Defining APRNs and Clinical Nurse Specialists
What is a clinical nurse specialist? Advanced practice registered nurses (APRNs) are registered nurses who have completed additional education and training, either a master's degree or a doctorate. When nurses pursue a graduate degree, they select a clinical role and/or a specific population for their focus. Traditionally, there are four options: certified nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs). For today's purposes, we'll focus on the clinical nurse specialist.
What is a Clinical Nurse Specialist?
A clinical nurse specialist (CNS) generally specializes in a specific population, for example, (neonatal, pediatrics, or gerontology). Still, they can also focus on a disease, a type of care setting, or a type of problem, which means they can work as clinical experts across the healthcare delivery continuum ranging from mental health to acute care settings. Furthermore, "CNS's practice can be organized around five domains: expert practitioner, researcher, consultant, educator, and leader," which sets them up expressly to impact the CNS's three Spheres:
- direct patient care
- nursing practice
- healthcare systems
A CNS utilizes their advanced education and training to lead critical thinking and collaboration and implement quality initiatives and evidence-based practice (EBP), which sounds important while perhaps a little ambiguous. Therefore, you might wonder how that translates into what practicing CNSs do. To make the role more concrete in your mind, let's look at some examples of CNS roles in the healthcare setting.
Clinical Nurse Specialist: Leaders in Critical Thinking and Collaboration
CNS roles in healthcare are broad and extend from their core competencies.
- CNSs may supervise nurses in direct patient care.
- CNSs may serve as board representatives for nurses on an interagency council.
- CNSs evaluate and analyze patient outcomes thinking critically about appropriate EBP for improvement.
- CNSs provide consultation and critical thinking for nurses with challenging and complex patient cases.
- CNSs may lead research or studies for innovative nursing practice.
- CNSs may be part of or lead quality improvement teams in hospitals.
- CNSs work collaboratively with clinicians from other disciplines to optimize patient treatment and promote continuity of care.
What separates CNSs from other APRN tracks is the focus on utilizing their clinical expertise to impact nursing practice on a macro level. Yes, CNSs have direct practice responsibilities and roles, but their perspective is specifically trained toward critical thinking and analysis to improve the delivery, method, and practice of nursing systems.
Clinical Nurse Specialist: Nursing Specialties
According to the National Association of Clinical Nurse Specialists (NACNS), CNS certification is required, and most U.S. states require certification for a specific population such as Gerontology, Pediatrics, or Neonatal. For more information about CNS and specialty certification, contact the American Nurses Credentialing Center or the American Association of Critical Care Nurses.
Average Clinical Nurse Specialist Salary
Clinical nurse specialist salary varies widely depending on specialty, geographic location, and experience. The median salary for clinical nurse specialists in 2022 was $112,257.
CNSs who pick up per diem shifts or PRN jobs earn a higher hourly wage to offset the fact that no benefits are gained per diem.
Clinical Nurse Specialist Practice Authority
Like the sister APRN track of Nurse practitioners, a CNS's authority to practice and/or prescribe medications, treatments, and equipment is regulated by the state where they practice.
Physician collaborative practice agreements are required for a CNS to practice in 13 states, 19 states require physician agreements for medication and equipment prescriptions, and 28 states allow the independent practice of CNSs, as reported by the NACNS.
Clinical Nurse Specialist Programs
The NACNS maintains a directory of active CNS programs across the United States. At the time of this article, there are 64 which offer different programs and population or disease foci. Some offer only MSN programs, while others provide BSN to DNP or MSN to DNP.