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Clinical Nurse Specialist: Job Description, Salary, and How to Become One

If you're a registered nurse (RN) looking to advance your practice and make a meaningful impact on the healthcare industry, consider becoming a clinical nurse specialist (CNS).

Updated:   Published

  • Erin Lee
    Erin Lee, BSN, RN
    Specializes in Critical Care, Procedural, Care Coordination, LNC. Has 11 years experience.
Clinical Nurse Specialist: Job Description, Salary, and How to Become One

Are you an RN looking to advance your nursing practice and make a meaningful impact on the healthcare industry without completely giving up patient care? Consider becoming a clinical nurse specialist (CNS). 

By exploring this comprehensive guide, you will gain valuable insights into the CNS's responsibilities, potential earnings, and crucial steps to kickstart a fulfilling career in this field.

Table of Contents

CNS Job Description 

CNSs are highly skilled healthcare professionals with graduate-level education and recognition as advanced practice registered nurses (APRNs). A CNS has specialized skills in diagnosing and treating illnesses for particular patient populations, focusing on providing specialized care for at-risk patients or groups. 

Although CNSs may have similarities with nurse practitioners (NPs), the CNS role usually focuses less on direct patient care and more on administrative duties, research, and improving healthcare systems and patient outcomes. With advanced expertise in three central domains, CNSs can innovate and enhance the healthcare industry. Unlike NPs, CNS's responsibilities extend beyond patient care, as they integrate all three domains into their practice to revolutionize healthcare services and nursing practices at the organizational level.

The three domains of expertise a CNS integrates into their practice are direct patient care, influencing nursing, and impacting healthcare organizations.

Direct Patient Care 

Experienced CNSs rely on evidence-based nursing interventions and national guidelines to provide expert care and enhance patient outcomes. They conduct patient rounds, perform health assessments, and advise on complex care requirements. 

With a commitment to delivering top-tier care to at-risk and specialized patients, these professionals can employ their expertise in various healthcare settings, such as hospitals, ambulatory clinics, private practices, home care, and health systems. Patient advocacy and consultation are also significant components of a CNS's direct patient care responsibilities.

Related: Nurse Practitioner: What Is an NP, Salary, and How to Become One

Influencing Nursing

CNSs play a crucial role in healthcare teams by providing leadership and working collaboratively with others to enhance patient care through evidence-based practice. They serve as mentors, educators, and innovators, sharing their knowledge with nurses and other healthcare professionals.

CNSs evaluate and modify practice standards to ensure evidence-based care and promote quality improvement. They guide RNs in devising, implementing, and evaluating changes in healthcare practices. Additionally, they advocate for the value of nurses' contributions to healthcare outcomes to organizational leaders. 

Impacting Healthcare Organizations

The role of a CNS is vital in influencing and enhancing healthcare organizations and systems. They have a comprehensive knowledge of healthcare systems, allowing them to improve patient safety, implement evidence-based practices, and lead quality improvement initiatives. 

Through collaboration with interdisciplinary teams, performing cost-benefit analyses of new patient care technologies, and optimizing patient outcomes, CNSs help healthcare facilities achieve recognition for outstanding patient care and nursing excellence.

Being proficient in all three areas is crucial as the actions taken in one domain directly affect the other three. A CNS must be flexible in their duties to meet the specific needs of the healthcare system, patient care unit, family, or community. Nevertheless, their main priority is consistently focused on direct patient care improvements and advocacy. 

By becoming a CNS, you will embark on a fulfilling career where you provide expert care, lead practice changes, collaborate with healthcare teams, and contribute to improving patient outcomes.

CNS Responsibilities

A CNS's responsibility will differ depending on the healthcare setting, patient population, and specialty area. A general overview of their duties includes:

  • Stay updated with current research and evidence-based practices
  • Integrate evidence-based interventions into patient care
  • Educate and mentor healthcare professionals, including nurses and students
  • Collaborate with interdisciplinary teams and contribute to policy development
  • Provide consultation to enhance patient care delivery and quality improvement
  • Develop, implement, and evaluate specialized healthcare programs
  • Participate in quality improvement initiatives and monitor patient outcomes
  • Foster collaboration and effective communication among healthcare teams
  • Engage in policy development, implementation, and advocacy efforts
  • Provide expert-level clinical care within a specialized patient population
  • Perform health assessments, diagnose, and manage complex health conditions
  • Develop and implement comprehensive care plans
  • Prescribe medications, medical supplies, and durable medical equipment (in most states)

CNS Salary

A CNS can earn a variable salary depending on their specialty, healthcare setting, work region, and years of experience. 

Glassdoor's May 2023 report shows that CNSs earn an average of $118,950 annually.

CNS Annual Salary Based on Years of Experience 

  • 1-3 years CNS experience: $87,039
  • 4-6 years CNS experience: $97,436
  • 7-9 years CNS experience: $108,708
  • 10-14 years CNS experience: $115,763
  • 15+ years CNS experience: $127,194

CNS Annual Salary by State: Highest Paying 

  • Vermont: $117,396
  • Arizona: $111,953
  • Wyoming: $111,727
  • Massachusetts: $111,709
  • Tennessee: $111,006

CNS Annual Salary by State: Lowest Paying 

  • South Carolina: $65,907
  • North Dakota: $67,850
  • North Carolina: $71,667
  • Arkansas: $72,500
  • Oklahoma: $74,300

These numbers significantly differ from the highs and lows listed above, as the aggregate data regarding state pay is from ZipRecruiter, while the remaining aggregate data above is from Glassdoor. Unfortunately, the Bureau of Labor Statistics (BLS) does not measure CNS average salary. 

How to Become a CNS

As with any graduate-level nursing degree, becoming a CNS is a multi-step process. 

Step 1: Undergraduate Nursing School

Apply to an accredited school of nursing to obtain a Bachelor of Science in Nursing (BSN) or Associate's Degree in Nursing (ADN) from an accredited nursing school. 

Step 2: RN-Licensure 

Pass the National Council Licensure Exam for Registered Nurses, NCLEX-RN, to obtain licensure as an RN. 

Step 3: Nursing Experience

Gain practical nursing experience by working in a clinical setting or healthcare facility. Many CNS graduate programs require at least two years and up to five years of RN experience.

Step 4: Graduate Nursing School

Pursue a Master of Science in Nursing (MSN) degree or a Doctor of Nursing Practice (DNP) degree specializing in CNS. 

Prospective CNS students should ensure that the CNS program chosen is consistent with state requirements and national standards for graduate APRN programs. It is crucial for the nursing school's CNS program to be accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN).

Based on the National Association of Clinical Nurse Specialists (NACNS) criteria, CNSs must obtain at least 500 supervised clinical practice hours for MSN programs and 1,000 clinical hours for a DNP program. 

Related: 10 Best BSN to MSN Programs in 2023

Step 5: National CNS Certificate

To become a certified CNS, you must obtain national certification from a recognized organization like the American Nurses Credentialing Center (ANCC) or the American Association of Critical Care Nurses (AACN). 

Certification based on the specific patient population a CNS serves is usually necessary. Some examples of CNS specialties include:

  • CNS-BC: Clinical Nurse Specialist Core Certification
  • CNS Wellness through Acute Care: 
    • ACCNS-AG: Adult-Gerontology CNS 
    • ACCNS-P: Pediatric CNS 
    • ACCNS-N: Neonatal CNS 
  • Acute/Critical Care CNS:
    • CCNS: Adult 
    • CCNS: Pediatric
    • CCNS: Neonatal 
  • PMHCNS: Psychiatric Mental Health CNS 
  • WHCNS: Women's Health CNS
  • CHCNS: Community Health CNS

Step 6: Apply For State Licensure

A CNS is considered an independent provider in most states, allowing them to practice and hold prescriptive authority without supervision from an MD, DO, DDS, or APRN.  To ensure legal compliance, it is important to carefully review your state's nursing board regulations for APRN CNS licensure and the scope of practice specific to the state you plan to work. 

Becoming a CNS can significantly enhance your nursing practice and allow you to make a lasting impact in the healthcare industry. This role offers various opportunities to provide specialized care, lead practice changes, collaborate with healthcare teams, and improve patient outcomes. 

By embarking on this fulfilling journey, you can become a trailblazer in revolutionizing the healthcare industry and become a nurse leader and innovator.

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Erin Lee

About Erin Lee, BSN, RN

"Do not go where the path may lead, go instead where there is no path and leave a trail." -Ralph Waldo Emerson

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traumaRUs
Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,232 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Agree with most of this. However, with healthcare much more of a business now then ever before, it is very important that all APRNs bring  something ie $$$$$ to their practice/hospital. Otherwise, you might soon find yourself out of a job. 

Also, I'm not sure the Core curriculum is offered any longer. The other issue is that many of the CNS certification exams have been retired ie they are no longer available. 

I'm both an adult health and peds health CNS. I'm an APRN in IL and fulfill the APRN role: ie seeing, diagnosing, treating and of course billing for my services. 

Erin Lee

Erin Lee, BSN, RN

22 Articles; 35 Posts

Specializes in Critical Care, Procedural, Care Coordination, LNC. Has 11 years experience.
traumaRUs said:

Agree with most of this. However, with healthcare much more of a business now then ever before, it is very important that all APRNs bring  something ie $$$$$ to their practice/hospital. Otherwise, you might soon find yourself out of a job. 

Also, I'm not sure the Core curriculum is offered any longer. The other issue is that many of the CNS certification exams have been retired ie they are no longer available. 

I'm both an adult health and peds health CNS. I'm an APRN in IL and fulfill the APRN role: ie seeing, diagnosing, treating and of course billing for my services. 

Thanks for sharing your experienced insight, it is very much appreciated! Can you help me understand what you mean by the CNS certifications have been retired? Are you referring to the post-graduate specialty certifications? My understanding is that to practice as an APRN you must have a national certification and state license, both ANCC and the AACN offer national CNS certification exams. But I did have a challenging time researching and finding some of the post-graduate CNS specialty certifications, so that would make sense, although some do appear to still be offered. Thanks again for sharing, I look forward to learning more about this. 

traumaRUs
Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,232 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Retired means that the certifying exam is no longer offered. Those of us that hold the "retired" certifications can continue to hold the certification provided they meet the requirements for recertification. 

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