A clinical nurse specialist is an advanced practice registered nurse who fills a highly specialized niche in the nursing profession. Unlike a nurse practitioner, who works with patients and provides a high level of specialized care, a clinical nurse specialist focuses on building knowledge and guidance for other nurses. They are experts in evidence-based practice and use their knowledge directly when providing patient care, and indirectly as experts who devise care plans and protocols at both the patient level and for the population as a whole.
Clinical nurse specialists work to advance the health care provided by those at the registered nurse level. They are highly educated nurses, usually holding at least a master’s degree. Many nurses working at this level have completed a doctoral program and now serve as consultants or experts for hospitals or even hospital networks, helping research and implement new standards to improve the quality of care nurses provide.
What can a clinical nurse specialist focus on?
Clinical nurse specialists can work in a wide variety of specialist areas, such as:
- Women’s health
- Pediatrics
- Adult-gerontology
- Psychiatric-mental health
- Critical care
- Neonatal care
- Oncology
- Emergency departments
- Pain management
- Wound care
Clinical nurse specialists may have a master’s degree or a doctoral degree. Their scope of practice depends on the state they are licensed in, how long they have been practicing at that level and their qualifications. In some states, these nurses can diagnose and prescribe independently but in others, they may be required to work under the supervision of a doctor.
Their day-to-day role may involve ordering tests, administering treatments, and making diagnoses. However, they’re more commonly found in a consulting role, developing new guidelines and protocols and helping the nurses who are on the front-lines implement evidence-based practice.
What are the domains of practice for clinical nurse specialists?
There are three domains of practice clinical nurse specialists engage in:
- Patient/client
- Nursing and nurses
- System and organizational
Patient/client
In the patient domain, the clinical nurse specialist will work directly with the patient. This could be through acute care, private practice, or a community clinic. Nurses who are working in this domain may work alongside registered nurses and other health care professionals as part of an interdisciplinary team to modify care plans and promote evidence-based practice. Clinical nurse specialists can deliver hands-on care, and sometimes do, but it’s not as big a part of their day-to-day work as it is for those in a registered nurse position.
Nursing and nurses
One of the most important parts of a clinical nurse specialist’s role is to act as a leader and communicator, investigating the latest research in nursing best practices, refining it, and devising care protocols for the nurses who are in the wards to use.
A clinical nurse specialist helps nurses to stay current in their skills and moves the field of nursing forward. Rather than nurses using certain protocols “because that’s what we’ve always done”, they are encouraged to follow the science and use evidence-based practice. It’s not possible for a nurse on a busy ward or who is working as part of a very small team in a clinic to stay up-to-date by themselves. The caseloads registered nurses face are significant. The role of the clinical nurse specialist is to mentor and guide nurses, helping them learn which aspects of current scientific research are relevant to their roles.
System and organizational
Demand for nurses has been increasing, and the health care system today is under much greater loads than it was a decade ago. This trend is likely to continue as the average age of the population increases and we have more people requiring care for acute or chronic health conditions.
It’s important for nurses and hospital leaders to find ways to save money while delivering efficient, safe, and effective health care. This is one of the things clinical nurse specialists working in managerial, leadership, or administrative roles do.
These nurses examine new medical products, programs, and interventions and provide hospital leadership with a cost-benefit analysis of them. They do the same for preventative protocols and can offer advice in a consulting role about practices or interventions that could reduce the costs faced by insurance providers and patients.
Some of this work is done on a patient level, while some of it is done in an academic setting.
Starting salary for clinical nurse specialists
Clinical nurse specialists are highly trained advanced practice nurses, and this means they command higher salaries than a registered nurse who is at the beginning of their career. To become a clinical nurse specialist, a nurse will need a valid RN license and lots of clinical experience. They’ll also need to choose a specialization.
What is the typical career path of a clinical nurse specialist?
The standard route to becoming a clinical nurse specialist is to first of all qualify as a Registered Nurse by studying for an associate’s degree in nursing (ADN) or a bachelor of science in nursing (BSN), then taking the NCLEX-RN certification exam. Passing this examination means you are licensed as a registered nurse in the state in which you took the examination.
If you earned your nursing license via the BSN route, you can pursue a master’s degree from one of many different universities. If you are an ADN-qualified nurse, you have the option of upgrading your associate’s degree to a bachelor’s degree or pursuing a master’s degree through an RN-to-MSN program that includes some of the most important bachelor’s-level modules.
Many ADN-prepared-nurses opt to study for a BSN part-time while also studying for a bachelor’s degree. This gives them the opportunity to spend two years working as a registered nurse, potentially spending time in different departments along the way and getting some supervised experience that could be counted towards certifications.
Once a nurse has decided which area of nursing they’d like to specialize in, they can study for a master’s degree in that area. To qualify as a clinical nurse specialist, the degree must be accredited by the Commission on Collegiate Nursing Education.
In addition to the master’s degree, aspiring clinical nurse specialists will also need to hold a certification in their specialization. There are several certifying bodies, including the American Association of Critical Care Nurses and the American Nurses Credentialing Center. These bodies require nurses to hold a master’s degree and have extensive supervised clinical experience before offering advanced practice level certifications.
Areas a clinical nurse specialist can choose to focus on include:
- Adult gerontology
- Family nursing
- Nursing across the lifespan
- Pediatrics
- Neonatal
- Psychiatric-mental health nursing
- Women’s health
Clinical nurse specialists are granted licenses at the state level, which means they may need to re-certify if they move to a different state.
The nursing profession offers a significant level of mobility, even at this advanced practice level. Some nurses pursue a Doctor of Nursing Practice as the next step in their careers, allowing them to become a nurse practitioner and work in a more patient-facing role. Another patient-focused progression option is to become a nurse midwife.
Those who are more interested in the behind-the-scenes elements of nursing have the option of becoming a nurse educator or a nurse leader. The skills used as a clinical nurse specialist are highly transferrable and will be valuable in many other parts of the nursing profession.
Lots of people who qualify as a clinical nurse specialist choose to stay in that role for a long time. These professionals can command high salaries and these nurses enjoy significant respect and autonomy, making it an enjoyable profession to be in.
What is the starting salary of a clinical nurse specialist?
The median starting salary of a clinical nurse specialist is $105,061, according to market data gathered by salary.com. This is just the base salary and does not include any profit sharing, benefits, overtime, or other factors that could increase a nurse’s income.
What factors affect the salary of a clinical nurse specialist?
Earnings for clinical nurse specialists vary depending on where they’re working, their specialization and whether they’re attached to a teaching hospital, a non-profit hospital, a private clinic, or some other form of health care institution. Nurses who work in a consulting role or in a corporate setting usually earn more than those who choose to work in non-profit settings.
Geographic differences can be significant. Nurses working in California, for example, usually enjoy higher incomes than those who are based in states with a lower cost of living. It’s important to factor in the cost of living when comparing salaries because in many cases differences in rent and taxes can be large enough to nullify any increase in earnings seen from relocating.
Highest salaries for clinical nurse specialists
A clinical nurse specialist in the top 10% of earners could have a salary of $128,240. Nurses who enjoy salaries this high usually have many years of experience and additional qualifications beyond those required to earn the job title.
How can you negotiate a higher salary as a clinical nurse specialist?
Clinical nurse specialists working in private practices or clinics earn higher salaries than those in hospitals and long-term care facilities. Some clinical nurse specialists work as nurse leaders or take on other responsibilities in order to increase their earnings.
The best ways to get paid more as a clinical nurse specialist are to pursue as many qualifications as you can and to engage in continuing professional development. Not only will this help you earn more, but it will also make it easier for you to renew your clinical nurse specialist certification with the ANCC. Currently, qualifications such as the Adult-Gerontology Clinical Nurse Specialist (AGCNS-BC) certification must be renewed every five years via submitting proof of practice and continuing education.
The next logical step for many clinical nurse specialists is to earn a Doctor of Nursing Practice. This opens up many career options, including becoming a nurse practitioner or even a nurse anesthetist. These professions have higher earning potential than that of a clinical nurse specialist.
States that offer the highest clinical nurse specialist salaries
Clinical nurse specialist salaries vary significantly between states, as does the demand for nurses qualified to that level of the profession. If you’re interested in maximizing your salary, consider relocating to a state where there are many job openings.
What states have the most jobs for clinical nurse specialists?
Some of the states that have the most clinical nurse specialist jobs available include:
- California (7,855)
- Texas (5,344)
- New York (4,278)
- Pennsylvania (4,055)
- Ohio (2,540)
Why do some states have higher-paid jobs for clinical nurse specialists?
The list of states with the highest-paying jobs for clinical nurse specialists has a slight overlap with the list of states where such nurses are in the most demand, with California topping both lists.
The states with the highest-paying jobs for experienced clinical nurse specialists (the top 10% of earners) are:
- California ($162,000)
- District of Columbia ($150,000)
- Minnesota ($146,000)
- North Dakota ($143,00)
- Wyoming ($136,000)
California also tops the pay tables when you consider the average salary for clinical nurse specialists, with a median pay rate for this profession of $100,214. It’s the only state where median salaries for clinical nurse specialists is in six figures, although all of the top six states (District of Columbia, North Dakota, Minnesota, Massachusetts, and Wyoming) offer clinical nurse specialists an average salary of more than $90,000.
What types of jobs are clinical nurse specialists qualified for?
Clinical nurse specialist is a job title in its own right, and one with many specializations. When someone goes to university to study a Master’s of Science in Nursing they choose a specialization and can then earn the clinical nurse specialist title within that specialization.
This means two clinical nurse specialists could have chosen to focus on entirely different areas of nursing. Options for specialization include:
- Adult-gerontology
- Family nursing across the life span
- Neonatal nursing
- Pediatrics
- Psychiatric-mental health
- Women’s health
Clinical nurse specialists are advanced practice nurses and their skills and expertise can be applied to many other areas, including roles such as nurse leader, informatics nurse, or nurse administrator.
It’s common for nurses to pursue additional specializations after their first master’s degree, or to study a doctoral program and become a nurse anesthetist, certified nurse midwife, or nurse practitioner. The Bureau of Labor Statistics projects demand for jobs at this level will increase by 45% between 2019 and 2029, and the average salary for nurses with this level of qualification is $115,800 per year, making a doctoral-level qualification a potentially lucrative option for a nurse looking to further their career.
Factors that impact a clinical nurse specialist’s salary
Demand for nursing professionals is steadily increasing at both the registered nurse level and for APRNs. This means nurses at all levels have the chance to enjoy high salaries. Entry-level nurses will, naturally, find themselves offered lower salaries when they first join the profession, but there are things you can do to increase your earnings.
What qualifications can help you negotiate a higher salary as a clinical nurse specialist?
In addition to factors such as geographic location, experience, and the setting a nurse works in, the salary of a clinical nurse specialist is impacted by the specialization they choose. If you’re hoping to get a high salary as a clinical nurse specialist early on in your career, you’ll want to choose a specialization that is in demand.
Some of the highest-earning clinical nurse specialists work in neonatal nursing, in particular in neonatal nursing care. This type of nursing focuses on caring for premature newborns and babies born with serious health issues. Clinical nurse specialists focused on neonatal nursing develop (and sometimes deliver) evidence-based care for those babies.
Other in-demand specializations include:
- Clinical nurse educator
- Clinical nurse manager
- Clinical nurse consultant
- Intensive care clinical nurse specialists
Clinical nurse educators sometimes work in hospitals but are more often found in an academic setting where they develop training programs for the next generation of nurses.
Many nurses focus purely on clinical skills as they progress through their careers. If you’re looking to move out of patient-facing roles and use your experience as a nurse to guide policy, improve procedures and take on a more leadership-focused role, you’ll need to refine your managerial skills. This means learning about budgets, scheduling, personnel issues, law, and policy.
Consider studying these topics part-time while practicing as a nurse, to keep your options open for progressing into higher-paid management, leadership, or administrative positions later in your career.
Benefits offered to clinical nurse specialists
If there’s a specialization you’re particularly interested in but the salaries offered at your local hospital aren’t as high as you would like, consider looking at similar positions in private clinics or at a hospital in a different network. Budgets vary significantly between hospitals, so you could access a pay rise simply by switching employers.
Before you do this, however, consider the benefits your existing employer offers. For example, if you’re interested in pursuing a DNP, find out if your employer will sponsor your studies. It could be that staying where you are for a few years while upgrading your qualifications will save you tens of thousands of dollars versus having to self-fund your education.
Look at other benefits too, such as health insurance, vision, and dental plans, paid time off, profit-sharing, or overtime. Policies can vary between employers and the total cash value of benefits packages offered at some bigger hospitals can be significant.
Consider which benefits you make the most use of and how you feel about the working conditions at the hospital or clinic you work for. Are you happy with the hours you’re expected to work, the amount of time you spend on-call, and the overtime policies?
Many nurses look to move into administrative or leadership roles when they’re older and more experienced because they find 12-hour patient care shifts incompatible with family life. These shifts can be exhausting, too, and it’s common for young nurses to burn out. Before you swap to a clinical nurse leader or specialist role, make sure you understand the job description and the workload you’re likely to face.
In most cases, clinical nurse specialists enjoy more acceptable hours, higher pay, and a steadier workload, making the profession an appealing one for an experienced nurse who is looking to take a step back from hands-on care.
What’s the difference between a clinical nurse leader and a clinical nurse specialist?
Clinical nurse specialists and clinical nurse leaders have similar roles, but there are some differences in their day-to-day workflows. A clinical nurse leader is an experienced nurse who takes on a leadership role but is very much a generalist.
Clinical nurse leaders are responsible for ensuring evidence-based practice is used during the day-to-day operation of a ward or clinic. These nurses work as part of an interdisciplinary team and plan patient care, work as advocates for individual patients and manage care at a broader population-level too. They focus on issues such as:
- Evidence-based practice
- Patient wellbeing
- Risk reduction
- Budget management
- Promoting excellence in healthcare
- Healthcare at the microsystem level
The above may sound a lot like the role of a clinical nurse specialist, but there are some key differences. A clinical nurse specialist is an APRN who focuses on healthcare macrosystems. They look at three key spheres of influence: the patient, nursing, and the healthcare system.
Clinical nurse specialists do serve as leaders within their nursing community, and like clinical nurse leaders, they focus on evidence-based practice, but at the advanced practice level. The CNL supervises direct patient care, but the CNS is considered an expert in their chosen specialization. The scope of practice of a clinical nurse specialist varies from state to state, but in some states, these nurses have independent practice authority.
What is the range of salaries for clinical nurse specialists?
The average salary range for a clinical nurse specialist can vary significantly but on a national level, the earners in the lowest 10% have salaries of $68,000 per year, while the highest earners have average salaries of $120,000.
Those who live and work in cities with a higher cost of living or where there are many vacancies for clinical nurse specialists can expect to earn more than $120,000 if they are very experienced, choose an in-demand specialization, and have a doctoral degree.
Clinical nurse specialists are not the highest-paid nursing professionals, that title currently goes to certified registered nurse anesthetists. However, they can expect salaries higher than that of a registered nurse, and more than double that of the national average salary across all professions.
Where can you learn more about careers as a clinical nurse specialist?
There are several organizations offering advice, information, or certifications for people interested in a career as a clinical nurse specialist, including:
American Nurses Credentialing Center
The ANCC issues a wide variety of certifications for nurses, including specialty certifications for early-career registered nurses, nurse practitioners, and clinical nurse specialists. These certifications are widely recognized and are essential for anyone who wishes to advance their career in the nursing profession.
To earn these certifications, a nurse must have a significant amount of clinical practice time, a valid RN license, and the correct level of academic qualifications. There’s a nominal fee for each certification, and nurses must re-validate their certification after a given time period. For most qualifications, this is five years.
American Nurses Association
The ANA is a professional organization representing registered nurses and other nursing professionals. ANA members can attend meetings and conferences, receive mentorship and career assistance from more senior nurses, and also receive discounts on study materials and ANCC certifications. ANA membership is worthwhile for registered nurses who are looking to pursue a career as a clinical nurse specialist or to move into any other advanced field of nursing.
National Association of Clinical Nurse Specialists
The NACNS is a membership organization aimed specifically at clinical nurse specialists. It has a large membership and provides advice, education, and information for all members of the profession. The association provides regular reports on the latest developments in treatment protocols and initiatives. It also provides continuing education materials to help clinical nurse specialists maintain their certifications. Younger nurses can access career advice and support from the association.
Journal of Clinical Nursing
This journal is an international, peer-reviewed publication that is published on a monthly basis. It features papers about a variety of topics applicable to clinical nurse specialists, including evidence-based practice, clinical decision making, and nursing research. It covers a variety of sectors within the field of health care and is essential reading for anyone who works in clinical nursing or who would like to qualify in the field.
