The clinical nurse specialist role was first created in 1954 to address specific needs in acute and mental health care settings. Clinical nurse specialists are educated and trained to integrate care across the continuum and across three “spheres of influence”: patient, nurse, system. While these APRNs also provide direct care, their role is most often focused on providing support within healthcare systems, which is why these pros are often referred to as the “nurse’s nurse.” Usually practicing in a less autonomous role, CNSs educate and support an interdisciplinary staff using evidence-based research to ensure the best care for specific complex and vulnerable populations. In many cases, independent practice among CNSs is not as clearly defined as it is for their NP peers. As of 2020, CNSs enjoy independent practice authority in 28 states. Of these states, 19 allow CNSs to prescribe independently. The remaining states either require CNSs to maintain a collaborative physician agreement to practice and/or prescribe drugs and other interventions, or otherwise do not recognize the CNS role for APRN licensing purposes. Clinical nurse specialists can specialize by population, a setting, or a disease (e.g., oncology, cardiac, psychiatric, critical care, neonatal, obstetric/gynecological, pediatric care, etc.). The vast majority of CNSs (76%) specialized in adult health/gerontology, as of 2019, according to the National Association of Clinical Nurse Specialists. They are experts in the design of nursing assessments, diagnoses, interventions, and innovations to achieve specific health goals. They work with other nurses and the members of the interdisciplinary healthcare team to improve outcomes and effect system-wide changes to improve programs of care. They are practice specialists, expert consultants, and leaders and collaborators of the interprofessional team, and they promote improvements in healthcare delivery and healthcare team competencies. National certification options include: American Association of Critical-Care Nurses (AACN)

• Clinical Nurse Specialist: Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
• Clinical Nurse Specialist: Wellness through Acute Care (Pediatric) (ACCNS-P)
• Clinical Nurse Specialist: Wellness through Acute Care (Neonatal) (ACCNS-N)

American Nurses Credentialing Center (ANCC)

• Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
• Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
• Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
• Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
• Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
• Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
• Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
• Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC)

Salary Differences Between Nurse Practitioners and Clinical Nurse Specialists

According to recent salary statistics, both nurse practitioners and clinical nurse specialists enjoyed salaries in the six figures, in most cases. According to a 2019 Medscape APRN Compensation Report, nurse practitioners earned an average gross income of $108,000, while clinical nurse specialists earned an average gross income of $102,000 during the same period. The report also found that the average salary for NPs during this time was $109,000, while for CNSs, it was $106,000. The average salary for CNSs with a doctorate degree was $104,000, compared with $102,000 for those with a master’s degree. NPs with a doctorate also earned more than their master’s-prepared counterparts: $114,000 vs. $107,000.