How to Become a Clinical Nurse Specialist

So, you’re a registered nurse (RN) and you’re looking for your next career advancement opportunity. You may want to consider becoming a clinical nurse specialist (CNS), an advanced practice registered nurse (APRN) who handles the responsibilities of an RN plus a host of administrative and education duties.

Like all APRNs, CNSs hold a master’s degree in nursing. This advanced training qualifies CNSs to take on some hefty responsibilities, including diagnosing patients, performing procedures, and prescribing medicines. You might think, “Hey, you just described a nurse practitioner (NP)!” and you’d be correct. However, CNSs and NPs differ in significant ways. NPs spend most of their time providing direct care: taking patient medical histories, conducting physical examinations, and analyzing patient data.

According to an National Association of Clinical Nurse Specialists (NACNS), survey, CNSs spend only about 33 percent of their time seeing patients. They spend other 67 percent attending to other duties, including:

• Consulting with nurses, staff, and others (20 percent)
• Teaching nurses and staff (20 percent)
• Leading evidence-based projects (15 percent)
• Assisting with EBP projects (11 percent)
• Precepting students (6 percent)

In short, NPs function mostly at the “micro” level, while CNSs perform a range of macro functions. As Peggy Barksdale, president of the NACS, puts it: “Every day across this country, clinical nurse specialists provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout their organizations, and ensure the use of best practices and evidence-based care to achieve the best possible patient outcomes. If every healthcare setting employed CNSs, more of the care provided would be based on research and best practices, our healthcare system would be more efficient, and we would all be healthier.”

If your favorite part of nursing is seeing patients, you might be better suited to the NP role. If, however, you love improving processes and making a difference at the planning and implementation level, CNS is the job for you.

In this article, we will cover:

• Pros and cons of becoming a clinical nurse specialist
• Educational commitment to become a clinical nurse specialist
• Licensure and accreditation for becoming a clinical nurse specialist
• Resources for becoming a clinical nurse specialist

Pros and cons of becoming a clinical nurse specialist

Clinical nurse specialists make up one of the four fields of advanced practice nursing. The others: NPs, certified registered nurse anesthetists, and certified nurse-midwives.

According to the National Council of State Boards of Nursing (NCSBN), the organization that develops nursing licensure examinations, CNSs specialize in the care of one of six patient populations:

• Family/individual across the lifespan: This population focuses on providing comprehensive care for individuals and families throughout all stages of life, from infancy through old age. Care strategies are tailored to meet the evolving health needs of each family member or individual over time, encompassing preventive, acute, and chronic health care.
• Adult-gerontology: Care for this population is centered on adults, including the elderly, and addresses the complex physical, emotional, and social health needs of this age group. It includes the prevention, diagnosis, and treatment of diseases and conditions that affect adults as they age, with a focus on improving quality of life and promoting independence.
• Pediatrics: Pediatric care is dedicated to the health and medical care of infants, children, and adolescents up to the age of 18. It encompasses a wide range of health services, from preventive health care to the diagnosis and treatment of acute and chronic diseases, with a focus on understanding the growth and development of children and how diseases affect this process differently than adults.
• Neonatal: Neonatal care focuses on the health needs of newborns, particularly the first 28 days of life, a critical period that lays the foundation for long-term health. It includes care for healthy newborns, as well as specialized care for premature or ill infants, covering a broad spectrum of conditions and disorders unique to this early stage of life.
• Women’s health/gender-related: This area of care concentrates on conditions and diseases that primarily affect women and the female reproductive system. It covers a broad range of health topics from adolescence through menopause and beyond, including gynecological health, pregnancy and childbirth, breast health, and conditions that have different impacts on women compared to men.
• Psychiatric and mental health: Care in this population focuses on individuals of all ages experiencing mental, behavioral, and emotional disorders. It involves the assessment, diagnosis, and treatment of psychiatric conditions, as well as the provision of support for recovery and maintenance of mental health. This includes care for conditions such as depression, anxiety disorders, schizophrenia, and substance abuse disorders, among others.

There are some significant upsides as well as drawbacks to this important position.

Pros

• CNSs are some of the best paid nurses in the field. According to Payscale.com, the average CNS salary is $88,228, with a range of $66,000 to $117,000. Indeed.com reports a much higher average annual income of $103,581. No matter whom you ask, this is a well-paying nursing job.
• Jobs opportunities will likely increase as disease prevention and the care of aging populations become higher public health priorities.
• Medical practice is moving toward empowering CNSs with __ increased authority__. With more autonomy, these nursing professionals can reduce costs by “reducing fragmentation of care and improving patient self-care abilities,” according to a 2012 report that calls for an end to collaborative practice agreements with physicians and prescribing restrictions.

Cons

• Risk of being overlooked. While CNSs make a difference in healthcare outcomes and costs, they could make a larger impact if more people understood how to use their expertise, according to the NACNS. Unfortunately, health professionals may not know the difference between a CNS and an NP, much less how the role fits in with the team.
• Bureaucracy! “The biggest problem, in my opinion, is that the nursing profession has too many cooks,” Storlie says in the blog. “Roles are being created to address problems that could be handled by the roles that already exist. CNSs are not used to the full advantage of their knowledge and scope.”
• Long hours. Hospital nurses, in particular, work especially hard.
• Dealing with unpleasant situations. Not every patient wants her blood pressure taken, and she will let you know it. Did you know that hospitals have Yelp reviews? Warm your hands before you touch patients; it will improve your rating.

Educational commitment to become a clinical nurse specialist

You’ll start your journey toward a CNS position as an undergraduate nursing student. You’ll take challenging science classes, gain experience in patient care, hang out in large groups of other future nurses, and drink bubble tea.

After you earn your BSN, you’ll need to earn your license to become = a registered nurse. You’ll need a graduate degree to become a CNS; either a Master of Science in Nursing (MSN) or a doctoral degree with a CNS specialization gets the job done. Your studies could take anywhere from three semesters (MSN, full-time) for four years (doctorate) to complete.

Accredited programs include:

• Michigan State University, where the MSN clinical nurse specialist-education program is entirely online with a one-day on-site orientation. This 47 to 51 credit-hour program is $806 per credit hour for Michigan residents and $831 for non-residents.
• Purdue University – Calumet Campus, which provides a Master of Science degree in adult gerontology (AGCNS). Students must complete 47 credits and 555 practicum hours at $316 per credit hour for Indiana residents and $464 per credit hour for non-Indiana residents.

Certificate programs include:

• University of Washington‘s School of Nursing offers certificates for perinatal clinical nurse specialists or pediatric clinical nurse specialist on an in-person basis only.
• The University of Wisconsin-Milwaukee offers CNS certificates in three different population areas: adult gerontology, pediatric, or maternal/infant. This is an online program, with clinical preceptor placements as close as possible to a student’s geographic location.

Licensure and accreditation for becoming a clinical nurse specialist

CNS licensure and certification requirements vary from state to state. Most states require national certification, either through the American Association of Critical-Care Nurses (AACN) or the American Nurses Credentialing Center (ANCC).

AACN certification exams ($255 each for AACN members, $360 for nonmembers) include:

• ACCNS-AG (Adult-Gerontology)
• ACCNS-N (Neonatal)
• ACCNS-P (Pediatric)

These exams consist of 175 multiple-choice questions. The certification exams are accredited by the National Commission for Certifying Agencies (NCAA). This certification must be renewed every five years.

ANCC certification exams ($295 for ANCC members, $395 for nonmembers) include AGCNS-BC (Adult-Gerontology). This certification must also be renewed every five years.

Resources for becoming a clinical nurse specialist

• The American Academy of Nursing (AAN). With more than 2,700 members, the AAN represents the nation’s top nurses in research, policy, and education. Founded in 1973, the AAN has an office in Washington, DC, to advocate for health equality, wellness, and other policy priorities. Its bi-monthly journal, Nursing Outlook, is always worth a look.
• American Association of Clinical-Care Nurses(AACN). AACN offers more than 300 continuing education courses and produces four journal magazines, including Critical Care Nurse and AACN Bold Voices.
• The American Association of Colleges of Nursing (AACN). Founded in 1969, this organization represents 825 member schools of nursing.
• American Nurses Credentialing Center (ANCC). This branch of the American Nurses Association (ANA) provides a CNS certification for renewal only. Called the Adult Health Clinical Nurse Specialist Certification (ACNS-BC), this certification must be updated every five years. For the best record keeping, enter your professional development continuing education credits on the site.
• The American Nurses Association (ANA). Founded in 1896 as the Nurses Associated Alumnae, the ANA is a professional organization with three branches: (1) American Academy of Nursing, (2) American Nurses Foundation for charity and philanthropy, and (3) American Nurses Credentialing Center. Lots of good information here.
• The National Association of Clinical Nurse Specialists (NACNS). This national organization of more than 2,000 members produces a peer-reviewed journal, supports task forces to formulate and advocate policies affecting CNSs, and promotes the profession throughout the healthcare industry.

Why are CNSs important?

“The number of people who have access to healthcare services has increased dramatically because of the Affordable Care Act,” says Peggy Barksdale, president of NACNS. “At the same time, the number of people who have chronic conditions, including multiple chronic conditions is increasing. More than ever, we need to ensure that every healthcare provider, including the highly skilled CNS, is able to perform to the top of his or her skills, education and expertise.”

(Updated on February 20, 2024)

(Last Updated on February 26, 2024)

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