Become a Clinical Nurse Specialist (CNS) – Education, Licensure & Salary

“I would advise any nurse considering advanced practice to explore all of the specialty options in advanced practice, and should they decide on the clinical nurse specialist, they choose a program with the most opportunity for clinical mentoring. The CNS is a wonderful role in nursing, where one must be committed to life-long learning and improving healthcare for individuals and for the nation.”

Catherine Paradiso, DNP, Assistant Professor, College of Staten Island CUNY School of Health Science

A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) who cares for patients with complex medical needs. Their work includes everything from wellness to treating patients when they’re sick. They offer various services, including diagnosing and treating acute or chronic illnesses. Their care often emphasizes specialized care for a particular population or at-risk group. 

In addition to their clinical skills, CNSs are adept at handling the administrative duties associated with managing a patient’s care. As a result, they are uniquely qualified to coordinate all aspects of a patient’s care, from diagnosis to treatment. This makes CNSs an essential part of a healthcare team, and their contributions are vital to ensuring that patients receive the best possible care.

All CNSs are first registered nurses (RNs) who then complete graduate-level coursework in clinical nursing practice. They hold a clinical nurse specialist degree, such as a master’s of science in nursing (MSN), doctor of nursing practice (DNP), or a post-master’s certificate. These programs include both didactic coursework and clinical experiences to prepare nurses for this advanced level of patient care. 

After completing a graduate degree as a clinical nurse specialist, CNSs must sit for a national certification exam and obtain a license to practice from their state’s nursing board. Certification and licensure assure that a CNS is highly competent in this field and has the skills necessary to care for patients independently. 

While CNS and nurse practitioners (NPs) are both APRNs, these two roles have several important differences. CNSs typically focus on one particular area of nursing practice, while NPs are trained to provide a wide range of primary care and specialty services. In addition, CNSs may play an important role in coordinating patient care management, while NPs are focused primarily on direct patient care. 

The guide below covers in-depth how to become a CNS, including a state-by-state guide on licensing requirements. 

Ask an Expert: Catherine Paradiso, DNP, MS

Dr. Catherine Paradiso is an assistant professor at the College of Staten Island City University of New York School of Health Science. She is also an adult nurse practitioner and psychiatric nurse practitioner with a history of diverse experience in advanced practice and senior leadership roles within the nursing community. She is a member of several professional associations, such as the American Association of Nurse Practitioners and the New York State Nurse Practitioner Association. Dr. Paradiso is also an inductee of the Sigma Theta Tau International Honor Society. Her commitment to nursing excellence and community service has earned her many awards and recognitions. 

Her scholarly contributions, particularly in transgender health, underscore Dr. Paradiso’s passion for emerging health needs and underrepresented populations. Her research has been widely recognized and presented at various regional conferences. Her education, which includes a DNP from the University of Buffalo and multiple degrees from institutions such as Stonybrook University and Rutgers University, complements her extensive publication record. What is something you wish the public understood about clinical nurse specialists?

Dr. Paradiso: A clinical nurse specialist (CNS) is a registered nurse who has earned a master’s, doctoral, or postgraduate degree in their specialty.

With this advanced training, the CNS expands the role of nurses in hospitals, home care, long-term care, and community settings. The CNS (depending on the state where they work) can prescribe medication, equipment, and more. They use the most recent research to improve the outcomes for patients by directly caring for them or by leading groups of healthcare providers. What advice would you give to aspiring clinical nurse specialist students?

Dr. Paradiso: I would advise any nurse considering advanced practice to explore all of the specialty options in advanced practice, and should they decide on the clinical nurse specialist, they choose a program with the most opportunity for clinical mentoring. 

The CNS is a wonderful role in nursing, where one must be committed to life-long learning and improving healthcare for individuals and for the nation. For more information, visit the National Association for Clinical Nurse Specialists.

How to Become a Clinical Nurse Specialist (CNS)

Step 1: Complete High School Or Equivalent (Four Years)

Earning a GED or high school diploma is an important step in becoming a nurse as most nursing programs require applicants to one or the other. A GED or high school diploma can help provide the foundation for essential tools nurses need, such as strong communication and critical thinking skills. Aspiring CNSs should focus on math, science, and psychology classes to help prepare them for additional studies. 

Step 2: Attend A Nursing Program At An Accredited School (Two to Four Years)

The next step to becoming a clinical nurse specialist is to complete an associate of science in nursing (ASN) or a bachelor of science in nursing (BSN). An ASN or BSN provides students with a strong foundation in the basic nursing principles essential for delivering high-quality patient care. In addition to classroom courses, students will have the opportunity to gain valuable hands-on experience in various healthcare settings that will help them develop essential clinical skills. 

Step 3: Pass the National Council Licensure Examination Practical Nurse Exam (NCLEX-RN) (Timeline Varies) 

To ensure that nurses are adequately prepared to meet the challenges of their profession, once they graduate from a nursing degree program, they must pass the NCLEX-RN exam. The NCLEX-RN is a comprehensive examination that covers all aspects of nursing care and is designed to assess a nurse’s knowledge and skills and to identify any areas where additional training may be needed. 

By passing the NCLEX-RN, nurses can demonstrate that they have the necessary tools to provide safe and effective care. 

Step 4: Apply for State Licensure as a Registered Nurse (Timeline Varies) 

Before becoming a CNS, one must first become a registered nurse (RN). After graduating from a nursing program and passing the NCLEX-RN exam, candidates can apply to their state’s nursing board for an RN license. 

Step 5: Obtain Entry-Level Work Experience (Timeline Varies)

Because advanced practice nursing requires a master’s degree, entry-level work experience as an RN is essential for aspiring clinical nurse specialists. In addition to providing a strong foundation in basic nursing care, working as an RN allows future CNSs to develop important skills such as patient assessment, critical thinking, and problem-solving. RNs also gain valuable experience working with other healthcare team members, which can be helpful when transitioning into a leadership role. 

Step 6: Complete a Graduate Nursing Degree (18 Months to Four Years)

To work as a clinical nurse specialist (CNS), you must have a master of science in nursing, a doctor of nursing practice, or a post-master’s certificate. These programs prepare nurses for the advanced level of practice required to provide high-quality patient care. Depending on the level of education pursued and previous degrees earned, these programs take between 18 months and four years to complete. 

Step 7: Obtain National Certification (Timeline Varies) 

Most states require that a CNS obtain national certification to be licensed. The American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN) are the two primary associations that provide certification for CNSs. More details on certification can be found below.

Step 8: Meet The Requirements For State Licensing (Timeline Varies) 

To provide care to patients, a CNS must hold a license to practice in their state. Requirements for licensure, as well as the title used, will vary by state. See the state-by-state guide below to learn more about state licensing requirements.

What Does a Clinical Nurse Specialist Do?

CNSs typically work in hospitals, but they may also work in clinics, private practices, or public health agencies. They collaborate with other healthcare team members to ensure patients receive the best care possible. CNSs work in specific areas of nursing, such as pediatrics, geriatrics, or oncology. In addition to providing direct patient care, CNSs play an important role in patient education and supporting nurses new to the field. Day-to-day duties for CNSs include:

  • Evaluating patients and developing treatment plans
  • Ordering and interpreting diagnostic tests
  • Prescribing medications and treatments
  • Educating patients and families about their conditions and treatments 
  • Collaborating with other healthcare professionals to provide optimal care for patients
  • Supervising and coordinating care with nurses and other healthcare professionals
  • Managing healthcare organizations and programs
  • Advocating for patients and healthcare policy reform
  • Researching the latest treatments and technologies to improve patient care
  • Managing staff, budgets, and resources

How Much Do Clinical Nurse Specialists Make?

While the Bureau of Labor Statistics doesn’t track salaries for clinical nurse specialists, it does track nurse practitioners. According to the BLS (May 2023), nurse practitioners earn $128,490 annually on average. (2024), a wage aggregate website, tracks earnings for clinical nurse specialists, and the percentiles for wages were:

  • 10th percentile: $73,000
  • 50th percentile (median): $99,277
  • 90th percentile: $128,000

Clinical Nurse Specialist Certifications

In most states, certification by a national agency as a clinical nurse specialist is required for licensure. The primary certification agencies are the American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN). 

The eligibility requirements for the Adult-Gerontology Clinical Nurse Specialist (AGCNS-BC) certification from the ANCC are:

  • A current and active RN license in the US 
  • A master’s, post-graduate certificate, or doctor of nursing practice degree from an adult-gerontology clinical nurse specialist (AGCNS) program accredited by the Commission on Collegiate Nursing Education (CCNE),  the Accreditation Commission for Education in Nursing (ACEN), or the Commission for Nursing Education Accreditation (CNEA)
  • The degree or post-master’s certificate must include a minimum of 500 faculty-supervised clinical hours 
  • Complete three separate courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology
  • Proof of coursework with content in health promotion and/or maintenance and differential diagnosis and disease management

The AACN offers certifications as ACCNS-Neonatal, ACCNS-Pediatric, or ACCNS-Adult-Gerontology. The requirements are:

  • Have a current, unencumbered RN or APRN license
  • Complete a graduate-level advanced practice education program in adult-gerontology, neonatal, or pediatrics that meets curriculum and clinical practice requirements

Clinical Nurse Specialist (CNS) Licensure Requirements By State

State Licensing Authority Eligibility & Details Renewal Requirements

Virginia Board of Nursing

In Virginia, CNS practice as a category of a certified nurse practitioner (CNP) license. To be eligible for a CNP license in Virginia, the following is required:

  • Evidence of a current Virginia RN license or RN license with multi-state privilege
  • Complete online application and fee of $125 through the online license portal
  • Verification of professional certification for the specialty area of educational preparation issued by the American Nurses Credentialing Center, Pediatric Nursing Certification Board, National Certification Corporation, American Academy of Nurse Practitioners, or American Association of Critical-Care Nurses Certification Corporation
  • Submit an official transcript from a graduate degree program in nursing designed to advanced practice registered nurses, sent directly from the education institution

License renewals for CNPs in Virginia are required biennially.

The renewal fee is $80 and CNPs must either have a current national certification or complete 40 hours of continuing education.

Kimmy Gustafson

Kimmy Gustafson


Thanks to her experience writing in healthcare, Kimmy Gustafson has delivered in-depth articles on timely topics for since 2022. Her aim is to assist both students and professionals in navigating the intricate process of selecting a nursing program and understanding the ever-evolving realm of nursing education.

Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.