How to Become a Clinical Nurse Specialist in 3 Steps

Nurse Types / Clinical Nurse Specialist

Clinical Nurse Specialists (CNS) are leaders in the nursing profession and healthcare. CNS professionals are widely accepted as nursing experts. They have advanced training and education in assessment, pharmacology, and physiology. Clinical nurse specialists are integral to many organizations because they promote effective, safe, low-cost, evidence-based healthcare services.

A nurse that wants to be recognized as an expert in their field, a CNS position may be the best option. 

For over 60 years, roles for CNSs have grown. Most states now offer fully accredited specialty education programs in advanced clinical practice. 

This article will cover everything you want to know about the CNS role:

• What is a clinical nurse specialist?
• What do clinical nurse specialists do?
• Where do clinical nurse specialists work?
• What are specific types of clinical nurse specialists?
• How do you become a clinical nurse specialist in 3 steps?
• What are the additional requirements of clinical nurse specialists?
• What are the salary and career outlooks for clinical nurse specialists?

What is a clinical nurse specialist?

A clinical nurse specialist is an advanced practice registered nurse (APRN) who has graduated from a Master’s or Doctorate program and is certified in their area of expertise. They have advanced training and education in assessment, pharmacology, and physiology. 

The National CNS Competency Task Force recommends these additional core competencies:

• Direct Care
• Consultation
• Systems Leadership
• Coaching
• Research
• Ethical Decision-Making, Moral Agency, and Advocacy
• Collaboration

In addition to providing direct care for prevention or intervention, the CNS’s scope of practice includes diagnosing and treating illnesses and injuries within their specialty. The expert’s specialty may be defined by:

• Patient population (e.g., geriatrics, pediatrics, women’s health)
• Practice setting (e.g., critical care, emergency room)
• Medical subspecialty or disease process (e.g., diabetes, infectious disease, oncology)
• Problem (e.g., wound care, pain management)
• Type of care (e.g., palliative care, rehabilitation)

A CNS specialty certification prepares professionals to work in different settings and roles. 

Qualities of a successful clinical nurse specialist

CNSs love learning and sharing what they learn. Additional qualities of a successful CNS include:

• Empathy
• Ability to communicate effectively
• Leadership qualities (able to motivate others and affect change)

They must also be passionate about improving the nursing profession, patient care, and the healthcare system. 

What do clinical nurse specialists do?

CNSs help organizations. Fundamentally, CNS practice seeks to improve conditions through mentoring and systemic changes that empower nurses. It aims to design evidence-based models to ease patient distress and promote ethical decision-making.

CNSs care for patients. Like other APRNs, they diagnose, develop care plans, treat, and provide ongoing care management for complex patients. In many states, the CNS can prescribe medications and other therapies. 

CNSs support nurses. They provide expertise and support to bedside nurses and steer change throughout organizations. They also promote best practices and evidence-based care to achieve optimal outcomes. 

CNSs use their advanced education and expertise to serve patients and healthcare organizations in a variety of ways, including:

• Advocating for cost-effective and quality patient outcomes 
• Serving as patient advocates
• Helping facilities achieve Magnet status 
• Assisting with staff retention and mentoring 
• Raising the standards for patient care 
• Increasing compliance with state and federal healthcare guidelines

Many CNSs serve in supervisory or leadership positions. They create or work with teams to develop policies and procedures. 

Others may work in academia or research. CNSs can assist with translating research findings, developing proposals, overseeing study design, or devising new evidence-based standards and protocols.

Graduate training prepares them to help design, implement, assess, and evaluate healthcare interventions that improve care delivery and outcomes. 

A day in the life of a clinical nurse specialist

A day in the life may start at a hospital or an outpatient clinic.

In the acute setting, the CNS will make rounds, perform assessments, and consult with nurses on complex patient care needs. CNSs use their advanced training to participate in initiatives such as preventing infections, reducing the length of stay, and avoiding hospital readmissions.

In an outpatient setting, the CNS may perform primary care assessments, well-child check-ups, or school physicals in the ambulatory setting. They may also counsel patients on disease management and treatment options. 

Common conditions treated by a clinical nurse specialist

CNSs treat clients with acute and chronic issues. Some common conditions a CNS manages include:

• Pregnancy/prenatal care
• Diabetic care
• Wound care
• Psychiatric or mental health care
• Neurological problems
• Cardiovascular disease

Depending on their specialty, you can see a CNS for many of the same conditions you might see a nurse practitioner for.

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Where do clinical nurse specialists work?

According to data from the National Association for Clinical Nurse Specialists (NACNS), most CNSs work in acute care settings, including hospitals (31.96%) and academic health centers (29.17%). Other places that a CNS may work include:

• Nursing schools (professors or administration)
• Outpatient clinics
• Public health agencies
• Private practice
• Veterans’ facilities/organizations
• Nursing homes or long-term care hospitals
• Professional organizations
• Medical suppliers (medical devices or pharmaceutical companies)
• Insurance companies

CNSs may also start their own businesses or work as consultants in many industries. 

What are specific types of clinical nurse specialists?

Most CNSs work in adult health or gerontology (75.85%). 

Other specialists are certified in:

• Pediatrics
• Adult psychiatric and mental health
• Child/adolescent psych and mental health
• Family health
• Women’s health
• Neonatal care

State practice requirements vary, but in most states, a CNS must be certified in their specialty. 

Closely-related fields

Other fields that are closely related include:

• Nurse Practitioner– Nurse practitioner (NP) training is similar, but there is a greater emphasis on direct patient care and less on systems leadership. 
• Clinical Nurse Leader– Clinical nurse leaders (CNLs) are not advanced practice nurses, but their specialization requires at least a master’s degree and focuses on leadership and organizational change.

How do you become a clinical nurse specialist in 3 steps?

If this specialty sounds like it’s for you, here are the 3 steps to becoming a CNS.

Step 1 – Become a registered nurse

To become a CNS, you must start as a registered nurse (RN). Educational programs, state licensing boards, and employers will not recognize a nurse without an active RN license.

Complete necessary education 

An RN who wants to be a CNS must earn a Bachelor of Science in Nursing (BSN) degree. The BSN degree typically takes four years to complete. 

Already-practicing RNs with an Associate Degree in Nursing (ADN) must choose a traditional BSN, Accelerated BSN (ABSN), or an RN-to-BSN degree program to earn the next required degree before applying to a CNS program.

To become a CNS, you must also earn your Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) before practicing. There are bridge programs such as the BSN to MSN and BSN to DNP to help speed up the process.

Although an MSN is the current minimum degree, the National Association of Clinical Nurse Specialists (NACNS) endorses a shift to the DNP by 2030.

Pass the NCLEX exam

After earning your degree in nursing, it is time to pass the NCLEX exam. This board exam assesses a nurse’s minimum competency for entry-level work as a clinical nurse. 

Step 2 – Accumulate experience

Experience improves nursing skills and helps nurses explore their passions and preferences. Most schools require at least 1–2 years of RN experience to enter their CNS programs.

Helpful skills and experience

Nurses known as the go-to nurse on their unit will make great CNSs. The CNS path is great for experienced or knowledgeable nurses who enjoy staying up-to-date on research and evidence-based practice. 

Clinical specialization is also a great option for nurses with experience in management and leadership. Those roles require similar skills and competencies nurses will need for a career as a CNS. If you have been successful in leadership positions and enjoyed the work, this job may be for you. 

Changing specialty to a clinical nurse specialist nurse

If you’re wondering if this rewarding career is for you, here are a few considerations for changing specialties to become a CNS. 

CNS positions are often part of management or leadership. That means the hours often differ from inpatient settings. They usually work normal business hours. On-call shifts, holidays, and weekends may not be required. 

It also means that the role has greater autonomy. Nurses comfortable working closely with their supervisors will notice that the CNS role is very different. The CNS may answer to upper-level administration and may not have day-to-day contact with their bosses. 

If you’re transitioning from a bedside nurse to a CNS, you will find that you spend more time looking up procedures and less time with patients. You’ll likely have more meetings and less time at the bedside. 

As a CNS, you have a bigger impact by supporting teams of nurses caring for patients rather than caring for patients yourself. 

Step 3 – Obtain certifications

To become certified as a CNS, you must complete an MSN or DNP program in clinical nursing and pass a national exam for CNS certification. 

Specialty CNS certifications are currently available through three nursing organizations. These include:

• American Nurses Credentialing Center (ANCC):
  • Adult-Gerontology Clinical Nurse Specialist Certification (AGCNS-BC)
• American Association of Critical-Care Nurses (AACN):
  • Adult-Gerontology Clinical Nursing Specialist (ACCNS-AG)
  • Pediatric Clinical Nurse Specialist (ACCNS-P)
  • Neonatal Clinical Nurse Specialist (CCNS-N)
  • Adult Acute/Critical Care Clinical Nurse Specialist (CCNS-Adult)
  • Pediatric Acute/Critical Care Clinical Nurse Specialist (CCNS-Pediatric)
  • Neonatal Acute/Critical Care Clinical Nurse Specialist (CCNS-Neonatal)
• Pediatric Nursing Certification Board (PNCB):
  • Pediatric Primary Care Mental Health Specialist (PMHS)

Some certifications, such as the Home Health Clinical Nurse Specialist (HHCNS-BC), have been replaced by newer practice certifications. 

What are the additional requirements of clinical nurse specialists? 

The main requirement for CNSs is continuing education. These courses allow nurses to stay current on nursing practice standards. The number of credits or hours required will depend on the certification and state boards. 

[ MORE: Earn your CEUs online, 100% free with Incredible Health. ]

What are the salary and career outlooks for clinical nurse specialists?

CNS salaries currently range from $51,000 to $166,500, but most fall between $82,500 (25th percentile) to $145,500 (75th percentile).

CNS salary is attractive, and so is the job outlook. According to the Bureau of Labor Statistics, master’s prepared APRNs are expected to see growth averaging 40% from 2021 to 2031.

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Job satisfaction

In addition to an excellent salary and job growth, CNSs can expect other aspects to contribute to increased job satisfaction. They have greater autonomy, the ability to provide high-quality care, and a voice in administrative decisions. 

Next steps 

When you achieve a CNS certification, the learning and growing don’t stop there! Clinical specialists have options for advancing their careers.

They may share their work with others by submitting articles to peer-reviewed books or journals. Or they may become leaders in their field by mentoring new CNSs. 

CNSs often seek specialty credentials to add to their certifications. Here are a few credentials offered to advance practice nurse specialists.

• Oncology Nursing Certification Corporation
  • Advanced Oncology Certified Clinical Nurse Specialist (AOCNS)
• Competency and Credentialing Institute
  • Clinical Nurse Specialist Perioperative Certification (CNS-CP)
• Hospice and Palliative Credentialing Center
  • Advanced Certified Hospice and Palliative Nurse (ACHPN)

A clinical nurse specialist wears many hats. Their roles and responsibilities offer many possibilities. If you are interested in this specialty, let us help you!

FAQs

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