The Clinical Nurse Specialist (CNS) is a clinical expert with extensive knowledge of direct bedside care of medically complex patients within a specific and specialized area of nursing practice. The CNS collaborates, coordinates, educates, coaches, and mentors nursing staff members. They advocate for patients, their families, and the nursing staff. Additionally, the Clinical Nurse Specialist conducts nursing research to advance the implementation of Evidence-Based Practice .
In the broadest of descriptions, the Clinical Nurse Specialist is a leader, clinician, researcher, educator, patient and staff advocate, consultant, intra-department liaison, and resource professional.
As an Advanced Practice Registered Nurse (APRN), the Clinical Nurse Specialist has earned a master’s or doctoral degree and national certifications that enable them to practice as a CNS.
The CNS collaborates in making clinical decisions. The Clinical Nurse Specialist uses high emotional intelligence to provide clinical leadership through problem-solving and critical thinking.
The Clinical Nurse Specialist develops nursing practice protocols and recommends best practices to improve patient outcomes and quality of care. The CNS integrates patient care practices throughout the entire care continuum.
Roles
The advanced degree of the Clinical Nurse Specialist prepares them to work in a variety of roles as a clinical expert, including:
- Serving as a specialty expert within a specific Service Line or Unit,
- Providing highly specialized and expert nursing care to medically complex patients,
- Conducting nursing research,
- Providing clinical coordination with interdisciplinary team members,
- Acting as a role model for staff nurses and other healthcare professionals, and
- Educating nursing staff, patients, and family members.
Additionally, the CNS monitors the latest nursing and patient care research to implement Evidence-Based Practices that improve the quality of care practices and patient outcomes.
As a part of the clinical leadership team, the Clinical Nurse Specialist works closely with the Clinical Nurse Leader, Nursing Administration and Healthcare Leadership. This close coordination results in developing and implementing innovative clinical care programs based on the latest research and Evidence-Based Practices. The Clinical Nurse Specialist and CNL also work closely to plan and coordinate care practices for patients with complex care needs.
Spheres of Influence
In addition to the roles mentioned above, the Clinical Nurse Specialist operates in three overlapping spheres of influence, including patients and their families, the nursing staff, and the healthcare system.
Patients and their Families
The Clinical Nurse Specialist provides direct patient care and communication between the patient, nursing staff, and family members. The CNS:
- Assures patients and families as to the quality of care provided,
- Assesses, diagnoses, and develops treatment and intervention plans as a clinical expert in the care of medically complex patients,
- Advocates for the patient and family members,
- Understands patient needs within a variety of care settings, such as hospital inpatient and outpatient units, community, nursing homes, or in the patient home,
- Develops innovative treatment plans for acute care and post-care within established care objectives and priorities,
- Educates patients and family members,
- Conducts comprehensive, holistic wellness and illness assessments using Evidence-Based Practice techniques,
- Orders diagnostic tests, procedures, and treatments,
- Prescribes medications and treatments as permitted by state Boards of Nursing, and
- Refers to other medical experts when necessary to provide comprehensive care.
Nursing Staff
The CNS serves as the bedside expert for the nursing staff to improve patient outcomes by providing clinical leadership and acting as a clinical consultant. The Clinical Nurse Specialist monitors quality indicators, delivers expert consultation, and oversees and coordinates care plans. Mentoring the nursing staff, the CNS works to advance their nursing practices. As a result, nursing and patient care teams apply state-of-the-art science utilizing Evidence-Based Practice recommendations to improve treatment plans.
- Develops core competencies of the nursing staff to improve patient outcomes,
- Is a clinical consultant for medically complex patients,
- Acts as a clinical expert and role model,
- Mentors, educates, and coaches the nursing staff,
- Encourages advanced nursing education,
- Develops and keeps current policies and procedures for the nursing staff and regulatory agencies,
- Acts as a change agent for the unit and the hospital standards of excellence,
- Leads multidisciplinary nursing teams to develop Evidence-Based Practice,
- Trains and consults with nursing staff on new equipment and technologies, and
- Monitors quality indicators for improved patient outcomes and satisfaction.
Healthcare Delivery System
Clinical Nurse Specialists have the knowledge and expertise to help shape patient care’s direction within their clinical unit and throughout the healthcare system. As experts in their areas of clinical expertise, the CNS helps establish care protocols and participate in developing policies for their specific patient population at all levels within healthcare delivery systems.
More specifically, the CNS:
- Acts as a nurse expert in practice specialties within clinical units and throughout hospitals where needed,
- Collaborates with other Clinical Nurse Specialists for patient care innovation and clarity throughout the hospital system,
- Consults with leadership team members on results of specific objectives, evaluation of staff and organizational needs, and innovative suggestions,
- Conducts research to develop and implement Evidence-Based Practice system-wide,
- Integrates evidence-based science into the wellness, health, and illness management of patients, families, groups, and communities,
- Enhances the reputation of the hospital through the clinical development of the nursing staff,
- Provides leadership in the design, implementation, and evaluation of process improvement initiatives,
- Represents hospital or health system at local, state, or national Conferences as a clinical expert,
- Builds partnerships within and across healthcare and community systems using leadership, team building, negotiation, and conflict resolution skills,
- Publishes articles, books, and training materials that advance the profession and bring recognition to their organization, and
- Facilitates and partners in multidisciplinary teams to improve the quality of care and effectiveness of cost containment and other projects system-wide.
Practice Specialties
Clinical Nurse Specialists may choose to practice in a specialty area. Here is a list of the more common practice specializations:
- Adult/Gerontology Acute Care,
- Adult Health,
- Adult Psychiatric,
- Child/Adolescent Psychiatric,
- Community Health,
- Gender-Related Wellness Acute Care,
- Gerontology,
- Home Health,
- Medical/Surgical,
- Neonatal Wellness Acute Care,
- Oncology,
- Orthopedics,
- Pediatric Wellness Acute Care,
- Perinatal,
- Psychiatric/Mental Health, and
- Women’s Health Acute Care.
Prior nursing experience is usually a significant factor in selecting an area of specialization. This prior experience provides a solid understanding of an area of practice specialization. When selecting an area of specialization, it may be helpful to consider the five conceptual aspects of practice specialization developed by the National Association of Clinical Nurse Specialists (NACNS):
- Patient Population – Pediatrics, Gerontology, Women’s Health, Neonatal, etc.,
- Practice Setting – Critical Care, Emergency Room, etc.,
- Disease and Medical Subspecialty – Diabetes, Oncology, etc.,
- Type of Care – Psychiatric/Mental Health, Rehabilitation, etc., and
- Type of Problem – Pain, Wound, Stress, etc.
Core Competencies
The National Association of Clinical Nurse Specialists (NACNS) developed a set of Core Competencies that frame the various aspects of the Clinical Nurse Specialist role.
These competencies illuminate the CNS role to include:
- Direct Patient Care – interact directly with patients, their families, and patient groups to improve the quality of life,
- Consultation – solve problems using specialized expertise in a system-focused manner when interacting with patients and staff,
- System Leadership – shape clinical practice and political processes throughout the healthcare system to bring about practical change,
- Collaboration – optimize clinical outcomes through authentic and advanced problem-solving engagement with patients, their families, care providers, and the healthcare system,
- Coaching – provide nursing staff guidance to advance care for patients, their families, patient groups, and the nursing profession,
- Research – conduct a systematic review and thorough analysis, interpretation, and application of scientific results in clinical practice, and participation in research projects, and
- Ethics – the ability to identify and articulate ethical issues surrounding the patients, care providers, community, and the healthcare system.
Practice Settings
Most CNSs work in hospitals, health systems, and other acute care settings. However, many CNSs may also work in private practice, nursing homes, long-term care facilities, educational institutions, and research organizations. Hospital-based Clinical Nurse Specialists work in clinical units that correspond to areas of specialization outlined in practice specialties.
Scope of Practice
Scope of Practice refers to the degree to which a Clinical Nurse Specialist may practice independently of oversight by a Physician. The Scope of Practice for a CNS includes two major aspects of practice:
- Practice Autonomy – the degree to which a CNS may practice without physician supervision or oversight, and
- Prescriptive Authority – the ability to issue prescriptions or order treatments.
The Scope of Practice varies by state, depending on state legislative and regulatory rules. Visit the Color Coded Map and Sortable List to view how CNS Scope of Practice varies by state. For more detailed information, visit the Board of Nursing for the state of interest. Individual employers may impose Scope of Practice rules more restrictive than the state permits.
Education
The ability to practice as a Clinical Nurse Specialist requires a graduate-level nursing education. There are several degrees or certificate types:
- Master of Science in Nursing (MSN), Master of Science, Nursing Major (MS-NM), or Master of Nursing (MN) – The master’s degree has been the most commonly offered degree type and is the minimum degree required for Clinical Nurse Specialist education. These degree programs are offered widely by public and private schools. The master’s degree in nursing focuses on advanced nursing theory and care practice. Read more...
- Doctor of Nursing Practice (DNP) – In addition to studying advanced nursing theory and care practice, the DNP emphasizes using research results to improve the CNS‘s nursing practice. DNP programs also emphasize the application of Evidence-Based Practice to improve the quality of patient care. Read more...
- Post-Master's or Post-Doctoral Certificate – Eligibility is limited to individuals with a graduate-level nursing degree. For example, someone holding an MSN as a Nurse Practitioner (NP) would be eligible to enroll in a Clinical Nurse Specialist certificate program. Read more...
Prospective students should verify that the Clinical Nurse Specialist program they are considering is accredited. Proper accreditation ensures that graduates are eligible to sit for the certification exams required before becoming licensed to practice.
Use the Clinical Nurse Specialist Search Tool tool to identify programs for this and other degree combinations from our survey of more than 500 schools.
The National Association of Clinical Nurse Specialists (NACNS) announced its endorsement of the Doctor of Nursing Practice (DNP) degree as a requirement for entry into practice for Clinical Nurse Specialists (CNSs) by 2030.
As a result, schools will continue to transition their master’s Clinical Nurse Specialist degree offerings to the Doctor of Nursing Practice.
Top 10 Specialized Degrees and Certificates
The top 10 most popular Clinical Nurse Specialist specialty degree and certificate programs include:
Some schools offer degrees and certificates in several additional Clinical Nurse Specialist specializations, including:
- Adult Psychiatric–Mental Health (APMHCNS),
- Child/Adolescent Psychiatric/Mental Health (C/APMDCNS),
- Urologic (UCNS),
- Orthopaedic (OCNS-C),
- Adult, Pediatric, and Neonatal Critical Care Nurse Specialist (CCNS), and
- Women’s Health (WHCNS).
Some schools offer subspecialties in these areas of specialization, such as cardiology, informatics, oncology, and neurology, to name a few.
Accelerated Degree Programs
Accelerated Degree Programs generally cost less and can be completed more quickly than enrolling in consecutive BSN and MSN or doctoral programs. Use the Accelerated Degree Program Search Tool tool to identify programs for this and other degree combinations from our survey of more than 710 schools.
Certificate Programs
Many schools that offer a Clinical Nurse Specialist master’s or doctoral degree also offer a Post-Master's Certificate (PMC) Program. These programs are open to individuals with a master’s or doctoral degree in another nursing specialty. These Certificate Programs should not be confused with certifications offered by Certification Boards or Professional Associations.
Dual Practice Programs
Some schools offer Clinical Nurse Specialist degrees in a Dual Practice Program. These programs award a single degree that combines the CNS with an additional clinical practice role. Education in Dual Practice roles enables graduates to work in an expanded range of practice settings and patient populations. This versatility provides the graduate with more career flexibility and growth opportunities.
Schools may offer CNS Dual Practice programs with these additional practice roles:
- Adult-Gerontology Acute Care Clinical Nurse Specialist (AGACCNS) paired with a:
- Adult-Gerontology Clinical Nurse Specialist (AGCNS) paired with a:
- Pediatric Clinical Nurse Specialist (AGCNS) paired with a:
Graduates from these Dual Practice Programs may sit for CNS and NP national certification exams and become licensed in both practice roles.
Use the Dual Practice Program Search Tool tool to identify programs for this and other degree combinations from our survey of more than 710 schools.
Tandem Degree Programs
Tandem Degree Programs award two degrees in the course of Clinical Nurse Specialist study. These programs save the student time and expense by eliminating duplicate coursework. Some schools offer CNS Tandem Degree combinations, such as:
- Bachelor of Science, Nursing Major (BS-N), followed by a:
- Bachelor of Science in Nursing (BSN), followed by a:
- Master of Science in Nursing (MSN), followed by a:
- Doctor of Nursing Practice (DNP), followed by a:
Graduates from these Tandem Degree Programs are eligible to sit for the appropriate national certification exams and become licensed as required.
Use this Tandem Degree Program Search Tool tool to identify Tandem Degree Programs from our survey of more than 710 schools.
Top 10 Degree and Certificate Offerings
This table displays a count of the Top 10 Clinical Nurse Specialist degrees and certificates offered by more than 710 graduate nursing programs. This count includes degrees awarded singly, as the higher degree in a Tandem Degree Program, or as part of a Dual Practice Program offering.
Practicing as a Clinical Nurse Specialist requires two additional steps following the completion of the selected degree or certificate: certification and licensing.
Certification
Before licensing, Clinical Nurse Specialist candidates must successfully pass national certification requirements established by the appropriate certification organization. Two organizations that provide these certifications are the American Nurses Credentialing Center and the American Association of Critical-Care Nurses.
American Nurses Credentialing Center (ANCC)
The American Nurses Credentialing Center (ANCC) issues the following certifications:
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC),
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC),
- Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC),
- Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC), and
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC).
The following certifications have been retired:
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC),
- Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC), and
- Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC).
American Association of Critical-Care Nurses (AACN)
The following certifications are issued by the American Association of Critical-Care Nurses (AACN) :
- Acute Care Clinical Nurse Specialist (Adult-Gerontology) (ACCNS-AG),
- Acute Care Clinical Nurse Specialist (Neonatal) (ACCNS-N), and
- Acute Care Clinical Nurse Specialist (Pediatric) (ACCNS-P).
Before applying for a state license to practice, the applicant must complete at least one certification matching the CNS Practice Specialty.
The CNS may obtain additional certifications in areas of specialization based on disease and medical sub-specialties, practice settings, or patient care or problem type. This site includes an extensive survey of over 300 nursing and related healthcare certifications.
License to Practice
The Board of Nursing for each state issues licenses to practice as a Clinical Nurse Specialist. CNS scope of practice, including Practice Autonomy and Prescriptive Authority, varies by state.
States participating in the APRN Compact and Nurse Licensure Compact have multistate APRN and RN license agreements. These Compacts ease the transfer of CNS licenses and the ability to practice among participating states. Participation in these Compacts varies by state. Check with your state’s Board of Nursing for more detailed information.
Professional Associations
The primary professional association for Clinical Nurse Specialists is the National Association of Clinical Nurse Specialists (NACNS). NACNS provides resources and representation for Clinical Nurse Specialists with state and local chapters throughout the United States.
Most Clinical Nurse Specialists belong to other associations representing specialized nursing and healthcare practice areas. These areas may include adult health, critical care, emergency care, oncology, psychiatry/mental health, or pediatrics, to name a few. Associations are also formed at the state and local levels, enabling their members to organize with their neighboring peers to address more localized issues. These associations may be chapters of national or international associations or organized independently.
Review this site’s extensive survey of more than 1,800 international, national, regional, state, and local professional associations providing representation and resources in specific nursing and healthcare specializations. These associations offer professional development resources and representation in numerous nursing and affiliated healthcare specialties.