Clinical Nurse Specialist RN to MSN Programs

What is a Clinical Nurse Specialist?

Definition of a CNS

A Clinical Nurse Specialist (CNS) is an APRN who provides integrated patient care in three overlapping spheres of influence (i.e. practice domains):

1. Patient/Client: Expert clinical care of patients, including diagnosis, treatment, and ongoing management of complex cases.
2. Nursing & Nursing Practice: Education of nursing personnel & staff nurses, including mentorship, training, team-building, support, and staff development.
3. Organization/System: Leadership over the larger healthcare system, including work in patient advocacy, policy development, healthcare delivery systems, and best practices & procedures.

CNSs do not usually have a patient assignment. Instead, the role goes beyond patient care to include coaching, research, program design, staff evaluations, and administration. To put it another way, CNSs are always focused on the bigger picture (e.g. continuous improvement of care, better resource allocation, patient safety, implementation of evidence-based practices, etc.) as it relates to their specialty (e.g. neonatology).

Because of the scope of their tasks, you’ll often find clinical nurse specialists taking on leadership roles in complex settings such as:

• Hospitals
• Specialized units (e.g. pediatric units, NICUs, etc.)
• Large healthcare organizations & networks
• Community-based healthcare organizations

According to the NACNS Census, acute care hospitals are the most common employers.

Note: As of 2018, the CNS was recognized as an APRN in almost all states, with a few exceptions (e.g. Mississippi). Check the NCSBN’s APRN Consensus Implementation Status Map for the latest updates.

CNS Specialties

The three most common clinical nurse specialist roles are:

• Adult Gerontology CNS
• Pediatric CNS
• Neonatal CNS

These are three specialties where you can still earn CNS certification. You may wish to sub-specialize in an area of care (e.g. trauma, oncology, neurology, critical care, diabetes management, etc.).

You’ll also encounter Psychiatric-Mental Health CNSs (PMH CNSs) and other specialist CNSs who are currently working in the field. However, we should point out that ANCC’s CNS certifications for many population groups are only available for renewal (as of 2018). That means most Schools of Nursing no longer offer graduate programs in these specialties.

CNS Scope of Practice

Since CNSs are regarded in most states as APRNs, you’re probably wondering how much power they can wield. On the downside, every State Board of Nursing has different regulations for CNS roles. On the upside, the NCSBN maintains a CNS Independent Practice Map and a CNS Independent Prescribing Map that summarizes the facts.

• In 2018, 28 states had granted CNSs the authority to practice without physician supervision.
• In 2018, 19 states allowed CNSs to prescribe independently.

But it’s interesting to note that most CNSs in the NACNS Census didn’t have (or want to bother with) prescriptive authority.

Is the CNS Being Phased Out?

This is a tricky question to answer, so we’ll try to give you both sides of the coin:

• No—It’s Still Going Strong: Judging by CNS job openings, there are plenty of opportunities out there. In fact, some states (e.g. Washington’s Department of Health) recommend that Level III/IV NICU units have a Neonatal CNS on staff to help with professional development and effect system-wide change. In California, neonatal & pediatric units are required to have a CNS in order to be licensed by the state. The NACNS is a strong advocate for the CNS profession and there are still a number of CNS certifications available.
• Yes—It’s a Dodo: As of 2018, a number of ANCC’s CNS certifications are now only available for renewal. The role of the Clinical Nurse Leader (CNL) has emerged as a viable alternative and some folks are reporting that employers have decided to hire CNLs or nurse educators instead of CNSs. In rural areas & small cities without major health centers, CNS job listings may be non-existent.

Clinical Nurse Specialist vs. Other Specialties

CNS vs. NP (Nurse Practitioner)

We’re going to call these two roles “cousins.” That’s because CNSs and NPs are both APRNs who:

• Are trained in the same core curriculum subjects during graduate school.
• Prescribe medications (in some cases). Your ability to prescribe as a CNS will depend on the scope of practice in your state.

The difference will lie in your day-to-day tasks. Every employer will have different expectations, but here are some broad generalizations:

• Clinical Nurse Specialist (CNS): You’ll be working “behind the scenes” in management, research, education, and support functions. Since CNSs are often responsible for instigating system-wide change in a hospital or facility (e.g. improving treatment plans, training staff in new medications & interventions, implementing unit protocols, etc.), they can spend a lot of their day in meetings & offices. They may also be coordinating various medical teams and mentoring/coaching staff nurses. CNSs still get to interact with patients (e.g. during training programs), but it’s not really hands-on care.
• Nurse Practitioner (NP): You’ll get tons of direct care time. In some states, you can be extremely independent, with the ability to see patients & prescribe medications. You will also have the option to work in small primary care operations and rural areas. If you really love working one-on-one with patients, and you don’t like the idea of administration and teaching, then the NP is going to be your best choice.

To find out what it’s really like, check CNS and NP job descriptions in your area and compare the responsibilities. For example, you may find than an Adult Gerontology CNS has a vastly different role than an Adult Gerontology Acute Care NP (AGACNP) in the same hospital.

Note: Torn between the NP and the CNS? A few schools offer combined dual CNS/NP programs that allow you to sit for CNS and NP certifications. You’ll have to maintain both credentials, but you’ll have more options in the job market.

CNS vs. CNL (Clinical Nurse Leader)

Another choice you’ll be facing is whether to become a CNS or a CNL. The role of the Clinical Nurse Leader was developed by the AACN, and the role of the Clinical Nurse Specialist is advocated by the NACNS, so there’s a bit of a rivalry going on between the two organizations about which one is more useful.

• Clinical Nurse Specialist (CNS): A CNS is an APRN with a significant scope of practice. CNSs tend to focus on managing change at the macro level (e.g. institution-wide) through their three spheres of influence. Because of their training in a specific specialty, CNSs are sometimes called advanced specialists or clinical experts. It’s a management & administrative role with a wide range of duties—CNSs may oversee a unit and report directly to the CNO.
• Clinical Nurse Leader (CNL): A CNL is not an APRN. CNLs tend to concentrate on improving patient safety, reducing risk, and developing plans of care at the micro level (e.g. a hospital unit, outpatient clinic, home health agency, etc.)—one CNL said his job was “root cause analysis.” It’s a supervisory role at the frontline of patient care (not an administrative one)—CNLs work with a variety of healthcare staff and report to the managers of their units.

Are you interested in leading a team of nurses and advocating for patients while you’re working on the floor? Then the CNL may be a good fit. Do you want to bring about research-led change in a specific field (e.g. oncology) and act as a trusted mentor & consultant to nurses (including CNLs)? Check out the CNS.

Note: We talk more about the CNL in our guide to RN to MSN Clinical Nurse Leader Programs. It’s worth looking at job descriptions to see which qualification is more in demand in your area.

RN to MSN Clinical Nurse Specialist Programs

RN to MSN CNS: Overview

RN to MSN CNS programs are designed for working RNs who have a diploma or an associate’s degree (e.g. ASN/ADN) and want to pursue an MSN or MS to become a clinical nurse specialist. In addition, there are a few RN to MSN CNS programs for RNs with a bachelor’s degree in a field other than nursing.

Our directory includes RN to MSN CNS programs in:

• CNS Specialty/Population Focus: Most RN to MSN CNS programs in our directory focus on adult gerontology, but we do have a few pediatric options. In addition, the National Association of Neonatal Nurses (NANN) has a list of Neonatal CNS graduate programs. CNS programs for other fields (e.g. psychiatry, community health, women’s health, etc.) have practically disappeared.
• Acute Care Adult Gerontology: If you favor hospital-based adult care, this is a CNS program worth considering. The curriculum for these RN to MSN CNS programs should match the standards for both Adult Gerontology CNS certifications.
• Sub-Specialty: You will also see a few Adult Gerontology RN to MSN CNS programs that allow you to choose a sub-specialty (other than acute care). Oncology is always a popular option. Check the requirements—some schools may expect you to have a BSN or significant RN work experience.

RN to MSN CNS: Admissions

RN to MSN Clinical Nurse Specialist programs tend have the same general prerequisites as NP programs. In other words, universities want to see:

• A diploma or associate’s degree in nursing (unless you have a bachelor’s in another field)
• A current RN license
• At least one year of RN clinical experience
• A baseline undergraduate GPA (usually 2.75-3.0)
• Letters of professional reference

When it comes to the clinical experience requirement, schools are often looking for RNs who are dedicated to their specialty. For example, if you’re interested in acute care CNS programs, you may be expected to have a foundation of 1-2 years in recent acute care practice before you can take the clinical rotations. If you want to apply for neonatal CNS programs, you may need some RN time in the NICU.

RN to MSN CNS: Undergraduate Phase

Remember that you must earn good grades on prerequisite undergraduate courses before the university will allow you to tackle the master’s degree. The length of this undergraduate phase varies between universities (e.g. 6 months – 2 years), but you can expect course titles such as research design, community/population health, policy, evidence-based practice, etc.

In some cases, you may be able to transfer previous coursework (e.g. statistics) or a portfolio (e.g. health assessment) for credit.

RN to MSN CNS: MSN Curriculum

Once you’ve made it to the graduate level, standard MSN or MS degrees take around 1-3 years to complete. Every School of Nursing has its own unique take on the master’s degree, but here’s how a standard CNS curriculum breaks out:

• Core Courses: 4-6 courses in leadership & research that will prepare you for management challenges (e.g. nursing concepts & theory, healthcare policy & economics, nursing ethics, research for health professionals, health promotion & disease prevention, epidemiology, organizational & systems leadership, etc.).
• Advanced Clinical Practice Courses: 3 mandatory courses in advanced pharmacology, advanced pathophysiology, and advanced health assessment. Some Schools of Nursing may add an advanced health assessment lab or an extra course in a relevant area (e.g. nursing informatics).
• Specialty/Concentration Courses: 2-4 courses in your area of interest. For example, a typical CNS adult gerontology program might include courses in theories of aging, complex acute care problems, health promotion across the lifespan, family assessment, etc. Meanwhile, a CNS adult oncology program could have courses in cancer genomics, cancer supportive care & symptom management, cancer pathophysiology, and palliative care. Specialty courses are often taken in tandem with clinical rotations.
• Elective Courses/Minor: 1-2 courses in CNS topics that you get to choose (e.g. outcomes management, quality improvement, program development, teaching in nursing, etc.). Some RN to MSN CNS programs don’t bother with electives.

You’ll notice a lot of similarities between NP and CNS programs, especially when it comes to the core & advanced practice courses. That’s deliberate. A healthy part of the CNS job still involves patients and universities want you to be ready to handle the challenges.

They’re also prepping you for CNS certification. For example, to earn the AGCNS-BC from the ANCC, you must complete graduate-level coursework in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology.

RN to MSN CNS: MSN Clinical Hours / Practicums

To help you experience the full range of CNS duties, RN to MSN CNS programs will always include clinical practicums (a.k.a. clinical rotations). You can expect to complete at least 500 clinical hours during your MS or MSN degree—that’s the minimum prerequisite for CNS certifications.

The choice of settings will depend on the specialty:

• Adult gerontology practicums might include work in an acute care/hospital-based setting, a geriatric-focused setting, and an ambulatory care setting.
• Pediatric practicums might involve work in an acute care/hospital-based setting and an ambulatory care setting.
• Neonatal practicums & acute care adult gerontology practicums will only involve work in acute care/hospital-based settings.

During rotations, you’ll be exposed to a CNS’s three spheres of influence (patient, nurse & system) under the supervision of a CNS preceptor. In other words, you’re going to be managing complex patient cases (and populations), learning how to educate & support other nurses, and developing your research & leadership skills to improve patient care.

Don’t be afraid to ask the program coordinator for specifics! You can also chat to CNS alumni about their clinical experiences (e.g. Did they find their own preceptor? What tasks & skills were covered in training?).

Online RN to MSN Clinical Nurse Specialist Programs

Are Online RN to MSN CNS Programs Available?

Yes. A small number of solid schools in our directory offer Online RN to MSN Clinical Nurse Specialist degrees. To expand your options, you may want to compare them with Online RN to MSN CNL Programs and Online RN to MSN Nursing Administration Programs. Here’s how a distance RN to MSN degree works:

• Undergraduate Phase: You’ll be expected to earn good grades in undergraduate courses from the university before you can proceed to the MS or MSN. Unless they involve clinicals or labs, these courses are usually offered online. This means you can work while you study.
• Graduate Phase: In a CNS program, you’ll be able to take all (or at least most) of your standard MS or MSN courses online. But you must also complete at least 500 clinical hours in order to graduate. You’re allowed to do clinical practicums in your own community. However, you may be expected to find the site and a CNS preceptor who is willing to supervise you. Many RNs end up on a part-time schedule during clinical rotations because of the workload.

What’s more, some universities will expect you to travel to campus (at least once) for orientations or workshops. For example, California State University Dominguez Hills’s RN to MSN program includes periodic on-campus meetings for a few courses. Budget for every expense.

Note: Do you live in a large metro area with great nursing schools? You could consider a blended program (online & on-campus courses). It’s not as convenient as a distance learning degree, but you’ll get more face-to-face time with instructors.

Online RN to MSN CNS Programs & State Licensure

Before you commit to an Online RN to MSN CNS program, check with your State Board of Nursing and the program coordinator about state licensure requirements.

Clinical nurse specialists are almost always considered APRNs (see the APRN Roles Map for exceptions), so they are governed by specific rules and regulations regarding clinical learning experiences. You need to make certain that all your online degree components will meet the state’s licensing criteria.

You should find details about this issue in the program’s FAQ section or the university’s State Regulations page. For example, California State University Dominguez Hills’s School of Nursing explicitly states in its admissions criteria that it cannot deliver online education in all states and asks out-of-state students to contact the school for more info. If you’re confused, don’t be afraid to ask the program coordinator for help.

Clinical Nurse Specialist Certification

Overview of CNS Certification

Check with your State Board of Nursing to find out what national certifications you need in order to practice as a CNS. Typically, states will want to see a CNS certification from the American Nurses Credentialing Center (ANCC) or the American Association of Critical Care Nurses (AACN).

If you’re interested in adult gerontology, it’s useful to know that some RN to MSN Adult Gerontology CNS programs will prepare you for both the ANCC’s AGCNS-BC certification and the AACN’s ACCNS-AG certification (which, despite it’s name, covers the spectrum of wellness to acute care). Talk to your mentors about which credential is best for your goals.

CNS Certifications

Adult-Gerontology Clinical Nurse Specialist Certification (AGCNS-BC)

The AGCNS-BC is offered by the American Nurses Credentialing Center (ANCC). To gain it, you must:

• Hold a current, active RN license.
• Earn a master’s (e.g. MS or MSN), postgraduate, or doctoral degree (e.g. DNP) from an Adult Gerontology CNS program accredited by the CCNE or ACEN.
• Tackle graduate-level coursework in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology.
• Complete a minimum of 500 faculty–supervised clinical hours in the adult gerontology CNS role and population.
• Take & pass the national AGCNS-BC exam. The exam covers Direct Care; Professional Practice; and Systems Leadership/Quality/Outcomes.
• Keep your certification & licensure up-to-date through continuing education. The certification period lasts 5 years.

Note: ANCC CNS certifications in other specialties (e.g. psychiatry, pediatrics, public/community health) were available for renewal-only in 2018.

Acute Care CNS-Adult Gerontology (ACCNS-AG)

The ACCNS-AG is offered by the American Association of Critical Care Nurses (AACN). To gain it, you must:

• Hold a current, unencumbered RN or APRN license.
• Complete a graduate-level Adult Gerontology CNS program accredited by the CCNE or ACEN.
• Tackle graduate coursework in wellness and acute care in adult gerontology patients.
• Complete 500 supervised clinical practice hours in adult gerontology during your graduate program—a portion must be focused on wellness and a portion on acute care.
• Take & pass the ACCNS-AG exam. The exam tests clinical and non-clinical judgement knowledge.
• Keep your certification & licensure up-to-date through continuing education. The certification period lasts 5 years.

Acute Care CNS-Pediatrics (ACCNS-P)

The ACCNS-P is offered by the American Association of Critical Care Nurses (AACN). To gain it, you must:

• Hold a current, unencumbered RN or APRN license.
• Complete a graduate-level Pediatric CNS program accredited by the CCNE or ACEN.
• Tackle graduate coursework in wellness and acute care in pediatric patients.
• Complete 500 supervised clinical practice hours in pediatrics during your graduate program—a portion must be focused on wellness and a portion on acute care.
• Take & pass the ACCNS-P exam. The exam tests clinical and non-clinical judgement knowledge.
• Keep your certification & licensure up-to-date through continuing education. The certification period lasts 5 years.

Acute Care CNS-Neonatal (ACCNS-N)

The ACCNS-N is offered by the American Association of Critical Care Nurses (AACN). To gain it, you must:

• Hold a current, unencumbered RN or APRN license.
• Complete a graduate-level Neonatal CNS program accredited by the CCNE or ACEN.
• Tackle graduate coursework in wellness and acute care in neonatal patients.
• Complete 500 supervised clinical practice hours during your graduate program—a portion must be focused on wellness and a portion on acute care in the neonatal patient population.
• Take & pass the ACCNS-N exam. The exam tests clinical and non-clinical judgement knowledge.
• Keep your certification & licensure up-to-date through continuing education. The certification period lasts 5 years.

Clinical Nurse Specialist Jobs

Clinical Nurse Specialist Careers

Once you hit the job market, you’re going to be facing tough competition from newly qualified CNLs, nurse educators, and nurse executives. But you can avoid frustration and get a jump-start on your career if you start by planning ahead:

• Research the Role Beforehand: Learn what the role of a CNS is in your state. Talk to CNS alumni about their experiences (and ask them how long it took to find a job). Examine local CNS job descriptions to see what’s on offer in your metro area. Shadow a current CNS for while. This will give you a better idea of whether a CNS program is the right choice.
• Choose a Job-Focused Degree: Opt for Schools of Nursing that offer career counseling, professional & career development workshops, and job fairs. Does the university have local partnerships with large hospitals and health centers (where your next job may be)? Can it connect you to CNS preceptors? Does it have an affiliated medical center where you can gain solid clinical experience in a big organization?
• Gain as Much Clinical Experience as You Can: For CNS positions, hiring managers & hospitals may want to see at least three years of relevant clinical experience on your résumé. If you can work part-time in a relevant setting or unit (e.g. NICU) while you study for your master’s degree, you’re going to look mighty good to employers.

Clinical Nurse Specialist Job Openings

• NACNS Career Center
• Indeed: Clinical Nurse Specialist Jobs, Clinical Nurse Specialist (CNS) Jobs, CNS Jobs, etc.
• Monster: Clinical Nurse Specialist Jobs.
• Glassdoor: Clinical Nurse Specialist Jobs.
• LinkedIn: Clinical Nurse Specialist Jobs.

Alternative CNS Job Titles

Finally, it’s useful to think beyond the CNS box. Other than “Clinical Nurse Specialist,” common job titles for CNSs include:

• Program director
• Case manager
• Care coordinator
• Trauma coordinator
• Staff development coordinator
• Research coordinator
• Clinical instructor

Clinical Nurse Specialist Salaries

Glassdoor’s page on Clinical Nurse Specialist Salaries, Indeed’s page on Clinical Nurse Specialist Salaries, and Payscale’s page on Clinical Nurse Specialist Salaries will give you ballpark salary figures for CNSs. In 2018, average CNS salaries ranged from $83,000-$112,000.

Clinical Nurse Specialist Resources

CNS Certification Bodies

• American Association of Critical Care Nurses (AACN)
• AACN: Certification Preparation Tools & Handbooks
• American Nurses Credentialing Center (ANCC)

CNS Professional Associations

• California Association of Clinical Nurse Specialists (CACNS)
• National Association of Clinical Nurse Specialists (NACNS)

CNS Conferences & Events

• CACNS Annual Conference
• NACNS Annual Conference

CNS Journals

• Clinical Nurse Specialist: The International Journal for Advanced Nursing
• CNS Communiqué

CNS Useful Resources

• NACNS Census
• NACNS: CNS Program Directory
• NACNS: CNS Scope of Practice
• NACNS: Continuing Education Resources
• NACNS Cost Analysis Toolkit: A Business Guide for the Clinical Nurse Specialist
• NANN: Neonatal CNS Graduate Programs