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As advanced practice registered nurses (APRNs) that serve a dual role as both clinician and change agent, clinical nurse specialists (CNS) contribute to advancing the practice of nursing through education, consultation, project management, clinical expertise, and research. While serving as advanced clinicians, CNSs also evaluate patients’ experience, nursing personnel, and organizational domains, with the ultimate goal of improving patient care and positively influencing healthcare delivery at all levels.
Their value lies in their ability to:
- Affect patient care by intervening in complex cases
- Provide support to nursing staff
- Consult and participate in multidisciplinary activities
- Design and evaluate programs of care
- Work on projects that advance nursing practice at the unit, department, division, institution, and network levels
Becoming a clinical nurse specialist gives RNs interested in advanced clinical practice the opportunity to also lead and collaborate with an interdisciplinary healthcare team, provide guidance and support to patients and their families, and serve in clinical, consulting, case management, and educational capacities.
As APRNs, clinical nurse specialists must possess a graduate-level nursing education, national certification and, in most cases, state licensure:
Step 1. Complete a Clinical Nurse Specialist Master of Science in Nursing (MSN) Program
For RNs with licenses in good standing, the first step to becoming a clinical nurse specialist is to earn a Master of Science in Nursing (MSN) or higher degree specific to the CNS role and a patient population focus of choice.
Many clinical nurse specialist graduate programs hold accreditation through The Commission on Collegiate Nursing Education (CCNE). CCNE-accredited CNS programs provide graduates with entry-level knowledge and competencies specific to the CNS role and a patient population focus, and ensure that they meet the requirements for certification through the American Nurses’ Credentialing Center’s (ANCC) or the American Association of Critical-care Nurses (AACN).
Curriculum Requirements
MSN-CNS programs are available through dedicated nursing schools, colleges, and universities, and consist of about two years of didactic coursework and clinical preceptorships.
By definition, CNSs specialize in a particular patient population focus. As such, all MSN-CNS programs are structured to include a track in one or more of these patient population foci:
- Family/Individual Across the Lifespan
- Adult-Gerontology (Acute care/primary care)
- Women’s health/gender-related
- Neonatal
- Pediatrics (Acute care/primary care)
- Psychiatric/mental health
Students may also further specialize their CNS program by choosing a focus of practice linked to healthcare needs, such as: oncology, palliative care, emergency medicine, etc.
As with all graduate programs that prepare advanced clinicians, MSN-CNS programs include a core that consists of:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced health assessment, including the assessment of all human systems, concepts and approaches, and advanced assessment techniques
- Advanced pharmacology, including:
- Pharmacokinetics
- Pharmacotherapeutics of all broad categories of agents
- Pharmacodynamics
The NACNS National CNS Competency Task Force recommends that the curriculum of CNS programs prepare graduates in the following Core Competencies:
- Direct Care
- Consultation
- Systems Leadership
- Coaching
- Research
- Ethical Decision-Making, Moral Agency, and Advocacy
- Collaboration
The clinical component of a clinical nurse specialist MSN program, which consists of at least 500 hours, allows students to apply the theoretical knowledge gained through coursework in real world settings.
Students can expect the clinical experiences they participate in to support and reinforce the above CNS Core Competencies. It is typical for clinical rotations in a clinical nurse specialist graduate program to take place in settings like:
- Hospital units
- Outpatient clinics
- Private practice
- Rehabilitation centers
- Long-term care facilities
- Home health agencies
- Public health agencies
Admission Requirements
Candidates for traditional, terminal clinical nurse specialist graduate programs must possess an active and unencumbered RN license, a Bachelor of Science in Nursing (BSN) and, many times, at least one to two years of experience as an RN working in a clinical capacity.
Many institutions also require the following:
- Minimum undergraduate GPA
- Minimum GRE scores
- Admissions essay
- Resume or CV
- Letters of recommendation
MSN Degree Options
Not all MSN degrees are designed for the BSN-prepared RN. Many institutions offer uniquely structured MSN programs specifically designed to accommodate candidates with different educational backgrounds:
- RN-to-MSN Programs for RNs with an Associate Degree in Nursing: RN-to-MSN programs allow RNs with an ADN to complete both a BSN and Clinical Nurse Specialist MSN in one, combined program. While a traditional MSN program takes about two years to complete, RN-to-MSN programs take about three years to complete.
- Direct-Entry MSN Programs for Bachelor’s Educated Non-Nursing Professionals: Direct-entry MSN programs allow candidates with a bachelor’s degree in a major other than nursing to complete a Clinical Nurse Specialist MSN degree in a condensed, accelerated format. Students of these programs are able to earn their RN license and then go on to earn a Clinical Nurse Specialist MSN all in one program.
Many institutions also offer clinical curse specialist MSN degree programs in part-time and online formats designed to accommodate the busy schedules of working nurses. Online programs—offered either as hybrid (partially online) or fully online programs—allow students to achieve their MSN through highly ranked accredited programs, regardless of their geographic location. Many partially or fully online programs partner with clinical sites across the country, allowing students to complete the clinical component of their MSN at locations close to home. In many cases, students are able to complete the clinical component of their program at their current place of employment.
Step 2. Earn National Certification in the CNS Role and a Patient Population Focus of Choice
Once students have graduated from an accredited clinical nurse specialist MSN degree program, they are eligible to take a national certification examination that aligns with the patient population focus they studied in their graduate program.
In most states, national certification is a requirement for state licensure. Even among states that do not require national certification or do not license CNSs, national certification represents an advanced level of knowledge in a specific CNS population and is therefore pursued by most graduates of CNS programs, regardless of state requirements. The certifying bodies for clinical nurse specialists are shown here with the various patient population focus certifications they offer:
American Association of Critical-Care Nurses (AACN)
- Clinical Nurse Specialist: Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
- Clinical Nurse Specialist: Wellness through Acute Care (Pediatric) (ACCNS-P)
- Clinical Nurse Specialist: Wellness through Acute Care (Neonatal) (ACCNS-N)
American Nurses Credentialing Center (ANCC)
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
- Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
- Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
- Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC)
Step 3. Apply for State Licensure
The scope of practice for clinical nurse specialists remains highly inconsistent from state to state, even amidst a national push for states to align with the APRN Consensus Model—an effort to recognize all APRN roles and standardize laws and regulations regarding educational programs, APRN specialties and subspecialties, independent practice, and full prescriptive authority, among others.
For example:
As of October 2015, 28 states recognized the CNS role and adhere to the APRN Consensus Model, which allow CNSs to practice independently with no written collaborative agreement or supervision with a physician:
- Alaska
- Arizona
- Arkansas
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Hawaii
- Idaho
- Iowa
- Kentucky
- Maine
- Maryland
- Minnesota
- Montana
- Nebraska
- Nevada
- New Mexico
- North Carolina
- North Dakota
- Oklahoma
- Oregon
- Rhode Island
- Utah
- Vermont
Another 13 states recognize the CNS role but require collaboration with a physician as a condition to practice:
- Georgia
- Illinois
- Indiana
- Kansas
- Louisiana
- Massachusetts
- Missouri
- New Jersey
- Ohio
- South Carolina
- South Dakota
- Tennessee
- Texas
The following states recognize the CNS, but not as an APRN role, which means licensure requirements often vary:
The following states do not recognize the CNS role in any capacity:
CNS prescriptive authority—which authorizes CNSs to prescribe pharmacologic and non-pharmacologic therapies—also widely varies from one state to the next. States that grant prescriptive authority to CNSs usually require a separate application and renewal process. CNSs that prescribe controlled substances are also required to secure DEA controlled substances registration.
The following states allow CNSs full prescriptive authority:
- Alaska
- Colorado
- Connecticut
- Hawaii
- Idaho
- Iowa
- Minnesota
- Montana
- Nevada
- New Mexico
- North Dakota
- Oregon
- Utah
- Washington D.C.
- Wyoming
The following states allow CNSs prescriptive authority, but only under the supervision of a collaborating physician:
- Arizona
- Arkansas
- Delaware
- Georgia
- Illinois
- Indiana
- Kansas
- Kentucky
- Louisiana
- Michigan
- Missouri
- New Jersey
- Ohio
- Oklahoma
- Rhode Island
- South Carolina
- Tennessee
- Texas
- Wisconsin
The following states do not grant prescriptive authority to CNSs:
RNs interested in becoming clinical nurse specialists must study their state board of nursing laws and regulations regarding licensure and scope of practice to ensure they meet all state requirements for legal practice as a CNS.
In states that license CNSs, the licensure process usually includes completing an application and providing the state board of nursing with:
- Graduate transcripts showing proof of the completion of an accredited CNS program
- Proof of national certification
- Proof of residency
Step 4. Maintain National CNS Certification and State Licensure
CNSs must ensure they maintain their national certification, RN license, and APRN-CNS license. In most states, CNS licensure renewal occurs annually or biennially, usually along with RN licensure renewal.
Some states require continuing education for renewal, while others recognize maintaining national certification as meeting the requirements for continuing education. CNSs with prescriptive authority often need to complete additional continuing education in pharmacology and pharmacotherapeutics to meet state renewal requirements.
The following professional associations serve as excellent sources of continuing education for clinical nurse specialists:
CNSs often also pursue specialty certification to add to their credentials:
- Oncology Nursing Certification Corporation
- Competency and Credentialing Institute
- Hospice and Palliative Credentialing Center