How to Become a Clinical Nurse Specialist

A clinical nurse specialist (CNS) is an advanced practice registered nurse who provides expert nursing care to patients with complex medical needs. CNSs play a vital role in the healthcare system, providing critical care and guidance to patients and their families. They also work closely with other healthcare team members, including doctors and nurses, to ensure that patients receive the best possible care. Often they serve as patient advocates, ensuring that their rights are respected and that they receive the best possible treatment. The need for skilled and knowledgeable clinical nurse specialists will only grow as the healthcare system becomes increasingly complex.

Clinical nurse specialists work in various settings, including hospitals, clinics, and private practices. While, at first glance, their duties may seem very similar to that of a nurse practitioner (NP), there are some key differences. CNSs provide direct patient care and work collaboratively with other healthcare team members. They also serve as consultants, providing expert guidance to other nurses and healthcare professionals. Many of the cases CNSs work with are complicated and require ongoing managed care. On the other hand, nurse practitioners often provide independent primary care to a specific population. The level of autonomy for NPs will vary by state.  

Becoming a CNS requires that registered nurses earn a master’s or doctoral degree in nursing or a post-master’s certificate and pass a national certification exam. Graduate studies will focus on advanced nursing practice and clinical specialty areas. Students will also complete supervised clinical experiences to gain hands-on experience in this field. 

A career as a clinical nurse specialist is rewarding and offers many opportunities for career advancement. Not only do they serve as a resource for other nurses and healthcare professionals, but they can also provide insight and expertise on a variety of topics. While clinical nurse specialists typically advance within their field, there are also opportunities to move into management or leadership positions. For example, they can become nurse managers or directors, working to oversee the operations of a healthcare facility. Alternatively, they may use their knowledge and skills to help shape healthcare policy at the state or national level. 

Keep reading to learn how to become a nurse specialist with the step-by-step guide below, as well as an overview of licensing and certification requirements.

How To Become a Clinical Nurse Specialist – Step-by-Step Guide

Step 1: Graduate from High School or Complete a GED (Four Years)

Nursing school is a demanding program that requires students to have both the intellectual capacity and the physical stamina to succeed. A high school diploma or GED is required in order to be admitted to nursing school, as it provides a baseline level of academic knowledge. In addition, nursing school curriculums are designed with the assumption that students have completed high school-level coursework in subjects like math and science. 

Step 2: Complete a Nursing Program (Two to Four Years)

The next step to becoming a CNS is to earn an associate’s or bachelor’s degree in nursing from an accredited program. These general education nursing programs provide the foundation to work as a nurse and complete additional studies. In addition to classroom courses, students will complete extensive clinical experiences to gain hands-on skills. 

Step 3: Pass NCLEX (Timelines Vary)

Once students have completed their undergraduate studies, they must take the National Council Licensure Examination (NCLEX) to become licensed registered nurses (RN). This exam tests a candidate’s knowledge of nursing care and ability to apply it to real-world situations. To pass the NCLEX-RN exam, students must demonstrate the skills and abilities necessary to provide safe and effective patient care. 

Step 4: Apply for State Licensure (Timelines Varies)

All nurses must have a registered nursing license in order to practice. Licensing ensures that nurses have met specific educational and training requirements. Requirements will vary by state. More details can be found in the certification and licensure section below. 

Step 5: Complete Clinical Nurse Specialist Education (Eighteen Months to Three years)

To work as a clinical nurse specialist, registered nurses must complete a master’s of science in nursing or a doctor of nursing practice degree. This degree prepares nurses to provide leadership and advanced care to patients. These programs vary in length but typically take between 18 months and three years. Many programs are available online so nurses can continue working while advancing their education. 

Step 6: Earn a Clinical Nurse Specialist Certification (Timelines Vary)

To practice as a clinical nurse specialist, nurses must earn a national certification. The primary certification earned is the Adult-Gerontology Clinical Nurse Specialist (AGCNS-BC) from the American Nurses Credentialing Center (ANCC). 

Step 7: Obtain a License to Practice as a CNS (Timelines Vary)

Clinical nurse specialists must be licensed by their state’s nursing board to care for patients. Requirements will vary by state. More details can be found in the licensing and certification section below.

Licensing and Certification Requirements for Clinical Nurse Specialists

Clinical nurse specialists must be licensed by their state’s board of nursing to practice. The requirements will vary from state to state but will typically include:

  • A current, active, and unencumbered registered nursing license
  • Complete a clinical nurse specialist degree 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)
  • Hold a national certification as a clinical nurse specialist
  • Pass a background check
  • Submit a completed application and pay licensing fees

Certification by a national agency as a clinical nurse specialist is required in most states in order to be licensed. The primary certifications earned by clinical nurse specialists are the Adult-Gerontology Clinical Nurse Specialist (AGCNS-BC) from the American Nurses Credentialing Center (ANCC) and the ACCNS-Neonatal, ACCNS-Pediatric, or ACCNS-Adult-Gerontology through the American Association of Critical-Care Nurses (AACN)

The eligibility requirements for this certification include:

  • 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

To be eligible for the AACN ACCNS-Neonatal, ACCNS-Pediatric, or ACCNS-Adult-Gerontology certifications candidates must:

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

Kimmy Gustafson


Among her many diverse writing endeavors, Kimmy Gustafson has also lent her expertise to since 2020, providing insightful and engaging content about the significant role of education in shaping our future generations of nurse practitioners. Many of her pieces include interviewing experts on timely topics such as healthcare workplace violence and moral distress.

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.