How to Become a CNS: Unlock the Clinical Nurse Specialist Requirements With 6 Realistic Steps

Welcome, FreshRN family! Today, we’re diving into the world of Clinical Nurse Specialists (CNS). Often shrouded in mystery and confusion, the CNS role is critical to our healthcare system. We will discuss how to become a CNS, as well as clinical nurse specialist requirements, the steps 👣 to success – and more!

Clinical Nurse Specialist Defined

Let’s establish a clear definition before we discuss how to become a CNS. A Clinical Nurse Specialist is an advanced practice registered nurse (APRN) who focuses on improving patient outcomes and nursing practice.

A CNS can perform advanced health assessments, diagnose, prescribe, and treat patients, focusing on the nursing care provided in a particular area. In addition to this care, the CNS improves the system by leveraging evidence-based practice to optimize nursing care delivery.

The CNS has three critical areas of focus:

1. The patient
2. The nurse
3. The healthcare system

To adequately support all three, the CNS will see patients as needed, however, that’s not their sole focus. They also use their clinical expertise and knowledge to support the nursing staff, which ultimately supports the organization. They do this in many ways, such as evaluating gaps and needs at the bedside for the end-user (the nurse) and then working to identify how to address them. This can mean crafting a new policy, advocating for resources to hospital administrators, or working with other disciplines behind the scenes to facilitate change.

All that support is possible because they have one foot at the bedside and one foot in the boardroom. Because hospital systems are so large and complex and our patients are very dynamic, the support of a CNS is critical to the well-being of the nursing staff and the field of nursing in general. Bedside nurses cannot provide the level of care our patients require and dedicate time and attention to improving the system as a whole. This is where the CNS comes in, who both help with day-to-day issues as they arise but step back and have a duty to ensure the growth and momentum of nursing.

If the nursing staff were an NBA basketball 🏀 team, here’s how it would stack up:

• Bedside nurses: Players
• Nurse manager: Head coach
• Assistant nurse manager: Director of basketball operations
• Clinical nurse specialist: General manager (GM)
• Chief nursing officer: President of the organization

The GM intimately knows all their players, talents, and needs but also understands the more extensive organizational operations. They know how to develop players, identify barriers, and innovate to ensure success.

If you want to hear from a highly experienced CNS, check out this interview:

Video: What is a Clinical Nurse Specialist (CNS)?

Clinical Nurse Specialist vs. Nurse Practitioner

While CNSs and NPs are Advanced Practice Nurses, their roles are distinct. Nurse practitioners (NPs) primarily focus on providing direct patient care and diagnosing and treating medical conditions. An NP will have a list of patients they must round on, evaluate their status, enter and modify orders, and write a progress note. The NP works with a specific physician or medical group to provide comprehensive care to individual patients during admission to meet their medical needs.

While the CNS can enter orders, perform procedures, and prescribe medications, they are not assigned specific patients during their admission. A CNS will assist the bedside nurses with needs during a shift on patients as indicated. Their home base 🏠 is on a specific nursing unit, supporting those nurses and the patients of those nurses. They may consult with physicians as needed but are not reporting to that physician.

Nurse Midwives and Nurse Anesthetists (CRNAs) are not clinical nurse specialists, but they are another type of advanced practice registered nurse in the nursing field.

Many NPs work in the outpatient setting, like private practice, as well as in acute care. While a CNS can work outpatient, most are in acute care.

Naturally, the day-to-day between a CNS and NP are very different. Let’s explore what a typical shift as a CNS looks like.

Clinical Nurse Specialist vs. Nurse Educator

A Nurse Educator primarily focuses on education and training. Their role is vital in preparing and mentoring current and future generations of nurses. Nurse Educators work in academic settings, such as universities and nursing schools, and in healthcare facilities where they develop educational programs, teach courses, and train nursing staff. They are responsible for curriculum development, teaching nursing theory and clinical skills, and evaluating nursing education programs. While Nurse Educators may also be involved in clinical practice, their primary focus is education, ensuring nurses have the knowledge and skills to provide high-quality patient care.

While both Clinical Nurse Specialists and Nurse Educators are integral to the nursing profession, a CNS is more involved in direct patient care and clinical practice improvements within a specialty area. In contrast, a Nurse Educator focuses more on the educational and training aspects of nursing.

A Day in the Life of a Clinical Nurse Specialist

Imagine a day balancing patient care with systemic improvements. A CNS starts with rounds, assessing patients as needed, and mentoring nurses with complex cases.

Rather than having a list of patients to round on like a nurse practitioner, unit-based CNSs report to their unit and check in with the nursing staff. They ask how the last shift went, which patients are not doing well and need extra assistance, perform procedures, and collaborate with other providers and physicians as needed.

Afternoons might be dedicated to team meetings, discussing quality improvement or new protocols. They might have a specific issue they are trying to improve at the organization level, like a new tube feeding or sepsis protocol. This would require collaboration across disciplines (physicians, dietitians, food service, nursing research, and more) and in-depth knowledge of what the end user (the bedside nurse) must do to provide care successfully.

CNSs juggle direct patient care with big-picture strategies to elevate the unit’s performance.

Here’s a video from Johns Hopkins outlining a more detailed walk in the life of a CNS.

How to Become a CNS

Let’s break down how to become a CNS for someone starting from scratch. Remember, this path demands dedication and a love for nursing and specialized care.

Step 1: Obtain a Bachelor of Science in Nursing (BSN)

Duration: 4 years

The first step is to earn a Bachelor of Science in Nursing (BSN) degree. This provides a comprehensive foundation for nursing theory, practice, and clinical skills. The BSN program must be accredited to be able to take your licensing exam (Step 2). Nursing students with a career goal of a CNS can pay particular attention to which specialty area they are interested in.

Important note ➡️ There are no RN-to-MSN programs available that would appropriately prepare someone for the CNS role. However, one could complete an RN-to-MSN program and then complete a CNS certificate.

Step 2: Pass the NCLEX-RN Exam

Duration: Immediately after BSN

Upon completing your BSN, you must pass the National Council Licensure Examination (NCLEX-RN) to become a registered nurse (RN). This exam tests your knowledge and skills for safe and effective practice as an entry-level nurse.

A nursing degree and passing the NCLEX-RN exam are required to obtain an RN license.

Step 3: Gain Clinical Experience

Duration: 1-2 years

Most CNS programs require at least one to two years of clinical experience. This time allows you to develop a solid clinical foundation and identify the specialty area you are passionate about, whether that’s pediatrics, oncology, or another field.

Step 4: Earn a Master’s or Doctoral Degree in Nursing

Duration: 2-4 years

Next, pursue an advanced degree— a Master’s (MSN) or Doctorate (DNP) with a CNS track in your chosen specialty in nursing. This nursing program will involve in-depth study in your specialty area, advanced nursing practice, research methods, and healthcare systems. This graduate program will require in-person clinical hours with various clinical rotations. You will select your specialty area, which will inform how you complete your clinical hours.

Clinical Nurse Specialists (CNS) can specialize in a wide range of areas, reflecting the diverse needs of the healthcare sector. Some of the specialty areas for CNSs include:

1. Adult Health: Focus on adult patients’ health and wellness, managing acute and chronic illnesses.
2. Gerontology: Specializes in the care of elderly patients, addressing the complex health issues that often arise as people age.
3. Pediatrics: Focus on the health needs of infants, children, and adolescents.
4. Neonatal: Specialize in caring for newborns, particularly those with illnesses or prematureness.
5. Women’s Health: Specialize in health issues unique to women, including reproductive and gynecological health.
6. Psychiatric and Mental Health: Provide care for patients with mental health issues, often working in collaboration with psychiatrists and therapists.
7. Critical Care: Work in intensive care units, specializing in the care of critically ill or unstable patients.
8. Oncology: Focus on the care of cancer patients, including pain management and symptom control.
9. Cardiovascular: Specialize in the care of patients with heart-related conditions.
10. Emergency Room: Focus on acute care in emergency settings.
11. Diabetes Management: Specialize in the care and education of patients with diabetes.
12. Pain Management: Focus on managing chronic and acute pain in patients.
13. Rehabilitation: Specialize in helping patients recover and regain skills after serious illnesses or injuries.
14. Occupational Health: Focus on promoting health and safety in the workplace.
15. Public/Community Health: Work on health issues within communities, often focusing on prevention and wellness.

Each of these specialties requires a deep understanding of the specific patient population, as well as expertise in the disease processes, treatments, and patient care techniques associated with that specialty. Clinical Nurse Specialists in these areas not only provide direct patient care but also play key roles in education, research, and administration to improve healthcare practices and outcomes in their respective fields.

To explore different Clinical Nurse Specialist Programs, check out this program directory from the National Association of Clinical Nurse Specialists.

Step 5: Obtain CNS Certification

Duration: Immediately after advanced degree

After completing your graduate degree, you must obtain CNS specialty certification. This involves passing a certification exam that assesses your clinical knowledge and skills in your chosen specialty.

Clinical Nurse Specialist (CNS) certification exams are administered by various professional nursing organizations, depending on the specialty area. Two of the primary organizations that offer CNS certification are:

1. American Nurses Credentialing Center (ANCC): A subsidiary of the American Nurses Association (ANA), the ANCC is a prominent credentialing body that offers CNS certifications in several specialties, such as Adult-Gerontology, Pediatrics, Psychiatric-Mental Health, and more. They are widely recognized and provide certifications that validate a nurse’s ability to provide advanced care in their specialty area.
2. American Association of Critical-Care Nurses (AACN): Although AACN is best known for critical care nurse certifications like CCRN, it also offers CNS certifications in areas related to acute and critical care nursing.

When preparing for CNS certification, it’s crucial to choose the organization and exam that align with your specialty and career goals. The certifications often require a combination of clinical practice hours in the specialty area, a master’s or doctoral degree, and passing the certification examination itself. The certification process is rigorous but rewarding, as it formally recognizes your expertise and advanced practice skills in the nursing specialty of your choice.

Step 6: State Licensure as a CNS

Duration: Varies by state

Once you have your CNS certification, you can apply for state licensure. This process generally involves:

• Filling out an application through your state’s Board of Nursing.
• Providing proof of education (transcripts) and evidence of your CNS certification from the accrediting body.
• Paying any associated application fees.
• Background checks and fingerprinting are often required

Your state may also require additional practice hours within your specialty, coursework, or exams as the requirements vary state by state. To learn what your state will require, and if there are any additional requirements, go to your state board of nursing’s website to see their specific requirements for Advanced Practice Registered Nurse (APRN) Clinical Nurse Specialist Licensure.

Now that you know how to become a CNS and all of the clinical nurse specialist requirements, here are some fast facts!

10 Fast Facts About Clinical Nurse Specialists

1. CNSs have been part of the nursing fabric since the 1940s.
2. They often specialize in areas like pediatrics, geriatrics, or oncology.
3. CNSs are pivotal in bridging the gap between administration and clinical staff.
4. They play a crucial role in policy formulation and implementation.
5. CNSs are often involved in research to advance nursing practices.
6. They are mentors and educators for nursing staff.
7. Clinical Nurse Specialists can prescribe medications in some states (this is called “Full Practice Authority” or “Prescriptive Authority”).
8. They work in various settings, including hospitals, clinics, and educational institutions.
9. CNSs have a significant impact on patient outcomes and satisfaction.
10. They are advocates for both patients and nurses.

Job Outlook For Clinical Nurse Specialists

The demand for Clinical Nurse Specialists (CNSs) is robust and expected to grow. This growth is fueled by an increasing emphasis on improving healthcare quality and outcomes and the ongoing evolution of healthcare systems. CNSs are highly valued for their expertise in specialized areas of nursing, their ability to provide cost-effective, evidence-based care, and their role in mentoring and educating nursing staff.

Factors Influencing Demand

1. Aging Population ➡️ With the aging baby boomer generation, there’s a growing need for specialized nursing care in gerontology, chronic disease management, and palliative care.
2. Healthcare Reform ➡️ Ongoing changes in healthcare policies and the emphasis on preventative care and managing chronic diseases increase the need for CNS expertise.
3. Advancements in Healthcare ➡️ As medical treatments and technologies advance, there’s a greater need for specialized nursing knowledge to integrate these innovations into patient care effectively.
4. Focus on Cost-Effective Care: ➡️CNSs play a crucial role in developing and implementing strategies to improve patient outcomes while reducing healthcare costs, making them valuable assets in various healthcare settings.

Salary Range For Clinical Nurse Specialists

The salary for a Clinical Nurse Specialist can vary widely based on factors like geographic location, area of specialization, years of experience, and the type of healthcare facility. As of my last update:

• The average annual salary for CNSs in the United States typically ranges from $80,000 to $120,000.
• CNSs can earn at the higher end of this range or even more in high-demand specialties or metropolitan areas with higher living costs.
• It’s important to note that salary potential can increase with advanced degrees, certifications, and years of experience.

For a sample job description that outlines the clinical nurse specialist requirements, click here.

Career Opportunities For Clinical Nurse Specialists

Clinical Nurse Specialists have diverse opportunities for career advancement and specialization. They can specialize in pediatrics, gerontology, oncology, psychiatric/mental health, or critical care. Additionally, CNSs can take on roles in healthcare administration, policy development, or education, providing even broader career prospects.

It is important to be aware of the area in which you want to live and work. There may not be as many in-person job opportunities if you live in a rural area.

The Job Center from the National Association of Clinical Nurse Specialists is a phenomenal career resource (bookmark 🔖 it!)

Final Thoughts on How to Become a CNS

Clinical Nurse Specialists are critical to a healthcare organization that fosters excellence in nursing practice and patient care. Whether through direct patient care, nurse-to-nurse interaction, or systemic change, their impact is profound and far-reaching. For those who love both the art of nursing and the power of change, becoming a CNS could be your calling. Let’s celebrate and support our CNS colleagues, for they truly make a world of difference in healthcare!

Thank you for reading about how to become a CNS!

More Professional Development Resources For Nurses

• National Association of Clinical Nurse Specialists
• How to Be a Better Nurse: 4 Essential Tips
• “I’m Not Drowning Anymore” – A Professional Development Plan For Nurses
• What is Critical Thinking in Nursing?