Clinical Nurse Specialist

A clinical nurse specialist (CNS) is a nurse with advanced skills, clinical education and a graduate or doctoral level degree. They are expert diagnosticians and are responsible for administering evidence-based interventions and treatments to patients. A CNS shares their expertise with specialists and other nurses to enhance the performance of the healthcare system and implement system-wide changes. A review of clinical literature demonstrated that a hospital-based CNS reduces cost of care, length of hospitalizations and improved patient outcomes.


A clinical nurse specialist (CNS) is a nurse with advanced skills, clinical education and a graduate or doctoral level degree. They are expert diagnosticians and are responsible for administering evidence-based interventions and treatments to patients. A CNS shares their expertise with specialists and other nurses to enhance the performance of the healthcare system and implement system-wide changes. A review of clinical literature demonstrated that a hospital-based CNS reduces cost of care, length of hospitalizations and improved patient outcomes.

Their domains are the “three spheres of influence”. The spheres are the system/network organization, nursing personnel and the patient/family. A CNS can center their practice on specific settings, such as urgent care clinics, critical care and emergency rooms or procedures such as surgery. They can also focus their work on medical illnesses or conditions, such as cardiovascular diseases, oncology or diabetes or a specific patient population, such as women, geriatric or pediatric.

A CNS is a highly trained and educated specialist. The nurse must earn a masters or doctorate in nursing which emphasizes the clinical nurse specialty. The candidate must pass the national licensing exam for nurses and the CNS certification exam that is administered by the American Nurses Credentialing Center (ANCC). The exam also certifies a CNS in home health, public/community health, pediatrics, child/adolescent psychology and mental health, adult psychiatric and mental health, adult health, geriatrics, diabetes management and CNS Core. The computer based examinations contain approximately 175 multiple choice questions. Most of the exam questions focus on the candidate’s specialty. The other questions concentrate on research, education, advanced practice nursing and the sciences. The ANCC has additional information regarding the exam on its website.

Acute care settings are the traditional work environment for a CNS, but their role in non-acute care is increasing. The broad-based expertise of a CNS permits them to work in private practices, private businesses, universities, clinics, homes, home care systems, hospitals and other settings.

The role and average day of a CNS varies significantly with the individual’s area of specialization. The responsibilities of a CNS in an oncology clinic are very different from those of a CNS in a university or corporate setting. Their five daily responsibilities include clinical practice, research, teaching, management and consulting.

The salary for a CNS varies based upon the hiring facility, geographical location and the training and education level of the nurse. The average CNS salary is $80,000, but the range is between $75,000 and $100,000 per year. The employment outlook for this specialty nurse is very positive. The U.S. has a nursing shortage that is anticipated to escalate in the coming years. Advanced practice nurses, such as CNS, are in particularly high demand because they can provide primary and specialized patient care for less than it costs to employ a physician. The extraordinary demand for these skilled health professionals could mean better benefits packages, higher salaries, more flexible work schedules and environments. Similar types of nurses include nurse anesthetists, nurse midwives and nurse practitioners.