According to the National Association of Clinical Nurse Specialists (NACNS), clinical nurse specialists use theory and research to administer and improve nursing care and promote wellness. They possess degrees at the master’s or doctoral level in nursing and are advanced practice registered nurses (APRN) with training in a particular specialization as well as physiology, pharmacology, and physical assessment. These specialized nurses serve in a variety of healthcare settings in roles such as researchers, clinicians, consultants, and educators.
The clinical nurse specialist (CNS) can work in the diagnosis and treatment of disease as well as patient management, and uses research-based care and best practices in the field to support nurses, administer care and promote positive changes in healthcare organizations. Focused on positive patient outcomes, such as reduced duration of hospital stays, cost, medical complications, and frequency of emergency room visits, as well as improved pain management practices and patient satisfaction, the CNS may take a leading role in the coordination of patient care.
The primary goal of a CNS is to identify gaps in the delivery of healthcare services. They do so by designing and implementing change and assessing and evaluating interventions. Clinical nurse specializations are delineated by particular populations, such as pediatrics, neonatal or gerontology; settings, such as the emergency room; diseases, such as oncology; or a type of care, such as rehabilitation and pain management. Areas of subspecialty include nurse education, clinical lipidology, primary, acute, cardiology, and palliative care, among others.
There are several steps to becoming a clinical nurse specialist:
- The first step is to obtain an associate degree in nursing (ADN) or bachelor’s of science in nursing (BSN) degree and then take and pass the National Council Licensing Examination (NCLEX) from the National Council of State Boards of Nursing.
- A licensed registered nurse (RN) with a qualifying degree may apply to a graduate nursing program with a CNS track. Note that some but not all CNS programs will accept an RN without a BSN degree, so it’s important to understand entrance requirements for each CNS program of interest prior to applying.
- After completing a graduate program with a clinical nurse specialist track — either a master of science in nursing (MSN) or doctor of nursing practice (DNP), or (for MSN holders) a post-master’s CNS certificate — a CNS candidate may pursue national and state certifications. The national credentialing entity will depend on a CNS’s chosen population focus; the American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN) both certify CNSs. States differ in their credentialing procedures and candidates should contact their local board of nursing for more information. After completing both of these credentialing processes, individuals earn the title of clinical nurse specialist, or CNS for short.
Types of Accredited Online CNS Programs
Registered nurses (RNs) with varying levels of nursing education may obtain a master’s or doctoral degree as clinical nurse specialists. A description of the different pathways follows:
- Online BSN-to-MSN CNS programs are available to RNs who already have a bachelor’s degree in nursing. These programs typically take about two years to complete and require 30-40 credit hours.
- Online bachelor’s-to-MSN CNS programs are designed for RNs with a non-nursing bachelor’s degree. These programs often follow the same degree requirements as the BSN-to-MSN programs with additional specialty courses in nursing.
- Online RN-to-BSN or RN-to-MSN CNS programs are available to registered RNs as well as RNs with a diploma or associate’s degree. These programs often have the same degree requirements as the bachelor’s-to-MSN and BSN-to-MSN programs, with the addition of significant prerequisite general education courses (up to 60 hours).
- Online post-MSN CNS certificate programs provide registered nurses with a graduate degree in nursing advanced preparation in a specialty or subspecialty of nursing practice. Programs are designed under national certification requirements and typically take 18 to 24 months to complete.
- Online BSN- or MSN-to-DNP CNS programs are available to registered nurses with a bachelor’s or master’s degree in nursing. BSN-to-DNP programs in CNS specialty areas require completion of 70 to 90 credits, while MSN-to-DNP in CNS programs are about 30 to 40 credit hours in length. Program completion may take from two to three-and-a-half years.
- Online MSN-to-DNP second certification programs (for MSN holders with a CNS certification) are possible for nurses with a CNS master’s degree who wish to certify in a new specialty area while pursuing their DNP. Two years of CNS nursing experience may be required for entry. These programs entail 70-90 hours of credits.
Admissions Criteria for CNS Programs
Most clinical nurse specialist programs require a BSN or higher from an accredited school; a minimum GPA of 3.0; a valid, unrestricted RN license; and specialized experience in professional nursing, depending upon the applicant’s area of interest. Candidates may also be asked to submit application essays, a current CV or resume, transcripts, and professional letters of reference. Some programs require completion of an undergraduate course in statistics or other prerequisites.
CNS Program Accreditation
CNS Program Curriculum
Credit-hours in CNS programs entail a combination of didactic coursework and clinical practice. Coursework is divided between core classes and specialty classes. Core courses may include:
- Advanced pathophysiology across the lifespan: Founded upon the principles of human physiology and pathophysiology, this course explores disease processes from the vantage point of physiological manifestation and clinical presentation.
- Clinical pharmacology for the advanced practice nurse: Nursing students will learn about pharmacological agents and herbal therapies used to treat patients of all ages and how to effectively manage all aspects of patient pharmacological therapy.
- Advanced physical assessment across the lifespan: This course guides students in developing their skills conducting individual health assessments of patients from infancy into the golden years.
- Nursing theory: In this course, students evaluate the factors that influence nursing theory. They learn about the terminology and criteria for evaluation of theories as well as links between research, theory, and practice.
Depending on the specialization a student chooses, CNS concentration courses may include:
- Pediatric health maintenance: Students learn about decision-making in the management of the health and developmental needs of children, the principles of primary care, and the role and responsibility of caring for children and their families.
- Adult-gerontology primary care: This class explores all aspects of caring for senior patients. Students learn to examine healthcare problems, identify patient needs and appropriate interventions, and understand biological and behavioral parameters.
- Advanced nursing assessment and intervention: Nursing students explore the management of clients with acute and chronic illness. The multifaceted roles of clinical nurse specialists (manager, clinician, researcher, educator, collaborator, and consultant) are examined.
All advanced CNS degrees require hands-on practical experience in the form of clinical hours in one’s chosen specialty area. Some DNP programs may also include an evidence-based scholarly project in conjunction with a DNP residency. Upon completion of an accredited program, graduates with a current and active RN license are prepared to take the CNS national certification exams.
Clinical Hour Requirements for CNS Programs
Clinical hours are a substantial part of the learning experience in advanced degree programs in CNS. For both master’s and doctoral programs, a minimum of 500 supervised clinical hours in the candidate’s area of specialization is required. Depending on the program and the state in which a participant lives, clinical hours may be completed under the supervision of an approved mentor in one’s local community. Some programs, however, require students to complete clinical hours in the state in which the degree program is administered.
Campus Visits for Online CNS Programs
An on-campus orientation is sometimes required for programs that are otherwise entirely online. As mentioned above, specialty tracks within graduate nursing programs require hands-on experience in the form of a clinical practicum (for MSN programs) or residency (for DNP programs).
Some online programs offer students the opportunity to fulfill this requirement close to home; others require campus visits with participation in classroom and evaluation sessions in conjunction with these degree components. In some instances, programs have additional required on-campus learning activities, such as labs, that can last from a few days up to a week.
A Complete List of Online CNS Programs
OnlineFNPPrograms.com analyzed all online CNS programs in the U.S. To be considered an online program, the school could not require more than ten on-campus visits throughout the program.
Please note that this data was collected between 2017 and 2018. Diligent efforts were made to report the most accurate and updated information; however, tuition and availability of programs regularly change over time. Additionally, while most of the programs listed are at the MSN level, some of these institutions also provide reasonable post-master’s certifications and DNP degrees at similar cost-per-credit.
Please contact program coordinators directly with questions not answered in this analysis and please contact us to add or correct existing information.
|School||MSN programs||DNP programs||Certificate programs|
|University of South Alabama||Adult-gerontology||Adult-gerontology CNS specialization||Adult-gerontology with clinical lipidology and palliative care subspecialties|
Indiana University – Purdue University Indianapolis
Purdue University, Calumet
University of Southern Indiana
University of North Dakota
East Carolina University
California State University at Dominguez Hills
Kent State University
Michigan State University
||Adult-gerontology||Adult-gerontology CNS specialization||No|
Saint Francis Medical Center College of Nursing
|Rush University||Adult-gerontology acute care
|Pediatric primary care||No|