The road to becoming a clinical nurse specialist (CNS) begins with earning a master’s or higher graduate degree through a program designed specifically to prepare RNs for advanced clinical practice in the CNS role. Schools that offer Master of Science in Nursing (MSN) or post-graduate certificate programs with a clinical nurse specialist track prepare students to:
- Serve as advanced clinicians that lead and collaborate as part of an interdisciplinary healthcare team
- Assist and counsel patients and their families through the healthcare delivery process
- Serve as educators, evidence-based researchers, change agents, and case managers
Graduates of CNS degree programs would go on to earn national certification in the CNS role and their patient population focus of choice, which would align with the focus of their degree program. Once certified, CNSs would be eligible to become licensed as advanced practice registered nurses (APRNs) through their state board of nursing before beginning work as independent practitioners or as part of a healthcare delivery team in hospitals, hospices, home healthcare, rehabilitation facilities, and outpatient settings, among others.
The Clinical Nurse Specialist Master of Science in Nursing (MSN)
The Validation Panel of the National Association of Clinical Nurse Specialists published the Criteria for the Evaluation of Clinical Nurse Specialist Master’s, Practice Doctorate, and Post-Graduate Certificate Educational Programs in 2011. The widely recognized and nationally endorsed criteria builds upon the NACNS 2004 Statement on Clinical Nurse Specialist Practice and Education designed to guide in the development, implementation, and evaluation of clinical nurse specialist graduate programs in the U.S.
The recommendations for CNS curricula and clinical requirements in the Criteria are in line with existing national standards for advanced practice registered nurses (APRNs), including the Consensus Model for APRN Regulation, the Essentials for Master’s Education in Nursing, and the National CNS Competency Task Force Organizing Framework and CNS Core Competencies, among others.
They also align with the requirements for national certification as established by the two bodies that certify clinical nurse specialists in the various patient population foci: American Association of Critical-Care Nurses (AACN) Certification Corporation and the American Nurses Credentialing Center.
The Criteria includes the following recommendations for CNS master’s degree programs related to accreditation, undergraduate preparation, program outcomes, curriculum and clinical sequences:
Criteria: The CNS program operates within or is affiliated with an institution of higher education. A nursing accrediting body that is recognized by the U.S. Department of Education must accredit the program.
MSN degree programs for clinical nurse specialists receive accreditation through the Commission on Collegiate Nursing Education (CCNE).
Post- graduate certificate and doctorate programs for clinical nurse specialists receive accreditation through the Accreditation Commission for Education in Nursing (ACEN).
BSN as the Foundation
Criteria: The CNS program builds on baccalaureate-level nursing competencies and culminates in a master’s degree, post-graduate certificate or doctorate.
Because clinical nurse specialists are APRNs, their education must be at the graduate level and must build upon baccalaureate nursing competencies. Therefore, taking graduate level clinical nurse specialist coursework requires a Bachelor of Science in Nursing (BSN), along with a current and unencumbered RN license.
A large number of institutions also offer MSN-Clinical Nurse Specialist programs that accommodate students with different educational backgrounds, but nonetheless include BSN coursework to establish the necessary competencies before introducing graduate level courses:
- RN-to-MSN Programs for RNs with an Associate Degree in Nursing: RN-to-MSN programs (also often referred to as MSN bridge programs), allow RNs that possess associate’s degrees in nursing to develop bachelor’s-level competencies and theoretical knowledge before moving on to graduate level coursework so as to earn both a BSN and MSN in one accelerated program. While traditional MSN programs take about two years to complete, these programs take about three years to complete.
- Direct-Entry MSN Programs for Bachelor’s Educated Professionals from a Non-Nursing Background: Direct-entry MSN programs appeal to students that possess a bachelor’s degree in a major other than nursing. Designed to appeal to career changers, direct-entry MSN degrees (also often called entry-level MSN degrees) allow students to first earn their RN and then complete all of the required components of the BSN and MSN.
Part-time and online formats have also become conventional options for students interested in a flexible learning schedule and 24/7 access from anywhere in the world. Online programs—which may be partially online (often called hybrid programs) or fully online—allow students to complete some or all of the program’s didactic requirements through web-based study and then satisfy the clinical requirements at partner sites close to home. In many cases, nursing graduate students are able to complete clinical sequences at their current place of employment.
CNS Graduate Program Outcomes
Criteria: The purpose of the CNS program is clear, and the program outcomes are clearly aligned with the mission of the parent institution and the mission/goals of the nursing unit.
The purpose of the CNS program must clearly define the patient population focus and any additional specialty preparations. The program outcomes/competencies should reflect preparation at the graduate level.
Students would select an MSN-Clinical Nurse Specialist program based on the type of patients they would like to specialize in working with, choosing a program with a concentration in at least one of these patient population foci:
- Family/Individual Across the Lifespan
- Adult-Gerontology (Acute care/primary care)
- Women’s health/gender-related
- Pediatrics (Acute care/primary care)
- Psychiatric/mental health
In addition to a chosen population focus, students may also choose to further specialize their CNS education by choosing a subspecialty focus, such as:
- Type of care (psychiatric, end-of-life, rehabilitative, etc.)
- Type of problem (wound care, pain management, etc.)
- Disease/medical subspecialty (oncology, diabetes, etc.)
- Setting (critical care, operating room, emergency department, etc.)
CNS Graduate Program Curriculum
Criteria: CNS curriculum is congruent with state requirements, national standards for graduate APRN programs, and nationally recognized master’s level or DNP CNS competencies.
MSN-Clinical Nurse Specialist programs must incorporate the appropriate theory and clinical courses to ensure graduates:
- Meet both state and national requirements
- Are successful on a national certification examination in the appropriate population-focus
- Are prepared to practice in the CNS role
The Criteria recognizes that CNS master’s degree curriculum should reflect the CNS Spheres of Influence (as defined in the National Association of Clinical Nurse Specialists’ (NACNS) Statement on Clinical Nurse Specialist Practice and Education), which include:
- Patient Sphere: Goal is to provide expert care to patients within the designated patient population focus
- Nurses and Nursing Practice Sphere: Goal is to identify areas of improvement and positively influence other nurses while furthering the advancement of evidence-based care
- Organizations/Systems Sphere: Goal is to identify the need for process and policy changes so as to influence and lead system improvements
An MSN-Clinical Nurse Specialist program must also include a Direct Care APRN Core and an Essential Graduate Core:
The Direct Care APRN Core would always include the following, three courses:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced health assessment, including the assessment of all human systems, concepts and approaches, and advanced assessment techniques
- Advanced pharmacology, including:
- Pharmacotherapeutics of all broad categories of agents
The Essential Graduate Core should focus on the following areas:
- Health promotion and disease prevention
- Healthcare financing
- Healthcare policy
- Human diversity and social issues
- Organization of the healthcare delivery system
- Policy, organization, and financing of healthcare
- Professional role development
- Theoretical foundations of nursing practice
Further, the NACNS National CNS Competency Task Force recommends that CNS programs prepare students in the following CNS Core Competencies:
- Direct Care
- Systems Leadership
- Ethical Decision-Making, Moral Agency, and Advocacy
Clinical Sequences in CNS Graduate Programs
Criteria: The CNS program must include a minimum of 500 supervised clinical (clock) hours for master’s and post-graduate preparation.
Students of MSN-Clinical Nurse Specialist degree programs must have the opportunity to practice in settings related to their chosen patient population focus and specialty area. Clinical clock hours refer to the hours in which the student implements the CNS role in one or more of the Three Spheres of Influence.
Further, students in CNS programs that prepare them in a specialty area of practice (in addition to their patient population focus) must document how the program’s clinical experiences address both. The Criteria recognizes that CNS programs that prepare students in a specialty area in addition to a patient population focus will have a greater number of required clinical hours.
Depending on their chosen focus, students of CNS master’s degree programs would fulfill the clinical sequences at sites that would include the following:
- Ambulatory care centers
- Outpatient clinics
- Rehabilitation centers
- Long-term care facilities
- Home health agencies
- Public health agencies
Students of online programs would work with their program director to be placed in local partner sites that accommodate clinical preceptorships so there is rarely a need to relocate or travel great distances to complete their clinical obligations. In many cases, students of online programs are able to complete most or all of their clinical sequences at their current place of employment.