Clinical Nurse Specialist (CNS)

I. What They Do

Clinical Nurse Specialists (CNSs) provide direct care to patients in one of a range of specialties, such as pediatrics, geriatrics, emergency care and oncology. CNSs may also serve as consultants, assisting other medical professionals working to improve patient outcomes and influence all levels of care. The National Association of Clinical Nurse Specialists (NACNS) describes CNS specialties in terms of population, setting, disease or medical subspecialty, type of care, and type of problem. This career is categorized as an advance practice registered nurse (APRN) role because it requires graduate-level education and clinical training.

CNSs spend 2-3 more years in school, beyond the requirements for RN licensure, completing master’s or doctoral degrees. Due to the high level of precision and knowledge demanded of them, CNSs are often relied upon to advise other nurses and serve in leadership roles.

Daily Responsibilities

  • Observes patient condition and diagnoses problems and illnesses
  • Orders medical tests and evaluates results
  • Treats diseases, injuries, and disabilities associated with the area of expertise
  • Advises nurses and other medical staff members on patient care issues
  • Promotes disease prevention and wellness
  • Conducts research to further knowledge about the area of specialty
  • Conducts physical exams

Ideal Candidates

  • Able to make informed decisions about health assessment and treatment
  • Enjoys working with teams of medical professionals to improve patient care and the treatment of specific illnesses and disorders
  • Communicates easily with patients, patients’ families, other health caregivers, and administrators
  • Enthusiastic about creating positive change in patient care through leadership and management skills, as well as education and coaching

Specialization Areas

  • Adult Health
  • Adult Psychiatric and Mental Health
  • Child/Adolescent Psychological and Mental Health
  • Diabetes Management
  • Gerontology
  • Home Health
  • Pediatrics
  • Public and Community Health

Work Environment

  • Physicians’ offices
  • Hospitals
  • Outpatient care centers
  • Colleges and universities
  • Community centers
  • Laboratories
  • Other health services offices and facilities

II.Career Outlook

As with other advanced practice nursing occupations, the demand for Career Nurse Specialists is on the rise. The general demand for healthcare is increasing, and services provided by trained CNSs and other APRN professionals, such as Nurse Practitioners and Nurse Midwives, can be less expensive than those provided by physicians.

Job Growth

Generally, there are far fewer professionals working in APRN fields when compared to other nursing professionals, such as RNs. In 2013, there were 113,370 employed nurse practitioners to 2,661,890 registered nurses. This is due to the stringent requirements for APRNs, who need to earn their RN license, graduate degree, state licensure and national credentials before gaining employment. Still, the demand for CNSs is high.

Projected job growth for APRNs between 2012-22: 31% (much faster than the 19% growth projected for RNs and the 11% average for all positions).

Projected Job Growth for CNSs, 2012-2022

  • 2012: 151,400
  • 2022: 199,000

Source: Bureau of Labor Statistics, Occupational Outlook Handbook. Accessed February 2015.

Job Growth Percent Change for Clinical Nurse Specialists (APRNs) vs Other U.S. Occupations

Job Growth for Clinical Nurse Specialists Graph
Source: Bureau of Labor Statistics, Occupational Outlook Handbook. Accessed February 2015.

Metro Areas with the Highest Number of CNSs Employed
Metro Area Number of CNSs Employed
Source: Bureau of Labor Statistics, Occupational Employment Statistics. Accessed February 2015.
New York-White Plains-Wayne, NY-NJ Metropolitan Division 4,610
Boston-Cambridge-Quincy, MA NECTA Division 2,850
Los Angeles-Long Beach-Glendale, CA Metropolitan Division 2,070
Chicago-Joliet-Naperville, IL Metropolitan Division 1,890
Atlanta-Sandy Springs-Marietta, GA 1,670
Industries Employing the Highest Number CNSs
Industry Number of CNSs
Source: Bureau of Labor Statistics, Occupational Employment Statistics. Accessed February 2015.
Offices of Physicians 52,860
General Medical and Surgical Hospitals 29,740
Outpatient Care Centers 8,120
Colleges, Universities, and Professional Schools 3,550
Home Health Care Services 2,940

CNS Salary

According to 2012 data from the Bureau of Labor Statistics (BLS), the average annual salary for CNS’s is over $30,000 higher than the yearly earnings for a registered nurse.

Average Annual RN Salaries Since 2007
Year Average Annual Salary
Source: Bureau of Labor Statistics, Occupational Employment Statistics, Annual Occupation Profiles. Accessed February 2015.
2007 $62,480
2008 $65,130
2009 $66,530
2010 $67,720
2011 $69,110
2012 $67,930
2013 $68,910

States with Highest Average Salaries for CNS in 2013

  • Alaska: $111,800
  • California: $110,590
  • Oregon: $107,560
  • Hawaii: $106,770
  • Massachusetts: $105,010

Source: Bureau of Labor Statistics, Occupational Employment Statistics. Accessed February 2015.

III. How to Become One

According to the Bureau of Labor Statistics Occupational Outlook Handbook, each state’s board of nursing determines the requirements for how to become a licensed CNS or other APRN in that state. Most states require an RN license and successful completion of an approved graduate-level program and a national certification exam.

These graduate programs will take approximately two years to complete. A bachelor’s degree and evidence of a current nursing license are required for admittance and most programs include clinical courses or practicum training in a setting relevant to the student’s specialty.

Education Requirements

Prospective CNS students should research academic programs accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN)

The National Association of Clinical Nurse Specialists (NACNS) maintains a CNS program directory. Some programs in this field are offered jointly with Nurse Practitioner and Nurse Educator programs, or as an emphasis area in a Masters of Science in Nursing program. Certificate programs are also offered for nurses who have already completed master’s degrees in related areas.

CNS graduate program entrance requirements:

  • A Bachelor of Science in Nursing or an appropriate baccalaureate degree
  • Current license as a registered nurse
  • Completed prerequisite coursework in statistics

Certification and Licensing Requirements

National exams for the CNS Core and 9 specialty areas are administered by the American Nurses Credentialing Center (ANCC).

Requirements to take CNS exam:

  • Masters of Science in Nursing degree or other graduate-level program preparation for the CNS role, which is accredited by the CCNE or ACEN
  • Current RN licensure
  • A minimum of 500 supervised clinical hours in the specialty area
  • Completion core coursework in advanced pathophysiology, advanced pharmacology and advanced physical/health assessment

CNS recertification requirements:

  • The ANCC requires certification renewal every 5 years. Check with each state’s board of nursing for additional requirements related to continuing education and periodic recertification.