How to Become a Clinical Nurse Specialist

A clinical nurse specialist (CNS) is a graduate-level registered nurse who is certified in a specialty of choice. Obtaining specialty certification demonstrates an advanced level of knowledge as well as advanced clinical skills in a niche area of nursing.

There are differences between a nurse practitioner (NP) and CNS. While both are advanced-practice registered nurses, their roles are different.

Nurse Practitioners:

• Take comprehensive health histories
• Diagnose, treat, and manage chronic and acute illnesses
• Often act a primary care provider
• Prescribe medications

Clinical nurse specialists have a different scope of practice. They can prescribe medications if they apply for authority to do so, but this is not always required in their practice. They usually focus on education, research, and consulting.

Why Are Clinical Nurse Specialists So Important?

Clinical nurse specialists are leaders in the field of nursing. They serve as mentors, educators, and advocates. They demonstrate expertise in their specialty area and maintain strong clinical skills.

As leaders, they can also promote and facilitate change. They utilize evidence-based practice to educate other nurses and to assist in developing cost-saving strategies in the delivery of care. They can also bring their observations and experience in patient care and apply it to research, policies, and to improve practices.

Nurses looking to advance to a CNS should value evidence-based practice. This means adhering to practices that have been proven effective through clinical research. Since research and therefore practice is always changing, nurses interested in a CNS role should be flexible and willing to facilitate and accept change.

Nurses should also be interested in education, as educating other nurses on best practices and current research is a significant component of what they do.

Nurses should be able to work well in groups and utilize a team approach to healthcare. A large part of the CNS role is to collaborate with all members of the healthcare team. Effective communication is essential.

Leadership skills are also a must with CNSs. They serve as mentors to nurses and bring their knowledge of bedside nursing to organizational leadership to improve clinical practice.

What Are the Educational Requirements for a Clinical Nurse Specialist?

Clinical nurse specialists are advanced-practice registered nurses who have completed a master’s program in nursing (MSN) or doctoral degree program (DNP). A DNP is necessary for those who wish to focus on research.

To advance to a master’s degree or doctoral in nursing, a student must complete an accredited nursing program and obtain a bachelor’s degree in nursing (BSN). Students should be sure the school is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN).

Successful completion of the NCLEX-RN is needed for licensure. The length of time it takes to obtain an MSN depends on the nurse’s starting point:

• Nursing students enrolled in a BSN program complete in about four years
• RN to BSN takes about two years
• BSN to MSN takes about two years
• BSN to DNP takes three to four years
• MSN to DNP takes one to two years

Additionally, both online programs and classroom programs are available to accommodate students. Both types have pros and cons depending on students’ needs, therefore researching individual schools is encouraged.

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General advanced-practice courses include concepts such as:

• Health promotion and maintenance
• Advanced pathophysiology
• Advanced health assessment
• Pharmacology for advanced practice nurses

The core curriculum for clinical nurse specialists include courses on:

• Theory and ethics
• Application of research to practice
• Context of health care for advanced-practice nursing
• Statistics in nursing research

Are Any Certifications or Credentials Required?

Upon completion of the MSN or DNP program, clinical nurse specialists can obtain additional certification(s) in the specialty of choice. The American Nurses Credentialing Center (ANCC) offers certification in the following areas:

• Adult health
• Adult-gerontology
• Adult psychiatric-mental health
• Child/adolescent psychiatric mental health
• Pediatrics

Basic requirements for certification are:

• Current RN license
• MSN, Postgraduate, or Doctoral degree
• Graduate program must include three separate courses in
  • Advanced physical/health assessment
  • Advanced Pharmacology
  • Advanced pathophysiology
• Worked a minimum of 500 supervised, clinical hours in the CNS role and population of choice

Additional requirements are needed for certification in adult gerontology, pediatric, and mental health specialties. Certification is obtained by exam and is valid for five years.

Other certifications are available as well and may meet state board requirements. For example, the American Association of Critical-Care Nurses (AACN) offers certification for adult, pediatric, and neonatal acute care CNSs, and meets the standards for the California BRN. Nurses are encouraged to review the requirements outlined in their state board of registered nursing.

Although BRN requirements can vary from state to state, CNSs must complete the following for licensure:

• Submit verification of completion of a graduate degree program
• Submit transcripts of the completed graduate degree program
• Provide verification of certification from an organization/ association (such as the ANCC)