How to Become a Clinical Nurse Specialist

Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). Their primary function is improving outcomes for patients, nurses, and system-wide organizations.

Difference Between a CNS and an NP

Like a nurse practitioner (NP), a CNS specializes in specific patient populations. While NPs focus on direct patient care, a CNS spends more time educating nurses and improving patient outcomes. Although their responsibilities still include providing high-level patient care, CNSs can also become supervisors on healthcare teams.

>> Related: Clinical Nurse Specialist vs Nurse Practitioner

CNS Roles and Specializations

Clinical nurse specialists commonly take on five basic roles:

• Leader

• Educator

• Researcher

• Consultant

Clinical nurse specialists can also specialize in the following areas:

• Family/Individual/Across the Lifespan

• Neonatal

• Pediatrics 

• Psychiatric/Mental Health

• Women’s Health/Gender Specific

A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like:

• How can I help the nurses at the bedside? 

• How can I help these patients on the unit?

• What changes would improve processes throughout the hospital system?

Clinical Nurse Specialist Duties and Responsibilities

According to CNS Andrea Paddock, CNS responsibilities may change daily:

“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”

In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).

Clinical nurse specialists will also perform the following activities according to the survey:

• Assist with evidence-based practice projects

• Assist other nurses/staff with direct patient care (aka act as a resource)

• Assist with research

• Teach patients and families

• Conduct research as the primary investigator

• Teach in the community

• Provide transitional care

In other words, CNSs wear several hats and are valued members of healthcare teams. 

A Day in the Life of a Clinical Nurse Specialist

What does a clinical nurse specialist do every day? Clinical Nurse Specialist Andrea Paddock shares a day in her life, including what a CNS does and her journey to become one.

>> Show Me Online MSN Programs

The median annual salary for clinical nurse specialists is $94,545 or $45 per hour as of November 2023, according to ZipRecruiter.

Clinical nurse specialists' salaries range between $71.000 and $137,000, with some making upwards of $162,500 annually. Your salary as a CNS may vary depending on your location, employer, and specialization.

Some hospitals or medical facilities seek out specific CNS roles with specialized skills. Sought-after positions like these often offer higher, more competitive wages.

Clinical nurse specialist positions require graduate degrees. So, pursuing this career path takes a lot of time, dedication, and education. It takes between 7-9 years to become a CNS, depending on your career and degree path. 

1. Become an Experienced Registered Nurse

Before becoming an APRN, you must earn your registered nursing (RN) licensure. To become an RN, you must complete an accredited Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) program. Since most CNS programs require BSNs, the process will be smoother if you go for a BSN right away.

After passing the NCLEX-RN exam, you'll earn your RN license and be able to start gaining valuable experience. Depending on the CNS program you want to attend, you may need 1-2 years of full-time RN experience.

2. Attend a Graduate CNS Program

You need at least a Master of Science in Nursing (MSN) degree with a clinical nurse specialist focus to enter this career field. However, over 20% of CNSs also choose to complete a Doctor of Nursing Practice (DNP), according to the  National Association of Clinical Nurse Specialists (NACNS).

3. Gain CNS Certifications

Administered by the American Nurses Credentialing Center, CNS certifications allow you to choose a specialty field. The most common clinical nurse specialist certifications include:

• Adult Health CNS
• Adult-Gerontology CNS
• Pediatric CNS
• Neonatal CNS
• Public Health CNS

Most CNS certifications require renewal every few years.

>> Show Me Online MSN Programs

Clinical nurse specialist programs are MSN or DNP tracks with a CNS focus. The National Association of Clinical Nurse Specialists (NACNS) lists 58 total CNS programs in the US.

From that list, we've found the best in-person and online clinical nurse specialist programs of 2024. Factors we considered in our ranking methodology include nursing school accreditation, academic outcomes, and tuition costs. We also looked at:

• Location
• Graduation rate
• Credit hours
• Program length
• Admission requirements
• Clinical placements

1. The University of Texas at Austin

UTA's Adult-Gerontology Clinical Nurse Specialist (AG-CNS) program focuses on health restoration and promotion perspectives. The program also seeks to develop students' case management skills. Nurses in this program concentrate on physiological and psychosocial theories, concepts, and research underlying individuals' self-care and growth needs.

• Semesterly Tuition: Resident - $6,262 | Nonresident - $11,683
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Program Length: 2 years
• Contact Information:
  • Phone: (512) 471-7927
  • Email: nugrad@nursing.utexas.edu
• Online Options Available? No

2. Saint John Fisher College

St. John Fisher College offers an Adult-Gerontology Clinical Nurse Specialist MSN and post-master's certificate. They exclusively offer these programs on campus, so online study is not an option. The MSN path covers 43-44 credit hours and 385 clinical hours over two years.

• Tuition Per Credit:  $1,094
• Accreditation: CCNE
• Program Length: 2  years
• Contact Information:
  • Phone: (585) 385-8278
  • Email: dtydings@sjf.edu
• Online Options Available? No

3. University of Detroit Mercy

The University of Detroit Mercy's AG-CNS degree is a fully online graduate program. Throughout the course of study, students learn how to affect changes in direct patient care and facility administration. 

Additionally, the university's graduates have a 100% pass rate across adult-gerontology CNS certification exams from 2016-2021. APRNs in other specialties may earn a post-graduate CNS certificate at the University of Detroit Mercy.

• Tuition Per Credit: $940
• Accreditation: CCNE
• Program Length: 3 years
• Contact Information:
  • Phone: (313) 993-1828
  • Email: gradnursing@udmercy.edu
• Online Options Available? Yes

4. Alverno College

Alverno College's AG-CNS program prepares students to provide advanced care across the age continuum, from illness to wellness and acute to primary care. This degree encompasses 39 credits, including two capstone courses. Alverno College offers in-person courses scheduled every other weekend, and fully online options are not available to CNS students.

• Tuition Per Credit: $1,000
• Accreditation: CCNE
• Program Length: 3 years
• Contact Information:
  • Phone: (414) 382-6100
  • Email: admissions@alverno.edu
• Online Options Available? No

5. Indiana University -Purdue University - Indianapolis

IUPUI offers an Adult Gerontology and Pediatric CNS degree path. The university offers flexible start dates every semester, allowing students to begin studying in the fall, spring, or summer. Although students primarily attend classes online, IUPUI does require in-person lab days.

• Tuition Per Credit: Resident - $625 | Nonresident - $1,664
• Accreditation: CCNE
• Program Length: 2 to 3 years
• Contact Information:
  • Phone: (317) 274-2806
  • Email: nursing@iu.edu
• Online Options Available? Yes, with some in-person requirements

6. University of Pennsylvania

Penn Nursing offers AG-CNS, Pediatric, and Neonatal CNS degree paths. Students can complete these programs in as little as one year while gaining clinical experience at top-ranked hospitals. These include the Children's Hospital of Philadelphia and the Penn Health System.

• Total Tuition: $84,552
• Accreditation: CCNE
• Program Length: 1 to 3 years
• Contact Information:
  • Phone: (215) 898-4271
  • Email: admissions@nursing.upenn.edu
• Online Options Available? Not Specified

7. Johns Hopkins University

The CNS programs offered by Johns Hopkins University culminate in a Doctor of Nursing Practice degree. The university provides Adult-Gerontological Health, Adult-Gerontololgical Critical Care, and Pediatric Critical Care CNS paths. 

Although students may attend classes online, Johns Hopkins requires some on-campus immersions and in-person clinical rotations. Notably, distance students may complete clinical rotations in their locales.

• Annual Tuition: $52,704
• Accreditation: CCNE
• Program Length: 3 years
• Contact Information: (410) 955-4766
• Online Options Available? Yes, with some in-person requirements

8. University of Washington

The University of Washington offers Pediatric and Women's Health CNS paths that each culminate in a DNP. UW is one of a few Women's Health Clinical Nurse Specialist programs in the country. The university only allows students to attend these programs full-time, which prepares them for board certification in three years.

• Tuition Per Credit: $982
• Accreditation: CCNE
• Program Length: 3 years
• Contact Information:
  • Phone: (206) 543-8736
  • Email: asknursing@uw.edu
• Online Options Available: Yes, hybrid learning model

9. University of Wisconsin - Milwaukee

The University of Wisconsin at Milwaukee offers a post-graduate CNS certificate in three specialty areas. APRNs may pursue Adult-Gerontology, Pediatric, or Maternal/Infant CNS certification through UWM. Each certificate program consists of 18 credit hours, which students can complete in just one year. 

• Semesterly Tuition: Resident - $6,132.77 | Nonresident - $12,848.29 | Midwest Resident¹ - 8,807.97
• Accreditation: CCNE
• Program Length: 1 year
• Contact Information:
  • Phone: (414) 229-5047
  • Email: uwmchps@uwm.edu
• Online Options Available? No

¹ Eligible states for this rate are North Dakota, South Dakota, Nebraska, Kansas, Iowa, Missouri, Illinois, Indiana, Michigan, and Ohio

10. Rush University

Rush University offers three DNP programs for interested students: pediatrics, adult gerontology, and neonatal. The cohorts are kept intentionally small to optimize clinical placement and classroom experience. 

Rush University offers AG Critical Care, Neonatal, and Peds Acute Care CNS tracks that culminate in DNP degrees. The school intentionally keeps CNS program cohorts small (about 30 students per class) to optimize clinical placements and classroom experiences.

• Tuition Per Credit:  $1,344
• Accreditation: CCNE
• Program Length: 2 to 3.5  years
• Contact Information:
  • Phone: (312) 942-7100
  • Email: elizabeth_m_miranda@rush.edu
• Online Options Available? Yes, hybrid learning model

>> Show Me Online MSN Programs

CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties:

• Adult

• Pediatric

• Neonatal

• Geriatric

• Oncology

• Critical Care (Adult, Pediatric & Neonatal)

• Orthopedic

• Perioperative

• Psychiatric-Mental Health (Adult, Adolescent/Child)

CREDENTIAL	CERTIFICATION	ORGANIZATION
ACCNS-AG	Clinical Nurse Specialist; Wellness through Acute Care (Adult-Gerontology)	aacn.org
ACCNS-N	Clinical Nurse Specialist; Wellness through Acute Care (Neonatal)	aacn.org
ACCNS-P	Clinical Nurse Specialist, Wellness through Acute Care (Pediatric)	aacn.org
ACNS-BC	Adult Health Clinical Nurse Specialist	www.nursingworld.org
AGCNS-BC	Adult-Gerontology Clinical Nurse Specialist	www.nursingworld.org
AOCNS	Advanced Oncology Certified Clinical Nurse Specialist	oncc.org
CCNS	Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal)	aacn.org
CNS-CP	Certified Clinical Nurse Specialist Perioperative	cc-institute.org
HHCNS-BC	Home Health Clinical Nurse Specialist Certification (retired exam)	www.nursingworld.org
OCNS-C	Orthopaedic Clinical Nurse Specialist - Certified	oncb.org
PCNS-BC	Pediatric Clinical Nurse Specialist	www.nursingworld.org
PHCNS-BC	Public/Community Health Clinical Nurse Specialist (retired exam)	www.nursingworld.org
PMHCNS-BC	Adult Psychiatric-Mental Health Clinical Nurse Specialist	www.nursingworld.org
PMHCNS-BC	Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist	www.nursingworld.org

The continuing nursing shortage creates demand for all types of nurses across all specialties, including clinical nurse specialists. As our population ages, that demand will grow even more in the coming years.

Demand for Clinical Nurse Specialists

The numbers back up the projected demand for advanced practice nurses. The U.S. Bureau of Labor Statistics (BLS) predicts that APRN jobs will grow by 38% from 2022 to 2032. This increase is much faster than the growth rate of all other professions nationwide. Though the BLS prediction does not specifically address CNS growth, it's a reliable benchmark since CNSs are also APRNs.

CNS Career Field Exodus

The 2022 NACNS Census revealed that nearly one-third of CNSs plan to retire in the next five years. With a large portion of the career field taking their leave, the need for new CNSs to fill their positions will grow. 

• What is the Role of a Clinical Nurse Specialist?

  • CNSs wear several hats, including providing high-level direct patient care and identifying and implementing changes that improve patient outcomes and hospital systems.

• Are Clinical Nurse Specialists in Demand?

  • Yes, the BLS predicts that APRN jobs will increase by 38% from 2022 to 2023. Since CNSs are APRNs, they should expect a similar high growth rate.

• How Long Does It Take to Become a Clinical Nurse Specialist?

  • It takes between 7-9 years to become a clinical nurse specialist. This includes a 4-year undergraduate program, at least one year of RN experience, and between 2-4 years for a CNS program, depending on whether you pursue a master's or doctoral degree, respectively.

•  How Much Money Does a Clinical Nurse Specialist Make?

  • ZipRecruiter reports that clinical nurse specialists earn an average annual salary of $94,545 or $45 per hour.

• What's the Difference Between a Registered Nurse and a Clinical Nurse Specialist?

  • CNSs are advanced practice registered nurses (APRNs). While RNs can practice with an associate or bachelor's degree, APRNs must have at least a masters-level education. CNSs may take on more responsibility and autonomy due to their advanced education.

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