A clinical nurse specialist, or CNS, is a type of advanced practice registered nurse (APRN) with a master’s or doctoral degree and certification in a specialized area of nursing. A CNS is responsible for assessing, diagnosing, and treating patients. The scope of practice for clinical nurse specialists (CNSs) varies by state. CNSs also work as educators, researchers, and managers. A CNS can choose a specialty area based on one of the following:
Setting (such as emergency department, long-term care, specialty clinic)
Disease (such as cancer, diabetes, heart disease)
Population (such as children, women, adults)
Type of problem (such as stress, pain, wounds)
Type of care (such as rehabilitation, hospice, psychiatric)
What Does a Clinical Nurse Specialist Do?
A CNS utilizes evidence-based practice to care for patients and support healthcare systems. When caring for patients, a CNS may be responsible for:
Gathering medical histories from patients and/or caregivers
Performing physical exams
Ordering and analyzing tests from blood, urine, or other patient samples
Diagnosing patients based on history, exam, and lab results
Educating patients and creating plans of care
Prescribing medications or other treatments
Collaborating with other healthcare professionals
Assisting with or leading research studies
Teaching and observing student nurses
Demonstrating new equipment and procedures to coworkers
Other CNS roles may not include direct patient care or may be a blend of different types of responsibilities. CNSs also work as:
Expert resources for nurses caring for patients
Nurse educators in hospitals, clinics, and other settings
Researchers in their specialty
Consultants focused on improving healthcare delivery
Clinical nurse specialists rely on their experiences and education to guide their decision-making. CNSs have a strong foundation of clinical nursing skills in their field. Performing thorough exams, building relationships with patients, and using evidence-based practice are critically important skills. Excellent communication skills with patients and coworkers are essential. Successful CNS providers are able to collaborate with all members of the healthcare team, from nursing assistants to physicians. CNSs who choose a career as educators must be effective teachers and willing to constantly learn new techniques, equipment, and medications. The CNS then passes this knowledge on to staff members.
Like all advanced practice nurses, CNSs are required to complete ongoing education throughout their careers. In-person classes, skill demonstrations, and computerized testing are possible forms of continuing education. Each state has its own requirements for the number of hours required each year. Failure to obtain enough hours or complete certain classes would make a CNS ineligible to practice. CNSs may be responsible for reporting their own continuing education hours to their state board of nursing.
How Much Does a Clinical Nurse Specialist Make Per Year?
The National Association for Clinical Nurse Specialists conducts an annual census of registered CNSs in the U.S. Most respondents made between $75,001 and $150,000 per year. Pay will vary based on geographic location, care setting, experience, and specialty.
Clinical Nurse Specialist Salary
Median Annual Wage
Percentage
Less than $75,000
6.5%
$75,000 – $100,000
21.6%
$100,000 – $125,000
29%
$125,000 – $150,000
13.4%
More than $150,000
6.5%
The U.S. Bureau of Labor Statistics does not separately track CNS data. Looking at another advanced practice nurse position, such as nurse practitioner (NP), provides insight into the range of pay CNSs can expect. The median pay for nurse practitioners is $121,610 per year in the United States. The median hourly wage is $58.47 for NPs. The median pay represents the middle: half of NPs earned more than that amount, and half earned less. The annual average wage of NPs varies by over $100,000 across the United States. In the lowest-paying rural areas of the U.S., NPs make $94,480 compared to $199,630 in the highest-paying areas of California.
Where and When Do Clinical Nurse Specialists Work?
Clinical nurse specialists can work in hospitals, clinics, nursing homes, and other settings such as public health offices. According to the National Association for Clinical Nurse Specialists census, nearly half of CNSs work with adults or older adults. CNSs across all specialties reported spending most of their time precepting students, assisting with projects and research, providing direct patient care, and educating other staff members.
In hospitals and other institutions that are always open, a CNS can expect to work some evenings, nights, weekends, and holidays. If paid hourly, a CNS schedule could consist of 8 or 12-hour shifts. CNSs who have a greater focus on education and are salaried may work regular business hours. If part of the management team for a hospital unit, a CNS may be expected to take on-call shifts to assist staff as needed.
CNSs work within teams to deliver evidence-based care. They are regarded as experts in their field of nursing.
How Do I Become a Clinical Nurse Specialist?
The first step to becoming an advanced practice nurse, such as a CNS, is to become a registered nurse (RN). Today, most RNs complete a Bachelor of Science in Nursing (BSN) and then take the NCLEX-RN examination to become certified. Then, an RN wanting to become a CNS would complete either a master’s or doctoral program. Some programs allow students to prepare for RN licensure at the same time as completing a master’s degree if they have a bachelor’s degree in another field. Master’s and doctoral degree programs for CNSs take two to three years to complete. Still, other CNS programs are certificate programs, lasting only 18 months, and are offered to practicing nurses who have already completed a master’s degree. Part of applying to a CNS program is selecting a track of study or specialty, such as adult or pediatric healthcare. Competitive applicants to CNS programs have at least a year of experience in their field of nursing. The majority of CNSs hold a master’s degree.
After completing a graduate program, a hopeful CNS must then pursue national and state certifications. The American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN) both certify CNSs on the national level. The ANCC offers only Adult-Gerontology Clinical Nurse Specialist Certification, Board Certified, or AGCNS-BC. The AACN offers adult-gerontology, pediatric, and neonatal certifications that indicate CNS expertise in these populations from wellness through acute care. Each state has different requirements for practicing CNSs, but many require proof of certifications, including an RN license, a background check, and a fee.
What Are the Benefits of Being a Clinical Nurse Specialist?
A CNS is able to advance in their specialty as an expert and an educator while maintaining excellent patient care skills. A nurse who loves working with patients and is able to share that knowledge and passion can advance to become a CNS. As an APRN, a CNS will generally earn a higher wage, have greater career flexibility, and hold higher leadership positions than nurses without advanced practice credentials or training.
Effectively educating nurse coworkers is rewarding and can be measured as patient care and outcomes improve with shared knowledge. CNSs who participate in research and healthcare process improvement have the opportunity to affect not only the health of their patients, but the health of their entire specialty population.
What Are Other Advanced Practice Registered Nurse (APRN) Careers?
In addition to CNSs, three other types of APRN providers practice in the U.S. Advanced practice nurses in these roles have earned at least a master’s degree and have specialized to care for specific patient populations. They are certified to assess, diagnose, prescribe, and treat patients at various levels based on state regulations.
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