Clinical nurse specialist career guide

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A Clinical Nurse Specialist (CNS) is an expert in evidence-based nursing practice, both generally and within a specialized area. As a type of Advanced Practice Registered Nurse (APRN), a CNS treats and manages the health of both patients and populations while fulfilling leadership, research, and teaching responsibilities.

Aspiring CNS graduate students can generally expect to learn core subjects like nursing ethics, statistics, research methodologies, and healthcare policies. They’ll also have to choose a specialty area.

Are you interested in becoming a leader in a nursing specialty? Are you passionate about helping individuals? Do you want to bring positive change to patient care and the nursing profession as a whole? If you answered yes to these questions, then a CNS career may be the perfect fit for you.

Keep reading to find out more about what a CNS does, the salary outlook, and educational requirements. You’ll also learn about certification, accreditation, degree costs, and potential career pathways.

The job description

A CNS’s job description is extensive and can be divided into 3 general categories. Duties typically include:

Advanced patient care

  • Patient diagnosis and treatment
  • Development and implementation of treatment plans
  • Patient data and outcome analysis
  • Care coordination
  • Physical examinations
  • Education of patients and their families on health conditions
  • Diagnostic and laboratory test ordering
  • State-allowed medication prescription

Leadership

  • Supervision of staff
  • Nursing care management
  • Education of nurses and support staff about new policies and procedures
  • Promotion of wellness within the community
  • Collaboration within interdisciplinary teams to optimize patient care

Administration

  • Conducting and assisting with research
  • Evaluation of patient-specific and population-based care programs
  • Addressing system and patient care problems with innovative solutions
  • Maintaining high-quality, cost-effective patient outcomes
  • Design and implementation of evidence-based policies and procedures

Clinical nurse specialist vs nurse practitioner (NP)

Although both CNSs and NPs are Advanced Practice Nurses (APRNs), with similar educational requirements and overlapping duties, there are a few notable differences.

NPs generally focus on direct patient care. They usually work autonomously or in collaboration with other healthcare professionals. Their primary duties include treatment and diagnosis, prescribing medication, assessments, and ordering diagnostic tests 

A CNS focuses on research, policy development and implementation, and leadership in addition to direct patient care. CNSs can also prescribe medication if permitted within the scope of practice in their state.

The work environment

As advanced, graduate-level nurses, each CNS has a specialty. Psychiatric CNS, Gerontology CNS, NICU CNS, and Pediatric CNS are all types of clinical nurse specialists. However, there are various other specialties and a CNS must decide where they want to commit their focus. Their area of expertise can be defined by the following aspects:

  • Patient population – e.g. women’s health, geriatrics, neonatal
  • Type of patient care – e.g. rehabilitation, psychiatric, long-term care
  • Medical subspecialty or disease – e.g. diabetes, oncology, gynecology
  • Medical setting – e.g. emergency rooms, clinics, birth centers

These nurses fulfill roles in various settings across healthcare delivery systems. They can work in hospitals, private practices, schools, prisons, clinics, and medical centers. According to a 2018 CNS Census, out of 3,057 participants, 31.96% worked in non-federal acute care or hospitals, 29.17% worked at an academic health center, 10% were in nursing education, and 1.53% worked in private practices.  

The numbers

The U.S. Bureau of Labor Statistics (BLS) classifies CNSs under Registered Nurses (RNs). However, in a 2020 paper, the American Academy of Nursing (AAN) recommends, among other structural and legislative reforms, that CNSs be brought under the APRN category by the BLS.

According to the BLS, all RNs earned an annual median salary of $73,300 in 2019. The lowest 10% earned less than $52,080, while the highest 10% earned more than $111,2220. Clinical nurse specialists earn an average base salary of $95,985, with 64% reporting job satisfaction.

With an increase in the demand for healthcare, preventative care, and chronic conditions, employment is projected to grow by 7% between 2019 and 2029. That’s faster than the average for other occupations.

While the BLS doesn’t have CNS-specific data, it projects employment in master’s-level occupations to grow by 17% — the fastest of any education level. Considering these numbers, there is a demand for clinical nurse specialists.

The BLS data also shows top-paying states for RN annual average salaries as follows:

  • California – $113,240
  • Hawaii – $104,060
  • Washington, D.C. – $94,820
  • Massachusetts – $93,160
  • Oregon – $92,960

Clinical Nurse specialist salary information by state
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Payscale is a salary survey service meant to provide employers and employees with salary data at local levels to benchmark and compare. While Payscale has a much smaller sample size than BLS, Payscale does update more frequently so data may be considered fresher. Payscale also indicates salaries at a wider range of roles whereas BLS sometimes aggregates numerous professions into one category which may skew salary data. For this reason, we find Payscale to be a good secondary salary indicator. All information received from payscale is via a paid API. You can read more about payscale and their data methodology here.

Nominal
Real salary
future outlook tooltip icon

The nominal salary is the unadjusted salary paid.

The real salary is adjusted to consider the purchasing power by state. We multiply the nominal salary by a state purchasing parities index to indicate the relative value of salaries by state. For instance, while New York or California might pay the highest nominal salary, these states are relatively expensive and so the real value of the salary is often less than a cheaper to live in state with a lower nominal salary.

Highest salary states

1.

California

$126,070

Average salary

2.

Oregon

$112,459

Average salary

3.

Hawaii

$110,475

Average salary

4.

Alaska

$106,157

Average salary

5.

Washington

$103,852

Average salary

6.

New York

$103,357

Average salary

7.

New Jersey

$101,213

Average salary

What to consider

Before deciding to become a CNS, there are a few vital considerations to keep in mind.

The skills that you will need

CNSs are life-long learners who must keep up to date with the latest evidence-based practices and research in their specialties and the nursing profession. Problem-solving and critical-thinking skills hold them in good stead.

Because they fulfill management, supervision, and consultation roles, CNSs should also have exceptional communication and leadership skills. Additionally, the ability to mentor, listen, and teach is crucial to implement new policies in a healthcare setting. As direct patient-care nurses, CNSs also need to be attentive, compassionate, and understanding. Additionally, the desire and drive to improve healthcare policies and patient outcomes makes a good clinical nurse specialist.

The time required to become a CNS

The time it takes to become a certified CNS varies by individual. CNSs are licensed RNs with graduate-level degrees, at least. Some earn their Doctor of Nursing Practice (DNP) degree instead, which may become a requirement in the future. In fact, the National Association of Clinical Nurse Specialists (NACNS) issued a statement endorsing the DNP as the entry-level degree for CNSs by 2030.

If you’re new to the profession, you’ll first need to earn a qualifying degree to become a licensed RN. It typically takes 4 years to earn a bachelor of science in nursing (BSN) degree. However, there are other routes one can take to become eligible for RN licensure. An associate degree in nursing (ADN) takes 18 to 24 months, while an approved nursing diploma can take up to 3 years.

It typically takes 2 years to earn a master’s of science in nursing (MSN) degree, and 4 to 6 years to earn a DNP. Accelerated or bridge programs, such as an RN-MSN, ADN-MSN, ADN-DNP, BSN-DNP, or postgraduate degree, are also available.

Additionally, many schools offer online or hybrid learning, which is a combination of online and on-campus study. These types of programs are often more cost-effective and flexible than traditional degree programs, but on-campus attendance may still be required.

In short, it takes new students about 6 years to become clinical nurse specialists. It usually takes 2 years for a BSN-holder or between 4 and 6 years if they opt for a DNP. However, direct-entry or accelerated programs could take less time.

Ultimately, the time required to become a CNS depends on:

  • Current qualifications
  • The program type and format you choose
  • Whether you’ll study part- or full-time

The cost of the degree

Degree costs depend on numerous factors. Your degree type, school, and part- or full-time study choices all affect what you’ll pay. According to a 2020 report, a full-time student at a public 4-year institution pays the following tuition and fees per academic year on average:

  • $11,440 for a doctoral degree
  • $8,950 for a master’s degree
  • $8,760 for a bachelor’s degree

A full-time student at a private nonprofit 4-year institution pays, on average, the following tuition and fees per academic year:

  • $44,910 for a doctoral degree
  • $29,670 for a master’s degree
  • $37,500 for a bachelor’s degree

Accreditation

When looking over your study options, it’s crucial to do your research. Make sure any program you choose is accredited by an approved body. Many schools don’t recognize programs without sufficient accreditation and won’t transfer credits in such a scenario.

National accreditation ensures that a program meets high-quality standards approved by the U.S. Department of Education. State accreditation is only valid in a particular state. In the nursing profession, the primary accrediting bodies are:

  • The Commission on the Collegiate Nursing Education (CCNE)
  • The Accreditation Commission for Education in Nursing (ACEN)

The NACNS also established guidelines with criteria for the evaluation of CNS programs.

Steps to become a certified CNS

Becoming a CNS requires RN licensure, graduate-level education, clinical experience, and certification. Here’s a breakdown of the steps you can take to get there.

Step 1.  Earn an entry-level degree

The first step most students take after graduating high school is to earn an accredited BSN, which usually comprises 4 years of full-time study. This is a prerequisite to becoming a licensed RN. While an ADN or nursing diploma is also generally acceptable, a BSN is typically required to pursue an MSN.

Admission requirements are school- and program-specific. However, a minimum GPA of 3.0, strong SAT or ACT scores, a resume, professional references, and a personal statement are typical prerequisites. Majors or prior coursework in math, science, biology, chemistry, anatomy, and physiology may also be required.

Required credit hours are also program-specific but usually range between 120 and 180, with a ratio of 3 clinical hours to every 1 hour of classroom time.

Course concentrations vary but generally include fundamental subjects like:

  • Anatomy
  • Pathophysiology
  • Pharmacology
  • Psychology
  • Mental health
  • Reproductive health
  • Statistics
  • Nursing care

Some BSN programs provide specific clinical training. As CNSs must choose a specialty, it’s worth considering what you want to specialize in at this stage of your studies.

Step 2. Get licensed

You can complete the 6-hour NCLEX-RN exam after earning your entry-level degree. It tests candidates on core nursing subjects like risk reduction, care management, and preventative care.

Once you’ve passed, you can apply to your state board of nursing for RN licensure. Be sure to check specific requirements as they vary from state to state. A criminal background check may also be required. Additionally, you can apply for a multistate license, known as the Nurse Licensure Compact (NLC). It allows RNs to practice in 33 participating states.

Step 3. Earn an MSN or DNP

At this stage, licensed RNs can choose to find employment and study part-time or pursue their advanced education full time. A nurse can get a master’s of science in nursing (MSN) and choose to specialize in women’s health, neonatal care, mental health, gerontology, and many more,

For aspiring CNSs, there are both MSN and DNP clinical nurse specialist programs available.

MSN CNS programs

MSN CNS programs enhance the skills candidates learned while obtaining their RN licenses. It’s also the entry-level degree required to become a CNS and takes a BSN-holder 2 years of full-time study.

The curriculum generally equips graduates with advanced nursing skills to gain in-depth knowledge and clinical practice in their chosen area of specialty. They’ll also become proficient in research methodologies, leadership skills, and healthcare policy theory. A practicum of at least 500 clinical hours in a chosen specialty is also typically required.

CNS programs include specializations such as:

  • Gerontology
  • Pediatrics
  • Home Health
  • Public and Community Health
  • Adult Health
  • Adult Psychiatric and Mental Health
  • Child or Adolescent Psychological and Mental Health
  • Diabetes Management

Additional coursework may include:

  • Nursing assessment and intervention
  • Healthcare information systems
  • Advanced pathophysiology
  • Advanced pharmacology
  • Advanced epidemiology
  • Nursing leadership
  • Clinical management
  • Ethics

Admission requirements vary but usually include an active RN license, an accredited BSN, and a minimum GPA of 3.0. Further, GRE scores, a completed statistics course, letters of recommendation, and a personal statement may also be prerequisites.

DNP CNS programs

As mentioned, a DNP is becoming the standard for CNSs. An MSN may still be a good option, although a DNP may be preferred by candidates who want to advance their scope of practice and pursue more extensive leadership roles.

These types of programs also prepare graduates to work as CNSs, equipping them with the required clinical training, extensive knowledge, and advanced nursing skills. They’re also designed to prepare CNSs for expert clinical and leadership roles in healthcare.

A DNP CNS program usually consists of evidence-based research, career training, advanced science, and 1,000 hours of  clinical practice. It can take 4 to 6 years, but it depends on the program type.

In addition to a chosen specialty and the above coursework, a DNP curriculum may include concentrations such as:

  • Population health
  • Diagnostic reasoning
  • Health systems finance
  • Policy development and advocacy
  • Social determinants of health
  • Translational research

Step 4: Get certified

The types of national certifications you’ll need to practice as a CNS depend on your chosen specialty and your state board of nursing requirements. Many professional organizations of specific specialties offer certifications. For example, an oncology CNS might require certification from the Oncology Nursing Society. Two prominent organizations that certify CNSs in various areas of specialty include:

  • The American Nurses Credentialing Center (ANCC)
  • The American Association of Critical-Care Nurses

While certification requirements vary, they may include:

  • A CCNE- or ACEN-accredited MSN degree or other graduate-level CNS program
  • 500 or more supervised clinical hours in the specialty area
  • Valid RN licensure
  • Completion of core coursework
  • Passing the certification exam
  • A nominal fee

The effect of specialization on pay
future outlook tooltip icon

Payscale looks at the skills listed on employee CVs by career and takes the average salary to extrapolate which skills correlate to a higher salary, on average. While this is interesting information, it is simply an indicator and should not be considered as a definitive accounting.

Clinical Education

Clinical Education

1.99% Average salary increase

or approximately

$1,689 in annual pay

Intensive Care Unit (ICU)

Intensive Care Unit (ICU)

0.65% Average salary increase

or approximately

$551 in annual pay

Potential career pathways

Here are a few potential career options for CNSs:

Psychiatric clinical nurse specialist

Psychiatric CNSs typically provide direct patient care, diagnosing and treating mental health and psychiatric disorders. They can work in medical centers, hospitals, advanced facilities, and private practices.

Many choose a subspecialty such as child and adolescent mental health, gerontological-psychiatric care, or substance abuse disorders. These CNSs can also administer psychotherapy and prescribe medication if permitted in their states.

Annual average salary: $108,220

Neonatal intensive care unit (NICU) CNS

NICU CNSs provide critical nursing care to infants in medical crises such as prematurity and respiratory distress. They also monitor clinical care to improve patient outcomes. NICU CNSs usually work in hospitals, critical care facilities, and medical centers.

Annual average salary: $84,406

Gerontology clinical nurse specialist

These CNSs assess, diagnose, and treat geriatric patients. They often work in advanced care facilities, hospitals, and private practices. Gerontology CNSs may also develop and implement policies to improve patient outcomes and minimize hospitalizations.

Average annual salary: $91,910

How experience affects earnings
future outlook tooltip icon

Payscale aggregates all employee salaries into experience and degree cohorts and charts out the average salaries accordingly. While this is interesting information, it is simply an indicator and should not be considered as a definitive accounting.

Average

Timeline Salary
Less than 3 years $76,893
3 to 5 years $81,151
6 to 11 years $84,237
12 to 19 years $87,592
20 years or more $94,883

Related careers

There are plenty of careers related to the CNS profession. These include:

Nurse practitioner (NP)

While many similarities exist in terms of education and training, certified NPs generally work in direct patient care more than CNSs. Many choose to specialize in primary, acute, or critical care in various areas, such as family health, neonatal care, or women’s health.

Average annual salary: $97,680

Nurse anesthetist

Certified Registered Nurse Anesthetists (CRNAs) work on a team, usually alongside an anesthesiologist. They can work in various settings, administering anesthesia to patients in emergency/trauma, general surgery, obstetrical, and numerous other medical units.

Average annual salary: $153,139

Nurse midwife

Certified nurse midwives often work in obstetrical and gynecological settings in hospitals, private practices, and specialized birthing centers. Their primary responsibilities usually include delivery, prenatal, and postpartum nursing care.

Average annual salary: $97,676

Continuing education

Healthcare is always evolving, with practices improving thanks to technological and scientific advancements, evidence-based research, and its successful implementation. To execute their duties effectively, clinical nurse specialists must keep abreast of the latest developments in their areas of specialty and the general nursing profession.

Many schools and official organizations offer Continuing Education (CE) certificate programs and coursework. CNSs can also expand their scope of practice with additional certifications. The National Council of State Boards of Nursing (NCSBN) and the National Association of Clinical Nurse Specialists (NACNS) are just 2 that offer a variety of educational resources for this purpose.

Financial aid

Nursing students, including those at the graduate level, may be eligible for financial aid such as grants or scholarships from their educational institution. It’s always wise to inquire whether your school offers financial assistance of any kind.

Government organizations and private corporations may also have loan forgiveness programs, grants, work-study programs, scholarships, or other types of financial aid designed for nursing students. You can start by visiting the federal government student financial aid website to learn more about the different types of aid available and to fill out a FAFSA  application to check your eligibility for federal aid.

In conclusion

A CNS career is suitable for those interested in research who wish to pursue a leadership role and still provide direct patient care. It’s an exciting, multifaceted profession that allows RNs to advance their career in a chosen specialty.

After earning an MSN or DNP and becoming certified, CNSs can further enhance their scope of practice with additional certifications. This can increase earning potential and set them up for more extensive leadership roles.

If you enjoy research, want to drive real changes in healthcare, and provide the best possible patient outcomes, then this career may be the right fit.

National Association of Clinical Nurse Specialists

The membership organization that represents CNSs. The NACNS advocates high-quality, evidence-based research and patient-centered care in the profession.

American Association of Colleges of Nursing

The AACN establishes and promotes high-quality standards in nursing education. It’s also a reputable accrediting body.

American Association of Critical-Care Nurses

Not to be confused with the above association, this AACN is a nonprofit association committed to supporting acute and critical care nurses to drive the best possible patient care.

National Association of Directors of Nursing Administration in Long Term Care

NADONA LTC is a professional organization dedicated to professional development, advocacy, board certification, and clinical excellence for nursing leaders in long-term and acute-care settings.