pharmacology and the latest evidence on health promotion and health maintenance. Expect to also have core classes focusing on how to apply research to practice, ethics and statistical methods.

After completing the MSN, a CNS nurse can take additional certifications offered by the American Nurses Credentialing Center (ANCC). CNS nurses often specialize in pediatrics, adult health, gerontology, women’s health or mental health. To obtain these certifications, your MSN or doctorate must be complete and you must have a current RN license. You must also have experience as a CNS, having worked at least 500 hours in supervised clinical roles in the population that you choose to specialize in. To obtain the certification, there is an exam. The certification is valid for five years.

CNS nurses also often obtain other certifications offered by other accrediting organizations such as the American Association of Critical-Care Nurses (AACN). For example, certifications are available in acute care in populations like neonatal, pediatric or adult patients. It is very important to choose nationally accredited programs from organizations like the ANCC and AACN because you must make sure that the certificates meet the state board of nursing requirements for your particular state.

To obtain a state license, most states require that you submit proof of a completed graduate degree program in the form of a transcript, and provide verification of your RN license and your new certification(s).

Clinical Nurse Specialist Salary & Career Outlook

The U.S. Bureau of Labor Statistics reports on career outlooks. While the agency does not have statistics specifically for the CNS, they do have statistics for the overall advanced practice registered nurse (APRN) outlook. These specialty nurses are very much in demand, with growth in clinical nurse specialist jobs expected to rise approximately 30 percent in the next few years.

Several factors are driving the growth. First, nearly one-third of all current RNs in America are at retirement age, so replacements are sorely needed. Second, there is an overall physician shortage in the United States, particularly in rural and other underserved areas. APRNs can nicely fill these roles. Third, there is a huge demand for healthcare, which is being offered in many non-traditional settings outside of hospitals, like acute care centers and emergency clinics. Fourth, the U.S. has an aging population and more healthcare is needed to cover them, particularly CNS nurses who can focus on gerontology research and improving patient outcomes. Finally, there is an emphasis on wellness, an area where CNS research is particularly important.

CNS nurses are the second largest specialty group within the APRN segment. Right now in the United States, there are about 60,000 CNS nurses, most of whom experience a high degree of job satisfaction. CNS nurses are highly sought after by a host of employers from many different industries. You can expect to earn between $99,000 and $109,000, with the median salary around $99,000. Of course, salaries are variable depending on where you work, your experience level, your employer and additional certifications you may hold.

Top 5 Specialties

Clinical nurse specialists have so many options when it comes to choosing a specialty. First, you can choose a specialty population, like neonatal, pediatrics, geriatrics or a focus on women’s health.

CNS nurses can also choose a specialty healthcare setting, such as the emergency room or critical care setting, home health or surgical center. Many CNS nurses choose to focus on a specialized area of medicine, such as oncology, neurology or orthopedics, or on a specific disease such as diabetes or infectious diseases. As a CNS, you can also focus on particular types of health problems such as chronic pain management, wound care or rehabilitation, or a specific area of care such as public health or psychiatric care.  You can also overlap specific care areas, by working in pediatric neurology or geriatric orthopedics, for example.

Many CNS nurses go on to obtain a doctorate to become expert clinicians. They study a curriculum that includes advanced science, evidence-based research and that’s rich in clinical practice. Many programs are designed to provide practice opportunities in a specialty clinical setting like hospitals, state or federal agencies or hospice programs. Some DNPs are specifically designed to provide experience with urban, rural or underserved patients. Most DNP programs do allow you to customize the program to meet your goals for specialization.

When choosing a specialty, make sure your program has curriculum recommendations from organizations like NACNS and the AACN.

Here are the top specialties:

• Adult Gerontology Clinical Nurse Specialist
• Neonatal – Clinical Nurse Specialist
• Pediatric – Clinical Nurse Specialist

Clinical Nurse Specialist Resources

Clinical Nurse Specialist FAQs

What does evidence-based practice mean?

Evidence-based practice is an approach that uses evidence from patient data and research studies to make decisions about patient care. All clinicians must have knowledge about evidence-based practice and know about the different levels of evidence that have been developed by the healthcare industry. Evidence-based information ranges from strongest (Level A) to the weakest (Level C) so that clinicians know how much importance to place on various reports and data. For example, level A evidence comes from carefully constructed randomized control trials which are the gold standard in study design. It can also be based on clinical practice guidelines.

What kind of research can I expect to do?

A CNS is an advanced nursing clinician, researcher and educator all in one. Your scope of research can be population-based, disease-based, specialty-based; you can customize your research to fit your interest.

Can I teach other nurses as a CNS?

There are teaching roles in family and patient education or you can teach other nurses or members of the healthcare team. Many CNS nurses enjoy becoming nursing school instructors. Some CNSs go on to obtain a doctorate in education (Ed.D.) to work as an official nurse educator, usually specializing in a focus area like diabetes or a population like geriatrics.

Can I hold a management position as a CNS?

Absolutely. Many CNSs become nurse managers or nurse leaders. A nurse leader may obtain extra education in leadership skills and usually leads an effort to improve patient care outcomes for a specific patient population.

Can I change to another specialty later in my CNS career?

During your CNS program, you will choose a specialty track, such as mental health or pediatrics. The ANCC offers the certification exam in each specialty. Changing to another specialty is generally difficult, because the certification requires a minimum number of clinical hours while you are in school. For example, for the pediatric specialty, a CNS must have at a minimum 500 faculty-supervised hours working specifically with the pediatric population.

Having said that, a CNS can more easily change subspecialties. For example, if your specialty is pediatrics, it is easier to change from pediatric cardiology to another pediatric subspecialty like neurology. In another example, a CNS certified in acute care can more easily change settings, let’s say from the ER to an intensive care unit.

Helpful Organizations, Societies & Agencies

• American Nurses Credentialing Center (ANCC)
• American Association of Critical Care Nurses Certification Corporation
• National Association of Clinical Nurse Specialists
• American Association of Colleges of Nursing
• Clinical Nurse Specialist: The International Journal for Advanced Nursing Practice

Clinical Nurse Specialist Scholarship

Looking for a way to become a CNS? Check out our scholarship here!

List of Clinical Nurse Specialist Programs

Take a look at our list of the best MSN programs in the United States!

What Now?

Do you like what you’ve read so far? Does the thought of evidence-based practice really appeal to you? Does clinical research sound exciting? Or perhaps you have always wanted to be an educator, teaching other nurses about the latest best practices? Does the idea of collaborating with a team of fellow healthcare professionals sound very appealing? Are you a leader who wants to further develop your leadership skill set?

Research is always changing and that means the practice of healthcare will too, so if you are a nurse who wants to be on the cutting edge of research and implement the latest evidence to improve patient care, being a CNS is a great choice. Contact us today to get started.