How to Become a Clinical Nurse Specialist (CNS)

Many nurses find their profession to be both meaningful and impactful. After all, nurses change — and often save — lives every day. The nursing profession is broad, though, and it requires leaders who can make sure patients get the best possible outcome. Clinical nurse specialists (CNSs) work as these types of leaders in the industry.

If you’re looking for a role that offers greater responsibility and the opportunity to have an impact on the nursing profession, becoming a CNS might be the right move for you. Keep reading to learn more about how to become a clinical nurse specialist.

Clinical nurse specialists work as advanced practice nurses. In addition to specializing in a particular population, like gerontology or pediatrics, they also possess training in physiology, pharmacology, and physical assessment. These professionals also tend to work as leaders in the field, and often take on responsibilities in management, consultation, or research.

Since CNS professionals work as advanced practice registered nurses (APRNs), they can meet with patients independently. They offer diagnoses and, in some states, prescribe medication.

However, clinical nurse specialists also take on a more far-reaching role. They work as leaders, expert clinicians, researchers, and consultants. They can work in many different specialties, broken down by demographic, location, or type of disease. Because of this range of responsibilities, a CNS is a great role for nurses who want greater responsibility.

CNS professionals work in various healthcare environments, including hospitals, doctor’s clinics, and nursing or residential care facilities. They may also work at schools or colleges as educators.

Certified nurse practitioners (CNPs) and CNSs carry out very similar roles. While CNSs often meet with and evaluate patients as part of a wider set of responsibilities, patient care is the main focus for CNPs. CNSs possess qualification to carry out other big picture responsibilities, like consultation, education, and management. CNPs also work mainly in healthcare settings, whereas CNSs can find jobs at schools or colleges to educate nursing students as well.

A certified registered nurse anesthetist (CRNA) focuses on one specific area: They administer anesthesia for patients undergoing surgeries or other particularly painful operations. They assess patient risk for anesthesia and educate their patients as well. In contrast, CNSs do not take on this responsibility. Instead, they stick to managing health departments, providing consultations, carrying out research, and educating nurses.

A certified nurse midwife (CNM) also sticks to a particular focus area. They specialize in women’s reproductive health, labor, and pregnancy. This means they carry out gynecological exams, provide family planning services, and attend mothers during labor. Only a small percentage of certified nurse specialists take on women’s health as a speciality area; instead they tend to work as leaders and experts in healthcare settings.

Generally speaking, the healthcare industry continues to see a demand for nursing professionals. The Bureau of Labor Statistics (BLS) projects that the number of registered nurses could increase by 9% from 2020 to 2030. On top of that, higher-level nurses like nurse practitioners could see 45% growth in their field in that same time period, according to the BLS — that’s much faster than average.

In terms of salary, registered nurses (RNs) earned median pay of about $75,330 in 2020, BLS figures show. However, March 2022 data from PayScale reports a higher salary of about $93,927 on average per year.

And the 2020 census from the National Association of Clinical Nurse Specialists (NACNS) found that only about 28% of clinical nurse specialists made $100,000 or less in annual pay.

Factors like location, experience, employer, and industry can affect CNS salary figures too. For instance, entry-level CNSs earn an average of $84,837 according to December 2021 PayScale data, while late-career professionals make average salaries of $101,330.

Individuals who want to become clinical nurse specialists should remain committed to their goals over the course of several years. That’s because these specialists not only need bachelor’s and master’s degrees, but they also must earn their RN licenses and gain experience working in the field.

Many colleges require bachelor of science in nursing (BSN) applicants to possess high school diplomas, although some also accept individuals with GED certificates. Programs also require students to complete their general education courses at the undergraduate level before they can begin their nursing courses.

RNs need either a BSN or associate degree in nursing to qualify for licensure. However, nurses who aim to become clinical nurse specialists often prefer to pursue a BSN. That’s because they need to earn a master’s degree later on, and graduate programs typically require applicants to possess bachelor’s degrees.

A BSN typically requires 120 credits and lasts four years for full-time students. In addition to general education courses, students take several nursing courses. These cover biology, anatomy, and physiology. They also teach students about on-the-job duties and considerations, like health assessment and health ethics. Plus, a BSN includes labs and supervised clinicals to give nurses hands-on experience in the field.

Sometimes, students are better suited to pursue nontraditional bachelor’s degrees. For instance, RNs who already hold an associate degree in nursing can enroll in RN-to-BSN programs, which allow students to transfer their previous credits. These RN-to-BSN degrees usually only consist of around 60 credits, which means students can graduate in two years. Accelerated RN-to-BSN programs can also help learners complete their degrees more quickly.

The NCLEX-RN exam evaluates RN candidates’ nursing skills and knowledge. Every state requires a passing score on this exam in order to qualify for state licensure.

Since the exam follows a computer adaptive format, the type and number of questions change depending on the test taker. You could see anywhere from 75-145 questions on the test. Each test taker also follows his or her own pace, but the test caps the time limit at five hours. Individuals pass the test if they stay above the passing line with a 95% confidence interval.

Test takers can expect to see questions in four major client care needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity.

After earning their RN licensure, aspiring clinical nurse specialists often gain experience as nurses. Since CNSs work as advanced practice nurses in their field, professional work experience can help them hone their expertise before they reach the more advanced nursing role of CNS.

This experience differs from the supervised clinicals students carry out in college. That’s because it counts as a real-world job, which graduate schools and employers like to see in candidates.

To gain this experience, look for jobs at hospitals, doctor’s clinics, or any other healthcare facility. You can find open positions through online job boards, career fairs, or advisors at your school.

Earning board certification can help you with your career prospects and salary potential. The professional organization called the American Nurses Credentialing Center offers board certification in a variety of concentrations.

If RNs want to focus on a specific population, for instance, they could apply for board certification in pediatric nursing. Once individuals get to the clinical nurse specialist level, they can also apply for several board certifications.

Certification requirements vary depending on which credential you choose. However, typically candidates must take an exam and possess at least two years of full-time experience working as a nurse.

Since the clinical nurse specialist role fits into the advanced practice category, candidates need to earn a graduate degree. Most pursue a master of science in nursing (MSN) after earning a BSN and completing some RN work experience. Some apply for direct entry programs. These degrees allow bachelor’s degree-holders from non-nursing backgrounds to enroll directly into MSN programs.

Graduate degrees in nursing offer more advanced study in the field. MSN programs require students to take higher-level coursework, like evidence-based practice, population health in a global society, or physical assessment and diagnostic reasoning in advanced practice nursing.

MSN programs also allow students to specialize in specific areas. Common concentrations include gerontology, pediatric care, neonatal care, nursing informatics, and women’s health. Like with undergraduate degrees, students participate in labs and clinical hours.

Generally speaking, MSN programs require applicants to possess bachelor’s degrees. However, some RNs with associate degrees can enroll in RN-to-MSN programs as well. Traditionally master’s programs last two years, but some accelerated programs allow students to graduate in half that time.

As the highest possible degree for nurses, the doctor of nursing practice (DNP) trains nurses with the most advanced courses. Although this degree is not necessary to become a clinical nurse specialist, it can help CNSs carry out their roles with the greatest expertise and most comprehensive level of nursing knowledge. Plus, the NACNS recommends that all clinical nurse specialists earn doctorate degrees as entry into practice by 2030.

DNP programs often last 2-4 years, although some accelerated full-time programs allow students to graduate in just one year.

After completing their graduate degrees, clinical nurse specialists can finally apply for advanced practice licensure. Licensure for CNS professionals varies depending on the state, so check with your state board to learn what license you need and how to obtain it.

You can also earn certification. For example, the American Nurses Credentialing Center offers the Adult-Gerontology Clinical Nurse Specialist Certification. For certifications like this one, applicants need a graduate degree in nursing with specific courses like health promotion and advanced pharmacology. They also need to pass a qualifying exam. Previous work experience requirements depend on the type of certification.

Everybody’s pathway to becoming a CNS varies. The educational requirements for becoming a CNS last at least five years, especially if students go the traditional route of earning a bachelor’s and master’s degree. In addition, CNSs usually need work experience as an RN. This can add an extra 1-2 years.

That said, many nurses go a nontraditional route. They may earn their associate degree and then enroll in an RN-to-MSN program after several years of working. They might look for accelerated programs to reach their goals faster. Or they might work in an entirely different field and then apply to a direct entry MSN to change their careers.

Clinical nurse specialist salaries depend on many factors: location, years of experience, employer, and setting. PayScale lists the average CNS salary as $93,927 in March 2022. The site also reports that average CNS pay ranges from $84,837 to $102,833 for entry-level to late-career professionals.

A CNS and nurse practitioner (NP) both take on similar advanced practice roles. Nurse practitioners meet with patients individually to evaluate, diagnose, and treat them. CNSs can take on these responsibilities as well. However, these duties only make up a small part of their scope of practice.

Generally speaking, CNSs work as leaders in the nursing industry. They carry out research, educate incoming nurses, optimize workflow to improve patient outcomes, and offer consultations to create best practices.

Some certified nurse specialists can, while others cannot. Almost 25% of clinical nurse specialists can prescribe medication, according to the 2020 NACNS census. Each state sets its own laws regarding whether advanced practice nurses can prescribe medication. Some nurses can do so independently, while others need to enter supervisory or collaborative agreements with physicians to write prescriptions.

Yes, a CNS is a type of advanced practice registered nurse (APRN). Because certified nurse specialists work in these advanced practice roles, they need more training than their RN peers. They must graduate with master’s degrees, although many go on to pursue doctorates.