Press Room

In this edition of Rick’s Round Up, NACNS President Rick Bassett, MSN, RN, APRN, ACNS-BC, CCRN, FCNS, LSSGB, answers questions from nurses navigating the Clinical Nurse Specialist (CNS) journey.

From post-master’s bridge programs and DNP transitions to understanding the differences between CNS and AGACNP roles, Bassett provides clear guidance on certification, licensure, and career opportunities. He also explains the ANCC role reclassification, shares insights on CNS career growth, and highlights pathways for aspiring and experienced CNSs alike.

Whether you’re planning your education, relocating to a new state, or seeking clarity on your credentials, this round-up offers practical advice to help you advance your CNS career with confidence.

1. I am almost finished with my MSN Ed. Are there programs that will take my credits, maybe as a bridge program? I took the 3 P’s already.

Thank you for your question! Since you’re almost finished with your MSN in Education and have already completed the 3 Ps (Advanced Pathophysiology, Advanced Pharmacology, and Advanced Physical Assessment), you have some great options for bridge or post-master’s programs. Many universities offer post-master’s certificates or bridge programs that allow you to leverage your existing credits toward a Clinical Nurse Specialist (CNS) track. The availability and transferability of credits will depend on the school and the program requirements. I recommend the following:

• Check with your current institution first — they often have internal pathways for graduates.
• Explore accredited programs that offer a CNS post-master’s certificate. Since you’ve completed the 3 Ps, you may be able to shorten your course of study significantly. Check out the NACNS CNS Program Directory for a comprehensive list of options.
• Once your academic requirements are completed, you will need to sit for and pass a CNS certification exam.
• Confirm the accreditation and state requirements for the CNS Advanced Practice Registered Nurse (APRN) role, as you will need to submit transcripts and CNS certification exam results to obtain your state license.

2. I am a DNP and a certified hospice and palliative care nurse (CHPN). I am moving to Colorado in 2026 and would like to know how to become established as a CNS there.

• I am excited that you are interested in the CNS role. You have a great background that can provide great value to you in the CNS role. To move from an RN to an APRN license in the CNS role, you would need to explore accredited programs that offer a CNS post-master’s certificate. Check out the NACNS CNS Program Directory for a full list.
• An advantage of practicing in Colorado is that it empowers APRNs with a broad scope of independent practice; there is no physician oversight required by law.
• One other opportunity you will have once you are a CNS is to sit for the Advanced Certified Hospice and Palliative Nurse (ACHPN®) exam, which is only available to APRNs who are practicing in hospice and palliative care and recognizes ACHPN-certified APRNs as expert advanced practice practitioners.

3. What is the career outlook for a CNS? How different is an AGACNP from a CNS?

These are great questions to consider as you contemplate your career goals and path. CNS roles are expected to grow around 5-6% over the next decade, which is a little above average. Additionally, industry analysts project about 195,000 new CNS positions over 10 years. There is an ongoing demand for CNS clinical expertise and systems-level improvements. We are valued for our roles in reducing hospital stays, enhancing quality care quality and patient experience while leading evidence-based practice implementation. National average salaries range from $105,000 to $130,000, with experienced CNSs earning $150K+.

As for the differences between an AGACNP and a CNS, there are some similarities, but the roles differ more. The AGACNP and CNS can provide direct patient care in acute care settings like ICUs, ERs, or specialty units. Responsibilities include diagnosing, ordering/interpreting diagnostics, and prescribing treatment during episodes of acute or complex illness. However, the AGACNP role is primarily at the bedside.

The CNS functions as a clinician-consultant, educator, and systems leader across healthcare settings. They focus on evidence-based care, improving systems, mentoring staff, and consulting on complex cases, often working behind the scenes rather than leading day-to-day treatment. In summary, the CNS has a broader influence, supporting units, departments, and organizations — leading quality improvement, teaching staff, and optimizing clinical processes.

The academic preparation for an NP and a CNS has many similarities. In many states, their scope of practice, role autonomy, and prescriptive privileges are defined under the umbrella of APRN scope of practice and are similar to each other.

4. I have been a CNS in private mental health practice since 1990. I’m seeking help with ANCC’s reclassification of roles. What does this mean for me?

It is important to clarify the ANCC’s reclassification occurred in the late 2000’s: ANCC Role Reclassification – Authoritative Source Statement.

The American Nurses Credentialing Center (ANCC) implemented revisions and standardized the designations for advanced practice certifications, effective January 1, 2008. This update transitioned older credential formats to role-specific, board-certified titles, such as CNS-BC (Clinical Nurse Specialist–Board Certified).

The purpose of this change was to enhance consistency, transparency, and alignment with recognized advanced practice roles. Importantly, this reclassification did not alter the scope of practice, professional role, or authority of certified Clinical Nurse Specialists. Individuals who held CNS certification prior to this update retained their certification, with the credential title revised to reflect ANCC’s current nomenclature.
This is according to the American Nurses Credentialing Center (2008).

1. First, what are your certifications and licensure? If you have the ANCC certification PMHCNS-BC, you should be aware that this certification was phased out. However, you can continue to renew this or other retired ANCC certifications as long as you meet the certification renewal requirements. However, no new applicants can sit for this exam. Confirm this information with ANCC at https://www.nursingworld.org/our-certifications/cns-in-adult-psychiatric—mental-health-renewal/.
2. Secondly, what is your state’s definition and licensure of an APRN? If the state recognizes your current CNS certification and includes a grandfather or equivalent provision allowing previously licensed CNSs to maintain APRN status, then the ANCC reclassification of roles and resulting licensure changes in your state may have little or no impact on your ability to continue practicing as a CNS.

However, if your state no longer accepts your current certification or your academic preparation as meeting the requirements for licensure, then that can substantially impact or prohibit your ability to practice as a CNS regardless of previous certification and licensure status. Addressing this situation will likely require a complex process involving both legislative representatives and the State Board of Nursing to explore feasible solutions to allow for continued practice as a CNS.

It will be essential for you to fully understand the statute and licensure language and requirements in your state before engaging in these conversations.

5. I would like to go to school to become a CNS, but I’m unsure as to what schools truly offer the program, or if I will have to go for my MSN and get a certificate in CNS.

Great news — you have lots of options! If you have a BSN, you can enroll in a CNS graduate program for a master’s or DNP. There is no need to get an MSN first before applying to a CNS program.

However, those who already have a graduate nursing degree can apply to a CNS program that offers a post-master’s certificate. Any one of these options will prepare you to qualify to sit for the CNS certification exam and eventual licensure as a CNS. Please check out the NACNS CNS Program Directory, as it contains information on many programs, one or more of which will meet your needs. I would also encourage you to send an email or call the school to speak with the CNS program director.

For his second edition, NACNS President Rick Bassett discusses the CNS certification process, advice for finding a CNS program, and more.

1. What are the national CNS certification options for an experienced CNS, nationally board-certified in a specialty (CWOCN), and practicing since 1989? This question is in regards to Medicare billing as a CNS. Medicare will only allow billing by a CNS if they are ANCC certified.

This is a great question that needs some additional context in order to provide a clear answer. In most states, the title CNS is title-protected, which means you are academically trained, certified, and licensed as a Clinical Nurse Specialist before you can use the title CNS. With regard to Medicare billing, while they do mention ANCC, the American Association of Critical-Care Nurses (AACN) Certification Corporation also offers Clinical Nurse Specialist certifications, and my understanding is that those would be acceptable as well. It would be best to check with your local Medicare Administrative Contractor (MAC) to confirm which ANCC and AACN CNS certifications are accepted. Unfortunately, your CWOCN is not an Advanced Practice Registered Nurse certification, and my understanding is that it is not listed among Medicare’s recognized certification bodies.

To become a Clinical Nurse Specialist (CNS), you must apply to and complete a Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or a post-graduate CNS program. After completing the educational requirements, you must pass a certification exam administered by either the ANCC or AACN, and then obtain CNS licensure in your state.

2. I’m trying to find a CNS program that would allow me to practice in the hospital setting, not gerontology. Do you have any suggestions?

NACNS offers a valuable resource called the CNS Program Directory, which helps prospective Clinical Nurse Specialists identify programs by population focus, delivery format, and location. If you are seeking certification in Adult-Gerontology, it is important to note that gerontology content is required to sit for the certification exam. This requirement applies to both the ANCC and AACN certification pathways.

Currently, there are three population-specific CNS certifications available through AACN Certification Corporation:

ACCNS-Adult-Gerontology
ACCNS-Pediatric
ACCNS-Neonatal

The ANCC offers the Adult-Gerontology CNS (AGCNS-BC) certification.

If your interest lies in Pediatric or Neonatal CNS practice, you may pursue programs that focus exclusively on those populations. These certifications do not require gerontology content, and graduates are eligible to practice in hospital settings without it.

3. I have been an RN for 20 years, but 99% of my work experience is in ambulatory care. In fact, I am a Certified Ambulatory Care nurse. I am interested in becoming a CNS, but I wonder if my lack of hospital experience would be an issue?

Congratulations on your 20 years of nursing experience and on earning your Ambulatory Care Nurse certification. It is exciting that you are considering becoming a Clinical Nurse Specialist. CNSs across the country specialize in ambulatory care, and your background positions you well for this path.

During your academic preparation, you will be required to complete clinical experiences in a variety of settings, which may include both clinics and hospitals. However, you can work with your program to focus the majority of your clinical hours in ambulatory care environments, aligning with your intended area of practice. This is a conversation you should have with the Program Director of the CNS program you are considering.

Importantly, a lack of hospital experience does not disqualify you from becoming a CNS. Your expertise in ambulatory care is valuable and can be leveraged throughout your education and future practice.

4. The University of Colorado has paused enrollment in its Adult-Gerontology CNS program with the Spring 2025 semester. I am wondering if the decision is related to a possible lack of interest in or knowledge about what a CNS can do, or a lack of CNS jobs in my state. Any thoughts?

Thank you for sharing this update. The University of Colorado’s decision to pause enrollment in its Adult-Gerontology Clinical Nurse Specialist (CNS) program beginning Spring 2025 appears to be part of a broader strategic adjustment rather than a reflection of the CNS role’s value or viability. While the university has not publicly cited a specific reason, such pauses often relate to internal factors such as faculty availability, curriculum restructuring, or shifting institutional priorities.

Nationally, the CNS role remains strong and continues to demonstrate its value across healthcare settings. According to the NACNS 2022 CNS Census, there is a growing demand for CNSs, particularly as nearly 30 percent of the current workforce plans to retire within five years. This underscores the need for succession planning and expanded educational pathways. While exact employment figures for CNSs in Colorado are not publicly available through NACNS or the Bureau of Labor Statistics, the census highlights a nationwide need for CNSs, suggesting that states like Colorado with robust healthcare systems are likely to reflect similar trends in demand.

However, awareness of the CNS role can vary by region and institution. Some healthcare leaders may lack a complete understanding of the CNS’s contributions, particularly in areas like quality improvement, clinical education, and systems leadership. This can influence hiring practices and program support.

5. I am currently pursuing an MSN degree in Nurse Executive Leadership. What is the next step to become a CNS?

Once you have completed your MSN degree in Nurse Executive Leadership, you will want to seek information on a Post-Graduate Certificate Clinical Nurse Specialist program. Please check out this resource, CNS Program Directory on the NACNS website, as there are several options across the nation.

6. I have a CNS title but not a license. What is the process to obtain one in my situation?

Thank you for your question. If you currently hold the title of Clinical Nurse Specialist (CNS) but are not licensed. It is important to clarify your status and ensure you are practicing within the legal and professional boundaries of your state. The title “Clinical Nurse Specialist” is protected in many states, meaning it may only be used by individuals who have completed the required education, obtained national certification, and are licensed by their state board of nursing.

Using the CNS title without meeting these requirements can be misleading and may violate state regulations. I encourage you to verify whether your state enforces title protection for CNSs. If you are unsure, contacting your state board of nursing is a good first step.

To move forward toward licensure, you will need to:

• Complete a CNS-specific graduate program: either a master’s, DNP, or post-master’s certificate focused on your chosen population.
• Earn national certification through an accredited body such as the ANCC or AACN.
• Apply for licensure as a CNS through your state’s board of nursing.

The NACNS CNS Program Directory is an excellent resource to help you identify programs that meet these requirements and align with your goals. This guide will help you complete the necessary academic preparation to become certified and licensed to practice as a CNS.