"Clinical Nurse" designation---what does it mean in your facility?

Aw yes, the "clinical nurse". Actually, in some states, Clinical Nurse Specialist is not a protected title...unfortunately,

traumarus, APN, CNS

sounds like something very similar to clinical ladder program. It usually goes by how many years experience one has, plus what they have accomplished within those years. My facility has a clinical ladder program. Everyone starts out at a III for experienced RN's, then you apply for a IV or V. There are criteria you must score to make your portfolio representative of your experiences, of course proper documentation or proof, if you will, is needed. After all the compiling you submit to a committee who then reviews your portfolio. Monetary rewards are awarded for level IV and V, with V being the most. In order to get this designation it must be maintained in order to keep it-not so easy to do. This very time consuming process has kept many of our wonderfully talented nurses from pursuing a level V--but it's worth it in the end (and I don't mean just money).It's a sense of accomplishment that is recognized by the hospital.

CN I = a new grad, less than 1 year experience
CN II = nurse with more than 1 year experience
CN III = nurse with more than 2 years experience, most nurses are CN III's
CN IV = nurses many years of experience and in very sepcialized areas.

No real clinical ladder in place.

We have the clinical ladder too. To get beyond CNII, you need to submit a portfolio to a committee.
The CN III and up are all required to join a committee, and are trained to be in charge, precept and take care of ECMO patients.