Clinical nurses, also known as clinical nurse specialists, are advanced practice nurses who have completed postsecondary education at the graduate or doctoral level and earned specialty certifications pertinent to their area of practice. They provide a high level of care to patients, as well as a high level of insight and guidance to other nurses and nursing staff. The origin of this career is based in the 1952 book “Interpersonal Relations in Nursing” by Hildegard Peplau, a pioneer of nursing whose views on the nurse-client relationship helped to define the clinical nurse as we know it.

Clinical nurses work in a wide range of settings, from specialty physician’s offices to hospitals to nursing homes and geriatric facilities. The scope of work they perform is equally diverse, ranging from women’s health to geriatrics to pediatrics.

What is a Clinical Nurse?

Clinical nurses have full scope of practice, meaning they have the authority to practice without physician supervision and to prescribe medication and medical equipment in many states in the U.S.

The role of a clinical nurse is similar to that of a nurse practitioner, with a few subtle differences. Both types of nurses are licensed to provide a level of direct patient care similar to that of a physician. However, nurse practitioners typically focus on primary care in either family medicine, pediatrics, or geriatrics. Clinical nurses, meanwhile, typically provide care for specific types of illnesses (cancer, diabetes), medical condition (pain, burns or wound care) or segments of the population (women’s health, geriatrics). Clearly there’s some overlap, but clinical nurses often can be found working in emergency rooms and hospital critical care departments, whereas nurse practitioners primarily work in community care clinics, long-term care facilities and physician’s offices.

Clinical Nurse Skills

Skill Name Importance Competence
Active Learning 4 4
Coordination 4 3.75
Critical Thinking 4 4.12
Service Orientation 4 4
Social Perceptiveness 4 4
Source: O*NET® 22.1 Database, O*NET OnLine, National Center for O*NET Development, Employment & Training Administration, U.S. Department of Labor, onetonline.org

Step One: Earn Your Education

Regardless of the clinical nursing specialty being pursued, the path to becoming some form of clinical nurse specialist involves completing graduate-level education.

Clinical nurses should first earn licensure as registered nurses by completing RN-level nursing education (this could mean a bachelor’s degree in nursing, an RN to BSN degree, an LVN to BSN program, etc.) and passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). After this, clinical nurse candidates usually earn a few years of experience working in a specialty field of nursing, and then advance their education to the necessary level by completing a master’s degree or Doctor of Nursing Practice in their chosen specialty.

Degree programs for clinical nursing vary by specialty. For instance, the M.S. in nursing program at Western Connecticut State University is designed for students who want to work as adult gerontology clinical nurse specialists. Curriculum includes coursework in topics such as advanced health assessment and advanced management of acutely ill gerontology patients. On the other hand, the Clinical Nurse Leader program at University of Pittsburgh is geared towards graduates in a variety of healthcare settings. The coursework for this program includes study in pathophysiology, applied statistics, healthcare quality and advanced pharmacology, as well as clinical experience.

Many graduate nursing programs allow students to complete much of the coursework online; however, most of these programs are offered in a hybrid format, since they include a certain number of clinical hours at an approved site.

Step Two: Earn Your Certification

Clinical nurses can earn a wide range of certifications that are directly tied to their area of specialty. Clinical nursing certifications range from public and community health to child and adolescent mental health. Here are a few highlighted credentials that clinical nurses can pursue:

  • American Association of Critical Care Nurses Neonatal (ACCNS-N): For clinical nurses who provide neonatal patient care from wellness through acute care. Applicants must have earned an unencumbered nursing license and completed a graduate-level neonatal clinical nursing program at an accredited college or university. Must be renewed every five years, and clinical nurses must log at least 1,000 hours of practice during the renewal period.
  • Clinical Nurse Specialist Certification (CNS): Offered by many state boards of nursing. Candidates must hold an unencumbered nursing license and complete a master’s degree with a clinical field of nursing. They also must have completed clinical nursing experience in five core areas: practice, education, research, consultation and leadership.
  • Advanced Oncology Certified Clinical Nurse Specialist (AOCNS): This certification by the Oncology Nursing Certification Corporation is valid for four years. Candidates must hold a current, unrestricted registered nursing license and complete one of three renewal options. All three options include a mix of practice hours and professional development.

Step Three: Continuing Education

Continuing education is a crucial component for all nursing professions, and this is especially true for advanced practice nurses such as clinical nurses. Continuing education requirements vary depending upon the organization that awarded the specialty certification, such as Clinical Nurse Specialist or Advanced Oncology Certified Clinical Nurse Specialist. Organizations such as the National Association of Clinical Nurse Specialists also offer many different forms of continuing education and professional development resources. Clinical nurses should inquire with their state boards of nursing to learn specific details about continuing education requirements to maintain licensure in their home state.

Sources
  1. Clinical Nurse Specialist Salary, Career and Jobs Outlook, Nurse Journal, https://nursejournal.org/clinical-nursing/clinical-nurse-specialist/
  2. Clinical Nurse Specialist Certification, State of California Department of Consumer Affairs, http://www.rn.ca.gov/pdfs/applicants/cns-app.pdf
  3. ACCNS-N (Neonatal), American Association of Critical Care Nurses, https://www.aacn.org/certification/get-certified/accns-neo
  4. Master of Science in Nursing, Western Connecticut State University, http://www.wcsu.edu/catalogs/graduate/sps/programs/master-of-science-in-nursing/
  5. Clinical Nurse Leader, University of Pittsburgh, http://www.nursing.pitt.edu/clinical-nurse-leader-cnl-curriculum
  6. “Who Are Clinical Nurse Specialists? They’re Change Leaders!” NACNS.org, Accessed June 2018, http://nacns.org/2017/09/who-are-clinical-nurse-specialists-theyre-change-leaders/

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