Understanding Clinical Nurse Specialists

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Unpredictable care delivery needs provide Clinical Nurse Specialists with unique and interesting daily responsibilities. The role is the ideal career for nursing professionals who enjoy variety and challenge. Due to their enhanced skill sets and responsibilities, Clinical Nurse Specialists make significant impacts on healthcare service delivery. Nursing professionals choosing this career shape organizational policies and procedures, and for half a century have led the caregiving community through many innovations. Throughout time, the medical community made little effort to distinguish the Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP) roles. However, society’s reliance on nurse practitioners to fill the United States physician shortage now requires state boards to delineate the disciplines for regulatory reasons.

An Occupation Unlike Others

CNSs ensure that organizations comply with medical best practices and perform optimally by facilitating patient research, care and education. [2] They also spearhead and lead improvement initiatives. To promote change, CNSs must influence others to take action, using several skills and tactics, such as:

Medical association involvement
As a result, CNSs are the link between medical research and clinical practice. This responsibility allows them to influence decisions across caregiving organizations.

CNS Job Duties and Skills

For over 50 years, CNSs have led caregiving innovation implementation. [4] The CNS’s expertise is the trademark of their professional role. CNSs use scientific procedures and evidence to evaluate, analyze and treat illnesses and manage the resources and talent to deliver patient care. These activities ultimately lead to frameworks that enhance community health. Individually, they practice distinct specialties varying in traits, such as:

Caregiving goals
Medical unit
Population coverage
Specific illness or condition
CNSs possess strong proficiency in leadership, collaboration and consultation. They must effectively report evidenced-based medical developments to all stakeholders and bring many disciplines together to execute complex intellectual improvement initiatives; they manage and streamline the daily interactions between patients, nurses and caregiving organizations. CNSs also include caregivers in decisions to foster engagement in patient wellness.

No Two Days Are the Same

CNSs typically perform varying tasks each day. [1] Some begin their day reviewing calls from clients. Throughout the day, they arrange patient prescriptions and consult with patients. At times, CNSs make hospital stay arrangements and visit clients to check on their condition or encourage them before complex surgeries or procedures.

CNSs also attend to client families by providing support and relaying patient status updates. They meet with consultants on behalf of patients to determine potential action plans. CNSs also review patient tests and historical vital statistics to monitor client conditions. Using this information, CNSs keep patients and stakeholders informed of the client’s condition and caregiving plans.

Autonomous Recognition for the CNS Role

The National Council of State Boards of Nursing (NCSBN) conducted research delineating the Nurse Practitioner and Clinical Nurse Specialist roles to help state regulatory boards evaluate how to govern the two disciplines. [3] Using information gathered from publications on the topic, the council created a poll, which they used to survey active Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs).

CNSs are one of four distinct advanced discipline-nursing practices; along with NPs, nurse midwives and nurse anesthetists. The medical community has distinguished advanced nurse practitioner roles for some time, but without resolute conviction, and is still working to provide definitive clarity for the disciplines. The NCSBN represents a contribution to the effort to meet this goal.

Regarding NP and CNS educational requirements, legislation in this matter varies by state. The boards also differ in issuing authority to individuals practicing these disciplines to dispense pharmaceutical prescriptions. Finally, the boards issue varying privileges for these professionals to prescribe medical equipment.

The poll revealed that NPs typically earn family nurse practitioner (FNP) certification, while CNSs commonly earn an endorsement for adult psychiatric and mental health. It also disclosed that CNSs spend more time completing administrative tasks, whereas nurse practitioners primarily deliver direct patient services. Most NPs reported working in private practices, while CNSs mostly worked in critical care settings. NPs reported typically working under physicians, but nurse supervisors typically managed CNSs.

The two roles overlap, but task frequency differentiates the two professions. In the poll, nurse practitioners and CNSs described commonly performing tasks, such as:

Differential diagnoses
Issuing prescriptions
Physical examinations
Treatment evaluations
In addition, they recommended treatments, implemented care plans and compared risks to patient benefits. They also monitored, evaluated and managed patient conditions over time to determine how treatment plans contribute to client wellness.

CNSs focus on advocating for patients, working with interdisciplinary teams and using research in the caregiving environment. Nurse practitioners expend more effort delivering prescriptions, using test results to determine care plans, regulate medication dosages and perform physical examinations.

CNSs typically work in cardiac, oncology, neonatal, pediatric and obstetrics and gynecological (OB-GYN) environments. Around 30 state boards do not designate disciplines among CNSs, and nearly 35 boards regulate CNS psychological and mental health specialists. From state to state, 30 boards regulate miscellaneous CNS disciplines.

Nurse practitioners commonly provide client-facing primary care in civic centers, learning institutions and hospitals and often treat critical illnesses, provide immunizations and manage chronic conditions. Throughout the United States, many state boards in varying numbers regulate these professionals in diverse disciplines.

A Promising Career Outlook

The BLS forecasts a 19-percent increase in CNS demand. [5] The United States population’s coming of age has spurred this growth. Increased lifespan and the desire to improve cost effectiveness augments the demand for CNSs. The CNS profession is among the highest paying nursing disciplines. Many practitioners report high job satisfaction, and most caregiving facilities offer medical and dental benefits with the position.

Actual CNS salaries vary broadly; overall, salaries range from $45,000 to $135,000 annually. Average CNS salaries vary from $68,000 to $98,000 annually. Entry-level CNSs typically earn around $77,000. Conversely, many earn over $90,000 with experience. Neonatal intensive care unit (NICU) CNSs average significantly more than other disciplines at around $125,000 a year.

A Chance to Make a Difference

CNSs observe and participate in the larger scope of delivering medical services. [6] As the understanding of the CNS role rises, these professionals will continue to produce improvements for caregiving in the United States. The position is an opportunity to work with varying personalities, overcome different challenges and take on increased responsibilities. It is an excellent career for those seeking to pursue upward mobility. The demand for these professionals increases as caregiving grows more complex and data driven.

CNSs deliver dynamic services that improve patient outcomes by evaluating and revising organizational objectives to deliver quality caregiving services. For half a century CNSs have led the caregiving community through many improvements, prompting acknowledgement as an innovation catalyst in the healthcare field. The medical community will increasingly seek these specialists to lead the way to change, as America prepares for an uptick in healthcare service demand.

Learn More

In today’s nursing landscape, specialization is the key to advanced roles and advanced care. Modern healthcare organizations need expert nurses able to provide focused care to unique segments of our population. The online Master of Science in Nursing Acute Care Clinical Nurse Specialist program gives you the opportunity to deliver evidence-based nursing to individuals while changing your healthcare organization for the better.


  1. University Hospital Southampton NHS Foundation Trust
  2. Mayo Clinic
  3. National Council of State Boards of Nursing
  4. National Association of Clinical Nurse Specialists – Statement
  5. Nurse Journal
  6. National Association of Clinical Nurse Specialists