One of the most advanced career fields in the health care sector is that of a clinical nurse specialist. These experts provide general care to patients in one of a variety of medical specialties, such as geriatrics, pediatrics, oncology as well as emergency care. CNSs, as they are commonly known, also work as consultants helping other medical professionals by working to improve health outcomes in all stages of care. According to the National Association of Clinical Nurse Specialists, the CNS career is normally categorized as an advanced practice registered nurse (APRN) career because it requires clinical and graduate-level training. Due to a high level of knowledge and precision demanded of this job role, CNSs are usually relied upon to provide leadership roles and advice to other nurses.


Career Overview


This is a pretty interesting career which, although challenging, can open one’s future to a myriad of opportunities. The best candidate for a clinical specialist’s job is one who is able to make quick, informed decisions concerning health matters and treatment. One who enjoys collaborating with teams of professionals to achieve specific goals and improve patient care. Also, in order to ensure maximum productivity, one needs to be an effective communicator so they can communicate easily with patients, caregivers, and administrators. Above all, one should be enthusiastic about enhancing positive impact in patient care science through management skills, leadership as well as coaching.

There are different areas that one may choose to specialize in. For instance, you can choose to focus on community health matters or gerontology. Other areas of specialization include:

  • Pediatrics
  • Home health
  • Diabetes management
  • Child psychology and mental health
  • Adult mental health and psychiatric
  • Adult health

The typical work environment for this nurse is mainly around hospitals, physicians’ offices, community health centers, laboratories as well as colleges and universities.

What Roles Does a Clinical Nurse Specialist Handle on a Daily Basis?


Generally, clinical nurse specialists are trained on improving things for both nurses and their patients. As such, they develop positive changes in the health care system by striving to develop new practices that help improve recovery chances for a diverse range of patients. Through a strong focus on evidence-based practices, these skilled nurses are relied upon to serve as clinical experts in their respective fields of specialization.

A day in a CNS’ life revolves around these five core responsibilities.

  1. Conducting physical exams
  2. Conducting research to improve knowledge about their areas of specialization
  3. Promoting wellness and disease prevention
  4. Advising other nurses and medical practitioners on patient related issues
  5. Treating injuries, diseases and disabilities commonly associated with various fields of medical expertise
  6. Observing patient conditions and diagnosing problems and illnesses
  7. Ordering medical tests and evaluating test results

History and Future Outlook of CNS Career


Just like other APRN job roles, demand for persons with CNS skills is on the rise. Generally, demand for healthcare expertise has risen consistently over the decade, especially as services provided by qualified CNSs and other nurses tend to be slightly cheaper than those provided by a physician.

Data shows that overall, there are fewer individuals working in APRN-related fields of nursing as compared to other professionals such as registered nurses (RNs). For instance, in 2013, there was an estimated 113,370 practicing clinical nurse specialists as compared 2,661,890 RNs. This happens because of the strict requirements for courses that are recognized under APRNs – in APRNs, you need a graduate degree, RN license, national credentials and state licensure to practice.

Still, demand for persons with APRN qualifications is high. For instance, the BLS projects that demand for CNSs will grow by 31% which is 19% faster than the projected growth of RN field.

Clinical Nurse Specialist Salary


The salary is comparable to other professions within the expansive healthcare industry, with almost 50 percent of employed CNSs making over $70,000 annually. As stated earlier, there is high demand for specialized workers in this profession also meaning that individuals who secure these jobs often end up getting good salaries. The salary figures are normally affected by several factors such as education credentials, experience, and job location. If you are planning to work in a metropolitan area, you can expect a better pay package than your counterparts working in suburban settings.

Currently, the leading areas in hiring CNSs are New York, Los Angeles, and Chicago. States that pay the best salaries to their CNSs include Alaska $111,800 per year, California $110,590, Oregon $107,560, Hawaii $106,700 and Massachusetts $105,010.


Like in most professions, the level of experience of the individual plays an important role in the clinical nurse specialist salary sheet. Individuals with between 1 and 5 years of experience get the lowest packages while those with over 10 years of experience attract the highest salaries. Here is a simple table showing how a clinical nurse salary can vary with experience.

  • 1 to 5 years $55,000 – $75,000
  • 5 to 10 years $75,000 – $105,000
  • 10 years and above $105,000 – $125,000

Office physicians are the leading employers of clinical nurse practitioners followed by general and surgical hospitals and outpatient care centers respectively.

CNSs on the Job


Unlike traditional RNs, clinical nurse specialists are trained to do much more than care for patients by helping to treat and prevent ailments under the supervision of a physician. They can also diagnose, treat conditions, disabilities and injuries as long as they are within their area of specialization. CNSs work directly with patients as well as other nurses when consultations are needed – in line with their primary role of improving health care system for everyone.

It is worth noting that CNS life is generally seen as a venerable one-man show with five core responsibilities on one professional’s shoulders: research, clinical practice, management, consulting and teaching. Healthcare does not operate with one set of guidelines, and as such the experience of clinical nurses is vital to its overall success. Because they also work as patient advocates, it is their job to coordinate money-saving practices and resources while still providing optimal health outcomes.

This is, therefore, a career suitable to those who are good at caring for others. So if you have a knack for solving complex problems while putting the interest of others before self, then clinical nursing could just be your right alley.

How to Become a Clinical Nurse Specialist?


Becoming a CNS requires significant schooling because it is one of the four advanced nursing practices. So here is a step-by-step guide on how to become a CNS.

Step One: Obtain a Bachelor’s Degree in Nursing

Most CNS degree programs require aspiring CNSs to earn a bachelor’s degree in a nursing school. The programs generally take 4 years. Courses under nursing degree programs include physiology, patient health assessment, pharmacology basics, anatomy, nursing throughout all life stages and pathophysiology basics.

Step Two: Acquire a state license as Registered Nurse

All states require CNSs to be licensed before practicing. Clinical nurse specialist degree programs on the other hand also require applicants to be licensed as a registered nurse. While the majority of states require students to pass the National Council Licensure Examination for RNs which is administered by the National Council of State Boards of Nursing (NCSBN), some states may have additional state nursing board licensure requirements. Additionally, CNSs licensed in one state can always apply for a license but only by endorsement in another state.

Step Three: Acquire Experience

Most graduate degree programs require candidates to have acquired experience as a registered nurse in the specialty they have chosen. On the other hand, schools require one to two years direct patient experience in a clinical setting. This experience can be gained by performing registered nurse nursing duties in private practices, hospitals or even outpatient settings.

Step Four: Obtain a CNS Master’s Degree

These programs usually take two to three years to complete depending on the specialty. You can earn your Master degree either online or in a traditional classroom setting. The safest way to ensure the rigor of the program’s academics and the validity of your degree is to choose a CNS program that has been accredited by a nationally recognized accrediting body. Most CNS programs usually have accreditation from the Commission on Collegiate Education and Accreditation Commission for Education in Nursing.

Step Five: Apply for Certification

The certification is not required in all 50 states hence, not all CNS specialties have a certification credential available. However, certification is highly recommended since most employers require their clinical nurse specialists to have it. The American Nurses Credentialing Center(ANCC) offers a nationally recognized certification for clinical nurse specialists. Some of the certifications ANCC offers include:

  • Pediatric CNS
  • Adult-Gerontology CNS
  • CNS Core
  • Adult Health CNS
  • Diabetes Management Advanced
  • Home Health CNS
  • Child/Adolescent Psychiatric Mental Health CNS

The qualification for every certification varies but the certification body usually requires that the students have a current RN license, have obtained the minimum required number of hours of clinical experience in the specialty (i.e. at least 500 faculty-supervised clinical hours), have completed a graduate degree in the selected specialty from an accredited school and pass the certification exam. In addition, ANCC requires certification renewal after every five years.

Step Six: Acquire an Advanced Practice Nursing License

Most states usually require CNSs be licensed by the State Nursing Board. The qualifications include having a graduate degree from accredited advanced practice nursing school, maintaining a registered nurse license and being certified by a well-recognized CNS certification authority.

Are Online Clinical Nurse Specialist Programs Available?

Nursing is a very hands-on profession, so most people might assume CNS online nursing programs are not available, but they actually do. Candidates can earn the bachelor and master degrees online at a range of schools with some even offering part-time curriculums as well. These online programs usually provide live web-based teaching in some cases and when time comes to finish clinical hours, they set the students up at a website the school has partnered with.

What Are Some of the Challenges CNSs Face?


CNSs in clinical practice usually face different challenges. One common challenge most CNSs face is a lack of clear-cut role definition within and outside the health-care arena. This is because some people are not familiar with the title CNS despite having over 75,000 CNSs in America. Another challenge is inadequate time for self-or organization defined responsibilities and accomplishments. This challenge serves as a barrier for CNSs’ effectiveness. They also face problems like learning staff preferences, becoming oriented to a new environment and grappling to gain respect from the staff.

Clinical Nurse Specialist vs. Nurse Practitioner


CNS and NP are both advanced practice nurses who sometimes work in the same types of health care facilities. While both are acknowledged as leaders in nursing credentialing and care, their roles remain distinct from one another. So to help aspiring advanced practice nurses make a good decision about which role will best suit their skills and personality, below are the core differences between the two nursing professionals.

  • Common Practice Settings

A clinical nurse specialist typically works in a large health care facility or even an entire department wing. They may practice in occupational health settings, hospitals, long-term care facilities, educational institutions, at a private practice setting, mental health settings, and even community health centers.

On the other hand, nurse practitioners mostly work in a private practice physician’s setting. Here they take over patient care duties in place of the physician but for certain patients. Other settings NPs may work in include nursing homes, school-based clinics, community clinics, ambulatory clinics and health maintenance organizations.

  • Job Duties

CNSs are often in charge of a department of nursing either at a hospital setting or at a private practice location. They have the expertise and education to lead the nursing staff in improving the patient care process. They assess, plan and intervene in complex cases providing support to nursing staff, patients, and their family members.

Nurse practitioners, on the other hand, work under the indirect supervision of physicians. They diagnose chronic illnesses, perform health assessments, manage acute episodes, interpret diagnostic tests and promote disease prevention. They are also involved in making medical treatment referrals and may sometimes prescribe medication depending on the state they practice in.

  • Salary

According to the Healthcare Profession and Salary Database, CNSs earn an average annual salary of around $70,000 with the highest paid clinical nurse specialist earning more than $120,000. On the other hand, the highest earning general nursing practitioner earns around $92,670 with average figure being at around $60,000 according to the Bureau of Labor Statistics. Generally, CNSs earn more than their general nursing colleagues with the same years of job experience.


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