Category: Blog


Ask Phee Phee Anything: NACNS and the Year of Advocacy

Ask Phee PheeIn case you haven’t heard yet, my name is Phyllis Whitehead, and I am the newly elected NACNS President. Phee Phee was my nickname given to me by my young nieces who couldn’t say Phyllis and now my grandchildren call me, and hence the name of this column where you can ask questions about all things NACNS.

One question I’m getting a lot lately is “what’s all this about advocacy and CNSs”.

Q. Why advocacy?

Part of the reason we are focusing on advocacy is because of my third-grade teacher. Mrs. Flora taught the class about nouns and verbs. She called verbs “action words” because they describe some type of activity.

Advocate is both a noun and a verb. That’s exactly what we want to do over the next few years – take action and advocate for our patients, for each other, and for ourselves. I call it “unstoppable advocacy”. Here’s what we plan to do:

First, we plan to advocate for diversity in all its forms. Not just acute care but all areas . . . Primary care/ambulatory care, LTC/subacute, HH/Hospice/Palliative. NACNS is an open, diverse, and inclusive organization.

Second, we will advocate for you:

  • Expand Professional Development Leg/Reg opportunities to promote our scope of practice and competencies
  • Launch the new LMS platform
  • Simplify the path to membership
  • Bridge the gaps between academia and practice
  • Work more closely with affiliates and CNSI

Already Underway

Finally, the CNS story has only begun to be told. It is ever-changing series of successful actions that barely registers with some of our colleagues. Maybe we are talking to the wrong people. Maybe we need to be stronger when delivering our message. Maybe both. This is what advocacy is all about – reaching the right people, at the right time with the right message.

Today, “Clinical Nurse Specialist” is a noun. Let’s make it a verb. Working together we are unstoppable. That’s why we advocate.


Get to Know Your 2022 Annual Conference Keynote Speakers

What Has The Pandemic Taught You?

Mark your calendars and get your tickets now, because the NACNS annual conference is fast approaching on March 14th-17th in Baltimore, Maryland. 

This year, the theme of the conference is the Rise of the CNS. Back in person for the first time in two years, the annual conference will feature workshops, networking opportunities, an awards presentation, and three keynote speakers. 

To get to know the keynote speakers a little better, we asked them all a question about what they’ve learned through the past two years, and how that will affect nursing in the future.  See what they had to say below. For more information on the annual conference and to register, click here!

As we enter the third year of the pandemic, what is the most important thing this situation has taught you and how will what you’ve learned inform your future decisions? 

Andrew Miller

Andrew Miller, MA Denver Health’s LGBTQ Center of Excellence

 One thing I’ve learned throughout the pandemic is the importance of flexibility and teamwork. This pandemic has been a challenge on so many different fronts for all healthcare workers and finding ways to accommodate and work together has been our saving grace, especially on some of the harder days. I am in constant awe of the incredible and brave frontline workers who I get to work with daily and their dedication to providing affirming and respectful care, even when times are scary.

Andrew Miller (he/him/his) provides training, consultation, and capacity-building assistance through the Denver Health’s LGBTQ Center of Excellence. Specializing in Transgender and Gender Expansive affirming care, Andrew provides trainings spanning across medical systems, public health departments, academic settings, and community-based non-profit programming. After graduating with a Master’s in Multicultural Clinical Counseling in 2019, Andrew combined his over ten years of national training experience with his passion for creating accessible, affirming clinical settings, and has focused his work towards medical and public health settings.

Mary Zellinger

Mary Zellinger, RN, MN, ANP-BC, CCRN-CSC, CCNS, FAAN, FCCM

 Teamwork, communication, and mentoring have always been cornerstones of successful interprofessional practice. During the pandemic, the need for effective and timely communication was especially essential. The importance of sharing information at least daily with colleagues internally in our healthcare system, and externally through list-serves, personal contacts, and organized webinars allowed all of us to learn from other’s experiences and quickly incorporate advances into our own practice.   Ensuring frequent communication with staff to provide support and share new information in a rapidly changing environment, frequent communication with patients who were unable to have family members with them, and frequent, scheduled communication with other team members and peers demonstrated to me that the impact of clear, informative, and ongoing communication prevents isolation and supports our mission of optimizing patient, staff, and community health.

Mary Zellinger RN, MN, ANP-BC, CCRN-CSC, CCNS, FAAN, FCCM was the CNS for Cardiovascular Critical Care at Emory University Hospital for over 42 years and was a collaborative faculty member of the Emory University School of Nursing in Atlanta, Georgia before retiring in November 2021.  She received her BSN from Duke University, her MN in Adult Health/Critical Care, and her Post Masters Nurse Practitioner degrees from Emory University.  

Deborah Klein

Deborah Klein, MSN, APRN, ACNS-BC, CCRN-K, FAHA, FAA

 One important thing the pandemic has taught me is that moral injury is real; nurses are tired, frustrated, and angry.  Many are retiring, traveling, or are leaving nursing resulting in dire staffing shortages. We must develop strategies that address moral distress and staffing shortages including ensuring a healthy work environment, effective communication, and meaningful recognition that creates well-being at work. My future actions will focus on developing and supporting these strategies. 

Deborah Klein, MSN, APRN, ACNS-BC, CCRN-K, FAHA, FAA recently retired as the Clinical Nurse Specialist for the Cardiac ICU, Heart Failure ICU, and Cardiac Short Stay/PACU/CARU at Cleveland Clinic in Cleveland, Ohio where she also served as Vice-Chair for the Ethics Committee. She has 45 years’ experience as a nurse and 39 years as a Clinical Nurse Specialist.

Watch the keynote speakers live at the annual conference.  For more information on the annual conference and to register, click here!


Ted Walker: The stars align at PAMC

Ted Walker, A-CNS, CNOR, NPD-BC, CPPS, remembers when he knew being a nurse was what he was meant to do as a career. 

Ted Walker

 Two years into his career, a Yupik elder approached him on the floor of the Bethel, Alaska hospital where he worked for the U.S. Public Health Service. He had wondered how long Walker would be working there. 

“He said, ‘I think that you are a good nurse. This will be the last time I’ll speak to you in English,’” Walker remembers. “For a non-native person, it was quite a thing to have someone say that.” 

“If you were going to be there and live, and do everything you could do to help them, you’d do everything you could to learn the language,” says Walker.  

And so, he learned medical/conversational Yupik. But he also learned so much more. The 20-something nurse learned about sub-arctic life and the delivery of health care in a 50-village service area the size of Oregon.  

“It was wonderful,” says Walker, “There was a real sense of community. Everything is around subsistence. It’s about hunting, fishing and gathering – and surviving the seasons.” 

He and his wife also welcomed their oldest daughter there.  

“I learned the operating room in Bethel,” says Walker. He remembers being on call and supporting the one operating room at the hospital. He remembers the cold 100-yard walk from his home to the hospital. 

From Bethel, Walker transferred as an OR nurse into the Air Force, where he would ultimately achieve the rank of colonel, earn his advanced practice nursing credential as Clinical Nurse Specialist and spend two years as chief of safety for the Air Force Medical Service. 

He retired from the Air Force in 2017 after 26 years and moved back to the state where he started his career. 

“I wanted to work somewhere that supported my core values,” Walker says. “I spent my whole career working with ‘integrity, service before self and excellence in all you do. It was serendipity in a way. All the stars aligned.” 

The best part of his job at Providence Alaska Medical Center (PAMC) is coming in as a consultant to help staff nurses, clinical managers and nurse educators work through challenges, helping them realize “that they really do know the answers.” 

“It’s just helping them get to that point,” Walker says. “Many times, it’s just talking about it and going through the solutions.” 

“The staff in this organization really do look at our core values from the Sisters,” says Walker. “They want to take care of the poor and vulnerable and the people who need our help. It’s just about figuring out how we are going to do it – safely and the best way we can.” 

Through a partnership between University of Alaska Anchorage, the state’s hospital association and Providence, Walker now helps introduce all new surgical nurses to the operating room in Alaska. Whether part of Providence or another health system, nurses spend four weeks of classroom training in Anchorage before going to their home hospital where they work with a preceptor for an additional 11 weeks. 

“The best thing about being a Clinical Nurse Specialist is working with your population or your system,” says Walker. “For me, being an OR nurse as long as I have been, this was an extension to show that I’m an expert.” 

“It’s just an honor to work in this capacity,” says Walker.  

Walker is one of more than 1,200 nurses working at Providence Alaska Medical Center and one of more than 1,600 nurses who work in service of the Providence Alaska Region. The World Health Organization extended its 2020 “Year of the Nurse and Midwife” celebration into 2021. Providence couldn’t agree more.


2022 CNS Trends Look Good In The New Year

Jan Powers and Phyllis Whitehead discuss 2022 trends and the CNS

Jan PowersPhyllis Whitehead

As 2021 — the second year of the pandemic — ends there are some very positive trends taking shape for the CNS community. CNSs numbers, responsibilities and influence continue to grow as 2022 is certainly trending in the right direction for NACNS and CNSs.

Recently, President of NACNS Jan Powers, and President-Elect Phyllis Whitehead sat down to discuss some of the future trends they see for the CNS. 

Overall, 2022 appears to be about growth.  Growth in the CNS population. Growth in student enrollment in CNS programs, And growth in mental health services for CNSs to help deal with job stress. Keep reading to see what Jan and Phyllis had to say;

Q. The healthcare system is losing nursing professionals. Do you see this being a trend for CNSs as well in 2022?

We have close to 90,000 clinical nurse specialists in the United States and our membership is growing. So, the short answer is no. I think that the CNS is stronger now than ever and will continue to grow in numbers. 

The pandemic has been horrible but one positive to come out of the chaos was the way CNSs contributed in leadership positions during the crisis.  We have CNSs that act as providers and then we have CNSs in the hospital really focusing on evidence-based practice and improving patient outcomes. I think the beauty of the role is we can go back and forth, and pivot based on what the needs are. I see a lot of CNSs that act in a provider capacity and then are also looking at organizational or system improvements.  We are confident that an important trend is that the role of the CNS will continue to expand in 2022 along with the number of nurses choosing the CNS career path.

Q. Is there one CNS trend for 2022 that you find surprising?

Yes.  Innovation.  We think the pandemic has created the opportunity for innovation. Innovation is where the CNS lives.  This has resulted in great gains in responsibility and influence for CNSs as they are looked to for leadership and new ideas during the pandemic. We are seeing signs that CNSs are using this evolving status to advocate for other CNSs, other APRNs and, of course, patients.

Q. Has the pandemic effected the number of clinical nurse specialists coming into the field?

 We had started to see a resurgence of the CNS role prior to the pandemic. What we’ve seen during the pandemic is really the rise of the CNS. We’ve really pivoted “on a dime” and increased innovation as to what do we need to do and how do we do it.  

The big question is how do we continue to meet the needs of all our patients, wherever they are, whatever the setting? In 2022, this expansion of the scope of a CNSs’ work will continue to ramp-up and with it, more innovation in healthcare settings will result.  Also, the trends toward CNS as credentialed service providers and prescriptive authority continues to remain strong.

Q. What are some goals for NACNS and for CNSs in 2022?

We had anticipated that there would be a decrease in applicants for nursing school, but we’ve seen an increase — which is super exciting. The thing that concerns us though is how do we keep them at the bedside? How do we maintain their mental health? We want to continue to work on that and advocate for clinical nurse specialists and all APRNs.  We do see those advocacy activities expanding quite a bit in 2022.  

To join or renew your NACNS membership:  https://nacns.org/connect/become-a-member/


Nursing Is Where Change Is Constant And Innovation Is The Answer

A Few Minutes With ANA’s Vice President Of Innovation Oriana Beaudet

Oriana Beaudet DNP, RN, PHN started her position as ANA’s Vice President Of Innovation just as the pandemic was beginning to impact the world. Some would say that it was a tough time to start a new job focused on innovation for nurses. Weren’t all nurses busy with pandemic-related duties? When would they have time to “innovate?”

Oriana Beaudet

The pandemic forced nurses out of their organizational routine procedures. It changed the way they got things done making the environment a fertile ground for innovation.  It’s this fertile ground that Dr. Beaudet is sowing with the “seeds” of innovation. We caught up with her recently to find out more about innovation and creating innovation spaces for nurses.

Q. Can you share the innovation work happening at the American Nurses Association Enterprise and tell us something about yourself?

I am the Vice President of Innovation for the American Nurses Association Enterprise and the American Nursing Association. The American Nurses Association Enterprise consists of three different organizations. It is the ANA, our membership organization where we create the scope and standards for the profession. It’s also where we have the Center for Ethics and Human Rights and where we do our Policy and Government Affairs advocacy work on behalf of the profession. Then we have the American Nurses Foundation, which is our philanthropic and research arm, and the American Nurses Credentialing Center, which is focused on credentialing and accreditation of nurses and organizations.

My role in the innovation space is to work across the ANA Enterprise to support the growth and advancement of the 4.3 million nurses in the space of innovation and build and grow our capacity and skills.

Q. How can innovation improve the work and lives of nurses?

Prior to the pandemic every organization had a fairly structured process for how change occurred within their organization. When the pandemic started unfolding in early 2020, we saw organizations, facilities and nurses who had to completely change what they were doing. Almost overnight, they weren’t going through their normal organizational change processes. They were innovating on the fly. They were trying to figure out how to address an emerging pandemic. 

We were also dealing with supply shortages and had different COVID-19 hotspots around the country. Part of the innovation work that emerged from this situation was the realization that nurses could make positive, impactful change quickly within their organizations without having to go through lots and lots of steps. They were able to test and try new models, new care practices, new ways of working and communicating. Facilities and organizations had to turn on a dime to meet the needs of the people. We saw lots of innovations. We saw the changing clinical presentation of patients and how hospitals had to care for their staff differently related to COVID-19, the list is quite extensive. But the biggest takeaway is the fact that people were willing to jump in and navigate new things at every turn to get the work done and to take care of each other.

Q. How do ANA and NACNS work together? How can CNSs get involved in the ANA Innovation work?

The work of the CNS is so important because they’re the translators between practice and research. They bring the newest research to practice and cut down the length of time it takes for research to be implemented into practice. CNSs work to shrink that gap, and they’re bringing this new knowledge and research to practice which creates space for innovation to happen faster. 

As an affiliate, NACNS has access to our innovation resources. Information is posted on https://www.nursingworld.org/innovation We have an innovation newsletter that we put out monthly, the “See You Now” podcast, Innovation Award and Virtual Innovation Lounges. Please engage with any of our activities we would love to see and hear from all CNSs who are doing incredible work. One of the things we just launched is an innovation community for members with almost 13,000 nurses who are already have an interest in this space. 

Q. What are the biggest challenges and opportunities that nurses are navigating today?

The last 18 months we saw where our health care infrastructure and organizations struggled and where they shine. I would say the challenge is to not revert to old ways of thinking. Learn from what has transpired do better and to keep striving forward. I think the opportunity is recognizing how the pandemic has truly created a space for the profession to highlight their skills and their scientific training. Nurses are passionate about their careers and their work, so we need to make sure we are positioning them to truly step into innovation spaces to guide healthcare forward.


Success Story: The CNS As Credentialed Provider

The University of Virginia Health (UVA Health), serving the Greater Charlottesville/Albemarle region of Virginia, took the important step this month to validate its 14 clinical nurse specialists (CNSs) as “credentialed providers.” This step formally recognizes CNSs as Advanced Practice Registered Nurses (APRN). UVA Health System includes a 631-bed hospital, level I trauma center, nationally recognized cancer and heart centers, and primary and specialty clinics throughout Central Virginia.

The entire credentialing approval process took four months and, today, CNSs at UVA Health can practice with full practice authority, ordering many services for patients based on their own professional assessment rather than relying exclusively on physician approval.

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN, lead clinical nurse specialist of UVA Health, coordinated the credentialing effort. According to Elgin, the other three APRN roles (nurse practitioners, nurse midwives, and nurse anesthetists) were already bundled underneath the credentialed provider structure and there was a growing need to recognize CNSs and align their level of responsibility and scope of practice with that of their APRN counterparts.

Beyond the interest in improving patients’ experiences, the ascension of CNSs to the status of credentialed providers means that UVA Health is in line with the CNS professional standards of practice. The change also will provide mechanisms for third-party billing of services provided by a CNS. At the same time, there is legislation in the Virginia General Assembly to elevate the scope of practice of the CNS to allow for prescriptive authority.

“There was a real need for credentialing CNSs,” said Elgin. “The fluidity of the CNS role is important, but it could lead to role confusion for colleagues. After centralizing the CNS team, I performed a systematic gap analysis, comparing our practice to the National Association of Clinical Nurse Specialists (NACNS) core competencies. Being able to validate our CNSs were ‘aligning with and meeting national standards’ is actionable language that is meaningful and powerful to an organization.”

NACNS core competencies can be found here. They include competencies in Direct Care, Consultation, Systems Leadership, Collaboration, Coaching, Research and Ethical Decision-Making, Moral Agency, and Advocacy.

The Benefits of Credentialing the CNS

As a credentialed provider, CNSs’ validation as an APRN by the UVA Health nursing body and interdisciplinary colleagues is helping to build the structures and processes that are necessary to facilitate reimbursement practices. Another significant improvement will be CNSs’ ability to formally consult other interdisciplinary clinicians without a physician co-signature. This efficient approach to patient care leverages the CNSs’ ability to generate revenue for the organization for the work they perform. Finally, and most importantly, validating a CNS as a credentialed provider creates an opportunity to rethink processes and structures around interprofessional practice and develop different and more efficient methods to work together in a healthcare setting.

A CNS-Credentialed Provider “How To”

The entire formal credentialing process at UVA Health took four months and involved the entire organization.

The process included working with stakeholders to obtain subcommittee approvals, a full vote by all of the organization’s clinical staff, and final approval by the UVA Health Board. Critical to the success of this effort was securing support from the chief nursing officer, director for advanced practice, as well as buy-in from the CNS team.

“Our CNSs had a vision for it, but we still put a lot of energy and effort into securing their buy-in,” said Elgin. “The change will create different workflows for our CNSs, so I needed them to be engaged in the credentialing process from the beginning if we were to be successful.”

The approval process started with the proposal being presented to the Advanced Practice Provider Subcommittee of the Organizational Credentialing Committee. Once approved, a recommendation was made to the Credentialing Committee to add CNSs as a provider type. Next, it was voted on and approved at the Credentialing Committee and the Credentialing Committee made their recommendation to the Clinical Staff Executive Committee. This executive committee also approved the proposal and sent it to the entire clinical staff for a vote. Finally, the last step was the UVA Health Board’s approval validating the CNS position as a credentialed provider.

Elgin credits her relatively smooth approval process to never underestimating the importance of engaging stakeholders both in formal and informal settings and really taking time to listen to them and hear their concerns.

About the author

Kimberley Elgin, DNP, RN, ACNS-BC, PCCN, CMSRN is a Director at Large for NACNS, the only national organization representing the 89,000 CNSs in the US. CNSs are the most versatile advanced practice registered nurses and work in a variety of health care specialties to ensure the delivery of high-quality, evidence-based, patient-centered care. As leaders in the acute, post-acute, and ambulatory health care settings, CNSs impact direct patient care, nurses and nursing practice, and organizations and systems to optimize care and drive outstanding clinical outcomes.

RISE Up By Giving A Hand Up

Succession Planning To Advance The CNS Profession

Jan Powers, in her recent National Association of Clinical Nurse Specialists President’s Letter titled “We Rise By Lifting Others,” stated:

“As CNSs, we must look to the future and work to improve the pipeline of qualified CNSs to fill positions of vital need. We must have an intentional focus on succession planning and simultaneously encourage younger nurses to explore and step up to the role of CNS.”

Five generations of nurses are now working together with the oldest generation reaching retirement. As a matter of fact, nearly 20% of CNSs will reach retirement age over the next five years. Succession planning is an important way to fill this potential retirement gap in the ranks of the about 89,000 CNSs in North America.

Succession planning is defined as the systematic process of recognizing and creating future leaders who ready and able to accept the roles and responsibilities of those leaving the workforce via retirement, resignation, or promotion. Succession planning is a future-oriented process.

In short, it’s about giving younger nurses a “hand up” by introducing them to the role of the CNS and encouraging them to pursue the career. It is primarily through this effort that we advance the CNS role and ensure it thrives well into the future.

The Big Question

Ask yourself this question:

Who will replace you when you retire or leave the organization?

To truly RISE UP as a profession we must lead others forward. This is where succession planning is so critical because our current CNS positions must pave the way for the next CNS to take our place. Below are some tips and ideas to think about as you begin a succession plan.

CNS Succession Planning Tips

1. Establish accountability

  • Agree who has the responsibility to make the succession decision. Establishing clear responsibility of organizational succession early on is key to avoiding confusion later and is important to ensure a CNS has input into the process.

2. Focus on learning, not just performance

  • Provide potential successors opportunities to experience the future role and be educated on responsibilities before the succession itself is decided and implemented. This is where mentoring is important.

3. Turn succession short-term by breaking down tasks

  • Succession planning is a journey with many steps. People tend to think better in the short-term so breaking down the succession process into smaller projects rather than trying to make a switch all at once has a better chance of success.

4. Build transparency with the scientific method

  • Be upfront about succession planning and use CNS data skills to measure a potential successor’s performance and leadership ability. Establish standards to measure the success of a transition and share this information. This not only makes the succession process cleaner, but it builds trust among coworkers and the organization generally.

Is 90,000 Enough?

There are about 89,000 CNSs in North America and it is not nearly enough. The pandemic is swallowing resources while the online job boards scream for more CNSs. Our goal should be to retain and add more CNS to the workforce every year. We can do this with mentoring, succession planning, advising younger nurses, speaking at nursing programs among may other things. In sum, by giving a hand up to younger nurses to become CNSs we ensure the continuity of our profession and truly “RISE By Lifting Others.”


Lt Colonel David Bradley Armed Forces Affiliate Interview with NACNS

Lt. Colonel David Bradley Interview – Q&A

Q. What prompted the reinvigoration of the military affiliate within NACNS?

A few colleagues and I have been attending the National Association of Clinical Nurse Specialist (NACNS) Annual Conference for years and always found it exciting and informative. We decided there was a real
need for a military affiliate, and — in true military fashion — we just went ahead and completed all the paperwork and executed the mission. We plan to launch NACNS’s military affiliate in October with representation across three branches of the military — Navy, Air Force and Army. We’ve had a lot of interest already.

Q. What do you hope to accomplish with the creation of the Armed Services affiliate?

People are just unaware of the Clinical Nurse Specialist’s (CNS) role. They ask: “What are your skill sets and how can we better utilize you?” There is a great need for education and awareness around the CNS in the military. We want to make sure that the role of the CNS is understood and valued. The best ambassadors for this effort are the CNSs themselves, so we want to put our heads together and have an organization to build awareness and appreciation of our role.

Being an affiliate linked to a national organization can support and help with visibility and grow awareness. Our second goal is to share and collaborate on evidence-based practice and research. NACNS gives us the best forum for accomplishing these goals.

Q. Can you tell us more about the benefits of a NACNS military affiliate?

The primary benefit of the NACNS military affiliate is that it establishes a platform to better market the role of the CNS. An active affiliate will highlight the great things CNSs are doing across the nation as well as showing how CNSs are making an impact in military healthcare. We also plan to use the military affiliate to network and establish a robust mentoring program for newer CNSs. That’s an area of opportunity for the military affiliate, providing experienced mentors for recently graduated CNSs.

Q. Do you have anything else you would like to share about the role of the CNS?

I’m always looking for better ways to describe the role of a CNS. When the message gets through, people really do understand the unique value we bring to the table. I’ve found that analogies go a long way in this regard; they’re a simple way to explain what otherwise can sound like a complicated role. Here’s one of the best analogies about CNSs that I’ve heard:

A CNS is like a pitching coach in baseball. Now, can you play baseball without a pitching coach? Absolutely. So, why do they have pitching coaches and pay them so much money?

Teams invest in pitching coaches because pitching is the most important position on the field. For a team to be great, it has to have great pitching. So, even small improvements to a pitcher’s mechanics, to his pitch selection, or to something as simple as how he grips the ball can have significant impact on the team. The pitching coach can look at the spin of the ball, the velocity, or the way the ball leaves a pitcher’s hand and be able to offer insight that no one else on the field can see. The pitching coach will see things others miss. “You’re dropping your shoulder,” he’ll tell the pitcher who can’t find the strike zone. This advice and corrective action can and regularly does change the outcome for a pitcher and for the game.

A CNS plays a similar role to the pitching coach, providing expertise and guidance at key moments, relying on their deep expertise, to improve the quality of care and outcomes in hospitals and health systems across the country.


These are the most lucrative nursing careers right now

3 highest paying clinical nursing jobs today

Which nursing careers pay the highest annual salary or hourly rates? Nursing jobs vary by specialty, setting, location, degree, and certification requirements. Nurses can specialize in treating a population (geriatrics, pediatrics, etc.) or specialize in a therapeutic area (oncology, dermatology, etc.) Additionally, shifts low in supply and high in demand can cause pay rates to grow in certain types of jobs.

Below are the nursing careers that generally pay the highest salary across all locations, specialties, and clinical settings. Most of the highest-paid nursing careers are APRNs, or advanced practice registered nurses, which are registered nurses who obtain a master’s level degree and additional experience or specialization after completing their Bachelor of Science in Nursing degree and RN certification.

1. Nurse Anesthetist (CRNA) – Nurse anesthetists administer anesthesia to patients who are undergoing medical procedures in a hospital, outpatient surgery center, or medical office. With additional documented experience in ICU or surgery, plus completing an additional program and passing certification requirements, RNs can become CRNAs and earn an average of $181,040 annually, according to the Bureau of Labor Statistics. CRNAs can make up to $230,000 annually, while most CRNA salaries range between $171,130 and $205,506, according to Salary.com.

2. Nurse Practitioner (NP) – Nurse practitioners also complete additional training and education to get their NP degree which enables them to treat patients more autonomously than many other types of nurses. Some states allow NPs to practice independently and prescribe medications while other states require NPs to work with a licensed physician. As of February 2021, nurse practitioners earn an average of $109,025 annually, according to data from ZipRecruiter.com.

3. Clinical Nurse Specialist (CNS) – A clinical nurse specialist has obtained a minimum of a master’s degree, plus additional training in a specialized area of nursing practice, according to Nurse.org, which reports that the median salary for clinical nurse specialists as of May 2020 is $106,604. Clinical nurse specialists may specialize in a therapeutic area or population, and specialty certifications are available in gerontology, pediatrics, and neonatal care, according to the National Association of Clinical Nurse Specialists.

Honorable Mention – Registered Nurse (RN) – While not among the very top-paying jobs, RNs are well-paid. Additionally, becoming an RN is somewhat of the “gateway” milestone along the way to achieving higher-paying advanced practice nursing jobs. Completing an RN opens many doors and provides nurses with many more options for advanced degrees and more lucrative nursing roles. According to the Bureau of Labor Statistics, the average (mean) income for RNs nationally as of 2019 (the most recent BLS data available) is $37.24 per hour which translates to $77,460 annually, assuming a full-time schedule of about 40 hours per week.

Of the nearly three million RNs employed nationwide, the highest earners are those who work in outpatient care centers or hospital settings, with an average hourly income of $40.73 ($84,720 annually), and $38.20 per hour ($79,460 annually) respectively.

Where you work as an RN also impacts your hourly wage and annual income. California and Hawaii are the top-paying states for RNs, with hourly rates of $54.44 and 50.03, respectively, followed by Washington, D.C., Massachusetts, and Oregon as top-paying states, where the cost of living is also higher.

Other ways nurses may increase their annual income

In addition to high-paying clinical nursing careers, another way to grow your nursing career and annual income is to shift into leadership, administration, or teaching. Nurse administrators such as hospital CNOs, medical directors, etc. earn more than $100,000, and nurse instructors earn an average of $83,160 annually and up to $133,000 in the 90th percentile.

Changes in supply and demand can also factor into nursing salaries, causing pay fluctuations in either direction. For example, critical care nursing is in unusually high demand in 2020-2021 due to the coronavirus pandemic. This is causing pay rates in some areas to quadruple, as demand also grows by a reported 400-500%, multiple experts report. Switching practice areas may be a more feasible career change than obtaining a new advanced degree for some nurses.

If none of the above are an option, another way for nurses to potentially grow their annual income is to consider trying out a new part-time side-gig for a few extra hours a week. This may be a more realistic method to increase earnings for nurses who are unable to shift full-time into a new, higher-paying nursing career.