Become a Clinical Nurse Specialist

For registered nurses looking to take their careers to the next level, becoming a clinical nurse specialist (CNS) offers the opportunity to leverage clinical skills while also improving patient outcomes and processes.

Clinical nurse specialists typically hold leadership roles and are in high demand. Research shows their role has a positive impact on patient outcomes, reduced hospital costs and length of stay, improved pain management and increased patient satisfaction.

Educational requirements and scope of practice for a clinical nurse specialist

A clinical nurse specialist is an advanced practice registered nurse (APRN) who has obtained either a master of science in nursing degree or a doctor of nursing practice (DNP) in a specialty practice area. The American Association of Colleges of Nursing notes CNSs work in a wide variety of specialty areas including geriatrics, oncology, pediatrics, psychiatric/mental health, adult health, acute/critical care and community health, among others.

Although clinical nurse specialists and certified registered nurse practitioners (CRNP) are both advanced practice nurses, CRNPs see patients in a primary care setting, while CNSs serve as experts in their specialty area. Both serve as a link between best practices in medical research and clinical practice.

Graduate CNS programs are tailored to the nurse’s area of interest. Some offer advanced degrees in gerontology or pediatrics while others offer a more general clinical nurse leader degree, or a master’s or doctoral program with a CNS option.

According to O-Net Online, the CNS collaborates with other health professionals to optimize patient care, advises other nurses and promotes disease prevention and wellness plans.

Some universities offer an accelerated master of science in nursing program that can be completed in 18-24 months, while others are tailored more to working professionals and can be completed at a nurse’s own pace.

A doctorate of nursing degree takes a minimum of three years if attending classes full time and 4 to 6 years if taken on a part-time basis.

Nurses who choose to pursue a master of science in nursing degree can expect to take classes including ethics, informatics and healthcare policy and learn about advanced management principles and practice. In doctor of nursing practice (DNP) or doctoral (PhD) programs, nurses learn evidence-based practice principles, how to manage resources while cutting costs and learning tools to provide delivery of patient care.

Master’s and doctoral programs for clinical nurse specialists are offered online and in an online/hybrid format that combines both online and classroom learning.

Most CNS programs range from $500 to $1000 per credit hour, with doctoral programs often being on the higher end.

In addition to an advanced degree, clinical nurse specialists must be certified by the American Nurses Credentialing Center and the American Association of Critical-Care Nurses. To become certified through the ANCC, nurses must take a competency-based exam — priced from $395 or $295 for ANA members. Certifications through the AACN cost between $255 for members and $360 for non-members.

CNSs also must seek state licensure. According to the National Association of Clinical Nurse Specialists, state laws and regulations for the CNS role vary from state to state. Eight states have given clinical nurse specialists the ability to practice without a physician’s supervision and six states have given clinical nurse specialists permission to prescribe drugs and durable medical equipment.

Nurses who have already obtained graduate degrees can obtain a post-graduate certificate to become a CNS. This requires another year or two of specialized graduate studies. Some colleges offer accelerated online programs that can be completed in nine months.

The post-graduate certificate is a good option for nurses who are seeking to move into a new specialty area. For example, if a nurse’s graduate program emphasized family medicine and she or he wants to transition into caring for older adults, she or he can obtain a post-graduate certificate in gerontology. Many universities offer post-graduate certificate programs online with costs ranging from $600 to $1,000. Financial aid and scholarships also are available.

On the job

Clinical nurse specialists have a variety of responsibilities relating to clinical practice, education, consultation and research. According to the National Council of State Boards of Nursing, certified nurse specialists are responsible and accountable for diagnosis and treatment of health/illness states, disease management, health promotion and prevention of illness and risk behaviors among individuals, families, groups and communities.

PhD-prepared clinical nurse specialists are additionally equipped to conduct research, lead research teams, and design and evaluate interventions for improved clinical and financial outcomes.

A survey found most clinical nurse specialists work in hospitals that are either accredited by the ANCC’s Magnet Recognition Program or are seeking accreditation. In addition, the survey found most clinical nurse specialists work in adult health/gerontology followed by pediatrics, family/individuals across the lifespan, psychiatric/mental health, women’s health/gender specific and neonatal.

And while 8 in 10 clinical nurse specialists work in acute care hospitals, some are also employed in ambulatory care, nursing education and academic health centers.

Salaries for certified nurse specialists are extremely competitive. The average annual salary for a clinical nurse specialist is $106,218 (as of February 2020), with the salary range falling between $96,038 and $116,350.

Jobs for clinical nurse specialists also are expected to increase with the aging population. According to the U.S. Census, by the year 2034, there will be 77.0 million people 65 years of age and older.

Often called “the Silver Tsunami” by healthcare experts, this large population of older adults means nurses will be caring for an increased number of older patients with multiple chronic health conditions.

CNSs who specialize in gerontology can meet the specialized needs of older adults and the frail elderly, making their role in high demand.

Psychiatric mental health advanced practice nurses (PMH-APRNs) with a clinical nurse specialist certification also are in demand, according to the American Psychiatric Nurses Association. According to the APNA, there are approximately 7,500 PMH-CNSs across the country who provide psychiatric and substance abuse assessments, diagnoses and treatment, including medication interventions and psychotherapy.

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