Clinical nurse specialists are advanced practice registered nurses (APRNs) that serve as expert clinicians in a specialized area of medicine. Clinical nurse specialists are found working in settings across the health care delivery continuum.
According to the National Association of Clinical Nurse Specialists (NACNS), there are about 70,000 practicing clinical nurse specialists (CNSs) in the U.S., about 15,000 of which are also licensed and otherwise qualified to work as nurse practitioners.
Clinical nurse specialists are:
- Licensed registered professional nurses who possess graduate degrees at the masters and/or doctoral level
- Clinical experts in the diagnosis and treatment of illnesses in specialties across the continuum of care
- Nurse practitioners who provide evidence-based care in a variety of healthcare settings
- Direct providers of Medicare services
- Specialists with prescriptive authority in 38 states
- Leaders and facilitators of change that work to improve quality, ensure patient safety, and lower healthcare costs
- Researchers who identify effective interventions that have proven outcomes
Clinical nurse specialists may focus their nursing practice on a specific type of care, a specific population, or a specific disease or medical subspecialty:
- Population: Clinical nurse specialists may focus on a specific population, such as pediatrics, women’s health, or geriatrics.
- Disease/medical subspecialty: Clinical nurse specialists may focus on a specific disease or medical subspecialty, such as diabetes or oncology.
- Type of problem: Clinical nurse specialists may focus their work on specific types of problems, such as wound care or pain management.
- Setting: Clinical nurse specialists may work solely in a specific healthcare setting, such as critical care, ambulatory care, or emergency rooms.
- Type of care: Clinical nurse specialists may focus their work on a specific type of care, such as rehabilitative or psychiatric care.
The Value of the Clinical Nurse Specialist in the Healthcare System
Because clinical nurse specialists work in nearly all areas of healthcare, their expertise is valuable in a wide array of healthcare settings. Since clinical nurse specialists possess unique and advanced level competencies in advanced nursing practice, they are able to meet the demands of a changing healthcare system, improving the quality of care while reducing costs associated with healthcare.
The NACNS identifies clinical nurse specialists as:
- Leaders of change in health organizations
- Developers of evidence-based programs
- Coaches of patients with chronic diseases
- Facilitators of teams in acute care and other facilities
- Researchers seeking evidence-based interventions
As such, the NACNS recognizes that the care of clinical nurse specialists accomplishes a number of goals, which include:
- Preventing patient complications
- Preventing hospital readmissions
- Improving the quality and safety of care
- Improving the outcomes of care
Clinical nurse specialists, as expert clinicians in nursing, serve as a valuable member of the healthcare team by:
- Providing direct patient care
- Providing expert consultation for the nursing staff
- Assisting patients in the prevention and/or resolution of illnesses
- Diagnosing and treating disease, injury, and disability
Comprehensive research on clinical nurse specialists, reports the NACNS, demonstrates the value of these nursing clinicians, as CNS practice results in outcomes such as:
- Reduced hospital stays and the length of hospital stays
- Increased patient satisfaction
- Reduced medical complications in hospitalized patients
- Improved pain management practices
- Reduced emergency room visits
A December 2013 NACNS Position Statement on the importance of clinical nurse specialists in the coordination of care revealed that clinical nurse specialists are able to promote high-quality healthcare services and decrease healthcare expenditures by managing a patient’s primacy and chronic healthcare and coordinating care using their advanced nursing abilities, skills, and knowledge.
How to Become a Clinical Nurse Specialist
The NACNS reports that clinical nurse specialists are educated and trained to partner with other providers in the leadership role for the coordination of care and care transitions. The coordination of care and promoting a seamless care transition, is often identified as being integral to the CNS role.
Education Requirements
Clinical nurse specialists are registered nurses (RNs) and graduate-prepared APRNs. The typical route to becoming a clinical nurse specialist involves earning an RN through a pre-licensure program (nursing diploma, Associate Degree in Nursing (ADN), or baccalaureate degree), earning valuable experience as an RN, and then achieving a Bachelor of Science in Nursing (BSN) and Master of Science in Nursing (MSN).
Because the majority of RNs complete a pre-licensure nursing diploma or ADN, enrolling in RN to MSN programs, which allow students to earn both a BSN and MSN at an accelerated pace, has become a popular option for RNs looking to become clinical nurse specialists. RN to MSN programs take into consideration the experience and pre-licensure education of an RN, thereby allowing students to transfer a large number of their undergraduate requirements and completing both their BSN and MSN in just 2 to 3 years.
Many of today’s RN to MSN programs are available as distance learning programs, allowing students to complete their didactic coursework through online study. This type of curricula delivery accommodates the busy schedules of today’s working student. Both online institutions and campus-based institutions offer this type of online learning experience.
Clinical nurse specialist programs may feature different specialty tracks, which require the completion of specific specialty courses. For example, one RN to MSN program may be focused on acute care, while another may be focused on oncology or gerontology. However, core courses in a CNS program are generally similar, as they include:
- Epidemiology
- Nursing concepts and theories
- Ethics for health professionals
- Research for health professionals
- Advanced health assessment
- Advanced pharmacology
- Advanced physiology/pathophysiology
- Health policy issues
- Health care financing
Certification Requirements
Upon completion of a CNS graduate program, graduates must achieve national certification through a national certifying body recognized by their state board of nursing.
The following certifying bodies offer national certification examinations for clinical nurse specialists, although not all state boards of nursing recognize all national certifying bodies/certifications:
- Oncology Nursing Certification Corporation
- Advanced Oncology Certified Clinical Nurse Specialist
- Oncology Nursing Certification Corporation
- American Association of Critical Care Nurses Certification Corporation
- Adult, Neonatal, and Pediatric Acute and Critical Care Nurse Specialist
- Acute Care Clinical Nurse Specialist: Wellness through Acute Care (adult gerontology, pediatric, neonatal)
- American Association of Critical Care Nurses Certification Corporation
- American Nurses Credentialing Center
- Adult health clinical nurse specialist
- Adult psychiatric and mental health clinical nurse specialist
- Child/adolescent psychiatric and mental health clinical nurse specialist
- Gerontological clinical nurse specialist
- Pediatric clinical nurse specialist
- Home health clinical nurse specialist
- Diabetes management – advanced
Once national certification through a recognized certifying body and in a recognized CNS certification area has been achieved, candidates must apply for state certification through their state board of nursing. All states require candidates to possess a current and unencumbered RN license and national certification to achieve state certification as a CNS.
Like the RN license, clinical nurse specialists must renew their national certification designation by meeting continuing education requirements.
Salary Expectations for Clinical Nurse Specialists
According to the NACNS, clinical nurse specialists generally earn between $65,000 and $110,000 per year, depending on the region of the country in which they practice and their CNS practice specialty.
The clinical nurse specialist job earned a spot on CNN Money’s Best Jobs in America in 2013 list, with the news agency reporting a median salary of $86,500 and a top salary of $126,000 for clinical nurse specialists.
Clinical Nurse Specialist Resources
- National Association of Clinical Nurse Specialists
- Clinical Nurse Specialist Foundation
- Society of Clinical Nurse Specialist Education