Clinical nurse specialists (CNS) are experts in the nursing field. Like other advanced practice registered nurses (APRN), they have an extensive, graduate-level education in pharmacology, physical assessment, and physiology. But they also have extensive training in a specialty practice area. These specialty areas can be broken down and defined by population, setting, disease, type of care, or type of problem. The possibilities are nearly endless—from geriatrics to pediatrics, rehabilitation to psychiatry, critical care to community health. In whatever setting he or she eventually chooses to practice, a CNS becomes a go-to source for information and care in their specialization area.
While the specialization of a CNS may be narrow, the associated responsibilities are extensive. A CNS can work in a hospital, an outpatient center, a clinic, or rehabilitation facility, and he or she often holds a leadership role. A CNS may supervise a nursing department, set facility-wide policy, or maintain regulatory compliance. They stay up-to-date on new research and best practices and implement these in their individual work settings. All of these responsibilities are in addition to the usual duties of an APRN, who oversees all aspects of patient care, including diagnosis, treatment, education, and recovery.
It takes a lot of work to be an expert, and becoming a CNS is no exception. While the journey can be long and arduous, the resulting social impacts and personal rewards may be considerable. The National Association of Clinical Nurse Specialists (NACNS) reported that clinical nurse specialists play a crucial role in reducing hospital costs and improve patient outcomes.
Discover how to become a clinical nursing specialist with the following guide.
Step 1: Earn a bachelor of science in nursing (4 years).
After graduating from high school, the first step for an aspiring CNS is to obtain a bachelor of science in nursing degree (BSN) from a program accredited wither by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN). Standard admissions requirements include a submitting a competitive high school GPA (3.0 or greater), personal essays, and SAT or ACT scores.
A BSN curriculum first establishes core competencies like critical thinking, communication, and information management; then, it explores nursing topics like pharmacology, pathophysiology, patient health assessment, health promotion, and disease prevention. Student nurses also perform clinical rotations that provide hands-on training experience.
A four-year BSN program is the most direct route. The first two years focus on core requirements and the second two years cover nursing in more depth. However, alternatives do exist.
A second-degree BSN program, for example, is intended for someone who already has a bachelor’s degree in a different field, and is switching professions into nursing. The core requirements and liberal arts education from the previous degree can be applied towards the BSN, shortening the time to graduation. Other alternatives (e.g., LPN-to-BSN program; ADN-to-BSN program; accelerated BSN program) are available for aspiring clinical nurse specialists with different backgrounds and contexts.
Step 2: Pursue a registered nurse license (less than 1 year).
After having obtained a bachelor’s degree, an aspiring clinical nurse specialist can sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam, which is administered by the National Council of State Boards of Nursing.
The NCLEX covers four categories of needs: physiology integrity, psychosocial integrity, health promotion and maintenance, and a safe and effective care environment. While individual states may have additional licensing requirements, passing the NCLEX-RN exam is the first and most critical step, as all graduate-level nursing schools require applicants to be licensed as an RN. Furthermore, all states require nurses to be licensed before practicing, and working as a registered nurse improves one’s chances of admittance to a graduate-level nursing school.
Step 3: Gain clinical experience (1-2 years).
Many graduate-level nursing schools require applicants to have work experience as registered nurses, and that work experience should be in the specialty area that the applicant would like to focus. Specific requirements vary from program to program, but most nursing graduate schools require at least one or two years in a clinical setting. And while some hands-on experience will have been gained in clinical rotations through a BSN program, further experience with direct patient care not only prepares students for further study, it also helps nurses select their area of specialization and gain a solid understanding of its complexities.
Step 4: Earn a master of science in nursing (2-3 years).
All clinical nurse specialists must have at least a master of science in nursing (MSN). Common admissions requirements for MSN programs include a BSN from an accredited university; a competitive GPA (3.0 or better); state licensure as an RN; multiple letters of recommendation; a personal essay; and an interview. This degree often takes two to three years to complete.
Students are trained in advanced practice nursing skills like pharmacology and pathophysiology, as well as general leadership subjects such as ethics, informatics, management, and policy. They also study their specialty area and gain supervised clinical experience in their chosen field. The array of possible specializations is genuinely vast; acute care, adult care, neonatal, pediatrics, geriatrics, cardiology, psychiatric health, critical care, and women’s health are just a few of the potential options.
Many MSN programs incorporate a clinical practicum where students treat patients in clinical settings. Therefore, prospective clinical nurse specialists are advised to obtain prescriptive authority (granted through the Drug Enforcement Agency), and the required pharmacology courses for this are often available as part of one’s graduate-level study. Please note that a CNS’s prescriptive privileges are based on the level of practice authority within his or her state of residence.
Step 5: Achieve CNS board certification and state licensure (timeline varies).
Almost all states require that a practicing CNS be certified in his or her specialty area. Professional certification is available through the American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN).
While not all specialties have official certifications, and precise requirements for certification vary between specialty areas, common requirements for taking the certification exam include a having a current RN license, a postgraduate degree in nursing, a set number of supervised clinical hours (e.g., at least 500 faculty-supervised hours), and relevant training in advanced pathophysiology and pharmacology. Once certified, a practicing CNS will need to recertify through either the ANCC or AACN every five years. Recertification often requires a set number of clinical practice hours as well as continuing education hours in CNS’ specialty areas.
As mentioned, the exact scope of practice for a CNS is different in each state. A CNS may need further licensure or certification by a state nursing board to practice. Requirements at the state-level often include maintaining an RN license, holding a master’s degree or higher from an accredited advanced nursing practice school, and working a set number of clinical hours in their specialty area over a particular period.
Step 6: Earn a doctor of nursing practice (2-4 years, optional).
A doctor of nursing practice (DNP) is the terminal degree in this discipline and demonstrates that a clinical nurse specialist is an expert in their chosen specialty. While it is not a requirement for practice, it is often necessary for clinical nurse specialists who wish to pursue research or become professors in their focus area.
DNP specialties can include topics such as cardiopulmonary, critical care, oncology, or trauma and emergency preparedness. DNP degree-holders also may be equipped to shape policy and treatment options at the highest level, influencing health outcomes for entire communities and populations.
In addition to clinical work, DNP programs also offer leadership, policy, and research classes. Courses may include advanced treatment of subjects like bioethics, scholarly writing, health policy and advocacy, and comparative quantitative research design and methodology.
Admissions requirements for DNP programs are not that different from MSN programs, and often include a BSN degree; a competitive GPA (3.0 or greater); an RN license; several letters of recommendation; a personal statement; and an interview. Note that it is possible to pursue a DNP without a master’s degree, as several schools offer BSN-to-DNP degree programs. Earning a DNP may take more time, money, and hard work, but it can provide new opportunities for research and academic endeavors.
Professional associations and certifying authorities at the state and federal level can provide the necessary licenses and continuing education for an aspiring CNS, as well as guidance and information about navigating the varied paths of the nursing world. As the profession evolves, the following resources are helpful in staying current and informed: