CNS Census

CNS Census Provides Valuable Insights into Education Levels, Employment, Practice and More


The second nationwide survey of CNSs, conducted by NACNS found that 3 in 4 clinical nurse specialists specialize in adult health or gerontology, most CNSs work in acute care hospitals that have or are seeking ANCC’s Magnet™ Recognition, more than half have nursing clinical-related responsibility for an entire health system, but only 1 in 5 CNSs are authorized to prescribe medications.

As a group, the survey found that CNSs spend most of their time providing direct patient care (22 percent), teaching nurses and staff (20 percent), consulting with nurses, staff and others (20 percent), leading evidence-based practice projects (14 percent) and assisting other nurses and staff with direct patient care (12 percent).

Title Protection and Prescriptive Authority
But the survey results also reveal issues that need to be addressed to allow CNSs to practice to the full extent of their education and training: title protection and prescriptive authority.

  • 21 percent of CNSs who responded to this survey are authorized to prescribe medications
  • only 16 percent are authorized to prescribe durable medical equipment

Prescriptive authority is a matter of state law. A 2015 analysis of states, completed by NACNS in collaboration with the National Council of State Boards of Nursing, indicates that CNSs have independent authority to prescribe in 19 states. The CNS needs a collaborative agreement with a physician to legally prescribe in another 19 states. The total number of states where a CNS may be eligible to prescribe is 38.

Another issue highlighted by the survey findings is reimbursement. CNSs in independent ambulatory care practice, or who have hospital medical board privileges are able to bill insurance companies directly for their services, rather than through a third party, reducing insurance costs. According to the survey findings, only 6 percent of CNSs bill directly a third-party payor, like a private insurance company, Medicare or Medicaid, or an individual patient for the services they provide.

Employment and Demographics
The CNS Census shows that the vast majority of CNSs (88 percent) work full-time and 4 in 5 (80 percent) work in hospital settings. Of those, more than half (58 percent) have responsibility across the entire hospital system or system-wide. Others have a span of influence that covers one or two units.

The overwhelming majority of clinical nurse specialists are white women. But, the CNS Census was completed by more men and minorities in 2016 than in 2014. The survey also revealed that 2 in 3 CNSs are nationally certified and, in addition to a master’s degree, more than 1 in 10 CNSs also holds a doctorate.

The online survey was completed by 3,118 nurses who had completed or were enrolled in a CNS education program. It was conducted from June 1 to December 31, 2016. This is the second CNS Census, the first was conducted in 2014 and the findings released in 2015. More on the first CNS Census is available here. NACNS launched this comprehensive workplace survey to collect information that can be used to not only describe the population of CNSs but also to differentiate what CNSs do. The association conducts the survey every two years.

Download the CNS Census infographics here.

2014 CNS Census Findings