State medians come from the same OEWS release as the national figures. The cost-of-living column divides each state median by that state's BEA Regional Price Parity, restating pay in national-average dollars so a high-cost state and a low-cost one can be compared directly.
Clinical Nurse Specialist Salary (2026): Data, Outlook & How to Become One
The median pay for Clinical Nurse Specialists is $97,550 a year ($46.90/hr), according to BLS OEWS, May 2025. Employment is projected to grow 4.9% through 2034, with about 189,100 openings a year (BLS EP, 2024–2034). Typical entry-level education: Bachelor's degree.
SOC 29-1141Healthcare Practitioners and TechnicalLast updated August 23, 2026
- Median pay
- $97,550
- Projected growth
- +4.9%
- Openings a year
- 189,100
- Typical education
- Bachelor's
BLS OEWS, May 2025
BLS EP, 2024–2034
BLS EP, 2024–2034
BLS EP, 2024–2034
Also advertised as: APN (Advanced Practice Nurse), Board Certified Clinical Nurse Specialist (CNS-BC), CNS (Clinical Nurse Specialist), Critical Care CNS (Critical Care Clinical Nurse Specialist), Emergency Clinical Nurse Specialist (Emergency CNS), ICU CNS (Intensive Care Unit Clinical Nurse Specialist).
How much do Clinical Nurse Specialists make?
10th percentile$68,940
Entry / lowest-paid tenth
25th percentile$80,330
Lower quartile
Median (50th)$97,550
Half earn more, half earn less
75th percentile$112,350
Upper quartile
90th percentile$137,470
Top-paid tenth
| Median annual wage | $97,550 |
|---|---|
| Median hourly wage | $46.90/hr |
| Mean annual wage | $101,420 |
| People employed | 3,379,720 |
Versus all US occupations
At $97,550, Clinical Nurse Specialists earn 91% above the $50,980 median across all US occupations, a difference of $46,570 a year.
Versus healthcare practitioners and technical occupations
The median is typical for the Healthcare Practitioners and Technical group, where the middle occupation pays $97,870.
Pay range
The top 10% earn $137,470 or more while the bottom 10% earn $68,940, a gap of 2.0×. That is a typical spread for a US occupation.
Rank in the bank
This median pays more than 76% of the 923 occupations in the NueCareer career bank.
Highest-paying state
California pays the most at $140,270, and still leads at $126,689 once local prices are taken into account.
Which states pay Clinical Nurse Specialists the most?
| State | Median | COL-adjusted | Employed |
|---|---|---|---|
| California | $140,270 | $126,689 | 338,940 |
| Hawaii | $136,320 | $123,983 | 12,940 |
| Oregon | $129,010 | $124,815 | 39,730 |
| Washington | $124,200 | $116,061 | 69,260 |
| Alaska | $109,480 | $106,957 | 7,510 |
| New York | $109,440 | $101,408 | 205,810 |
| New Jersey | $106,500 | $97,882 | 92,680 |
| Massachusetts | $104,550 | $98,859 | 88,200 |
| Nevada | $103,670 | $103,692 | 27,070 |
| Connecticut | $102,740 | $99,160 | 40,110 |
Is Clinical Nurse Specialist a growing career?
Clinical Nurse Specialists4.9%
All US occupations3.1%
+4.9% projected growth vs 3.1% for all occupations.
Faster than average
BLS projects employment of Clinical Nurse Specialists to change 4.9% over 2024–2034, against 3.1% projected for all occupations. That is 166,100 more jobs.
Annual openings
About 189,100 openings are projected each year, 5.6% of the 3,391,000 jobs that existed in 2024. Most come from workers leaving the occupation, not from growth alone.
Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
Demand for healthcare services will increase because of the large number of older people, who typically have more medical problems than younger people. Registered nurses also will be needed to educate and care for patients with chronic conditions, such as diabetes and obesity.
Job growth is expected across most types of healthcare settings, including hospitals and outpatient care centers that provide same-day services, such as chemotherapy, rehabilitation, and surgery. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings.
How to become a Clinical Nurse Specialist
The clinical nurse specialist is one of the four advanced practice registered nurse roles in the APRN Consensus Model, alongside the nurse practitioner, the certified registered nurse anesthetist and the certified nurse-midwife. It is also the role whose recognition is least uniform: on NCSBN's own state table as of December 2024, Mississippi, New Hampshire and Pennsylvania did not include the CNS among their recognised APRN roles, and California and New York recognised the role while granting it neither independent practice nor prescriptive authority. The path is a graduate CNS programme plus national certification plus state APRN licensure, and the certification landscape is much smaller than it was because the Consensus Model retired most of the old specialty CNS credentials.
The credential path, step by step
- Become a registered nurse first
BLS records the three usual paths into registered nursing: a bachelor's degree in nursing, an associate degree in nursing, or a diploma from an approved nursing programme, followed by the NCLEX-RN and state licensure. Every CNS certification requires a current unencumbered US RN or APRN licence.
- Complete a graduate CNS programme with a population focus
NACNS describes the CNS as prepared at master's, doctoral or post-graduate certificate level. The Consensus Model requires an APRN to be educated in one of six population foci: family and individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's health and gender-related, or psychiatric and mental health. ANCC accepts programmes accredited by CCNE, ACEN or NLN CNEA; AACN Certification Corporation accepts CCNE or ACEN. Programmes must include three separate graduate APRN core courses in advanced pathophysiology, advanced health assessment and advanced pharmacology.
- Log the supervised clinical hours the certification requires
Both certifying bodies set a floor of 500 faculty-supervised clinical hours. AACN requires those hours to cover all CNS roles, to be completed in the United States, and to span wellness through acute care within the relevant population.
- Pass a national certification examination that still exists
This is where people run into retired credentials. ANCC offers the Adult-Gerontology Clinical Nurse Specialist certification, AGCNS-BC: 175 items of which 150 are scored, 3.5 hours at Prometric, with a 2025 pass rate of 88 percent. AACN Certification Corporation offers ACCNS-AG, ACCNS-P and ACCNS-N for the adult-gerontology, pediatric and neonatal populations, each 175 items with 150 scored over 3.5 hours. Most other CNS certifications no longer exist to sit.
- Apply to the board of nursing for APRN licensure or recognition
National certification is what the state board uses to license or recognise you as an APRN, so the certification and the licence are two steps, not one. Check what your state actually grants a CNS before choosing the role: AACN states that its certification is accepted in all states that recognise the CNS as an APRN role, which is a deliberate qualification.
Exams you have to pass
Adult-Gerontology Clinical Nurse Specialist certification (AGCNS-BC)
175 items of which 150 are scored and 25 are unscored pretest items, over 3.5 hours. Eligibility requires an active RN licence, a master's, post-graduate certificate or DNP in adult-gerontology CNS from a CCNE-, ACEN- or NLN CNEA-accredited programme, 500 faculty-supervised clinical hours, and three separate graduate courses in advanced pathophysiology, advanced health assessment and advanced pharmacology. The 2025 pass rate was 88 percent. Certification runs for 5 years.
Administered by American Nurses Credentialing Center, delivered at Prometric.
Adult-Gerontology, Pediatric and Neonatal CNS certifications (ACCNS-AG, ACCNS-P, ACCNS-N)
Three population-focused CNS certifications with identical requirements: an unencumbered US RN or APRN licence, a CCNE- or ACEN-accredited master's or higher with the relevant CNS concentration, and a minimum of 500 supervised clinical practice hours across all CNS roles completed in the United States and spanning wellness through acute care. Each examination is 175 items with 150 scored, over 3.5 hours, and each certification runs for 5 years.
Administered by AACN Certification Corporation.
- How long the training takes
Neither NACNS nor the accreditors publish a CNS-specific programme length, so any single figure would be invented. What is fixed is the credential level, a master's, doctorate or post-graduate certificate, and the 500 supervised clinical hours both certifying bodies require.
- Continuing education
Required to stay credentialed
ANCC certification runs on a 5-year cycle, renewed with an active RN licence, 75 continuing education contact hours of which 25 must be in pharmacology, and completion of at least one of eight professional development categories, where the practice-hours category is 1,000 hours. AACN certifications also run 5 years, renewed either with 1,000 practice hours plus 150 CE points, or 1,000 hours plus 25 pharmacology CE plus the examination, or 150 CE points plus the examination. One consequence of the Consensus Model is worth knowing before you let anything lapse: ANCC states that where a certification is retired or designated renewal only, testing is unavailable as a way to renew or reactivate it, and such a certification cannot be reactivated if it has been lapsed for two or more years. AACN is blunter still about its own retired CNS credential: late or retroactive renewal is not available, and a lapsed holder must meet the eligibility requirements for a current CNS examination, most likely by obtaining a post-graduate certificate.
Licensing and state variation
Licensed state by state
This is the field where the CNS diverges most from the nurse practitioner, and it is worth checking before enrolling. On NCSBN's APRN Consensus Model by State table as of December 2024, Mississippi, New Hampshire, Pennsylvania and American Samoa did not include the CNS among their recognised APRN roles (Pennsylvania regulates CNSs through its education and certification elements while excluding the role from its roles element). California and New York recognised the CNS but specified neither independent practice nor prescriptive authority for it, while granting more to nurse practitioners. Full independent CNS practice and prescribing existed in 26 jurisdictions, including Alaska, Arizona, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Idaho, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Mexico, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia and Wyoming, while Georgia, Indiana, Louisiana, Michigan, Missouri, New Jersey, Ohio, Oklahoma, South Carolina, Tennessee and Texas required collaboration or supervision for both practice and prescribing. That table is the most recent regulator-published version and NCSBN has since taken its APRN maps offline, so confirm the current position with your own board. The APRN Compact has been enacted in four jurisdictions, Delaware, North Dakota, Utah and South Dakota, and will be implemented when seven have enacted it, so it is not yet available to anyone.
Who governs the credential
- National Council of State Boards of Nursing (NCSBN) — Convened the APRN Advisory Committee behind the 2008 Consensus Model that defines the CNS as one of four APRN roles, and publishes the NCLEX examinations and the compacts.
- American Nurses Credentialing Center (ANCC) — Certifies adult-gerontology clinical nurse specialists. Its older population-specific CNS certifications were retired as the Consensus Model took effect, and from 1 November 2017 only initial APRN certifications aligned to the Consensus Model have been available.
- AACN Certification Corporation — Certifies clinical nurse specialists in the adult-gerontology, pediatric and neonatal populations, all ABSNC accredited.
- National Association of Clinical Nurse Specialists (NACNS) — The specialty association. It endorsed the Consensus Model and tracks CNS scope of practice, though it defers to NCSBN for the state-by-state position.
Credential detail for clinical nurse specialists is researched by hand from the bodies that issue it, not derived from BLS or O*NET. Sources last checked August 23, 2026. Requirements change: confirm with your own state board before enrolling in anything.
- Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (2008) · checked August 23, 2026
- NCSBN: APRN regulation · checked August 23, 2026
- NCSBN: APRN Consensus Model by State, as of December 2024 (archived copy; NCSBN has removed the live version) · checked August 23, 2026
- NCSBN: South Dakota enacts the APRN Compact (implementation at seven states) · checked August 23, 2026
- ANCC: Adult-Gerontology Clinical Nurse Specialist certification · checked August 23, 2026
- ANCC: APRN Consensus Model and retired certifications · checked August 23, 2026
- ANCC Certification Renewal Handbook · checked August 23, 2026
- AACN Certification Corporation: ACCNS-AG certification · checked August 23, 2026
- AACN Certification Corporation: ACCNS-AG exam handbook · checked August 23, 2026
- AACN Certification Corporation: CCNS renewal handbook (no late or retroactive renewal) · checked August 23, 2026
- NACNS: What is a CNS? · checked August 23, 2026
- BLS Occupational Outlook Handbook: Registered Nurses · checked August 23, 2026
What the federal data says
Registered nurses usually take one of three education paths: a bachelor’s degree in nursing, an associate’s degree in nursing, or a diploma from an approved nursing program. Registered nurses must be licensed.
| Typical entry-level education | Bachelor's degree |
|---|---|
| Preparation needed (O*NET job zone) | Considerable preparation |
| Work experience in a related occupation | None |
| Typical on-the-job training | None |
What education people in the job have
O*NET incumbent survey: the highest level of education reported by people already working as clinical nurse specialists.
- Master's Degree85.7%
- Post-Master's Certificate4.8%
- First Professional Degree4.8%
- Doctoral Degree4.8%
What does a Clinical Nurse Specialist do?
Direct nursing staff in the provision of patient care in a clinical practice setting, such as a hospital, hospice, clinic, or home. Ensure adherence to established clinical policies, protocols, regulations, and standards.
Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families.
Day-to-day tasks
- Provide specialized direct and indirect care to inpatients and outpatients within a designated specialty, such as obstetrics, neurology, oncology, or neonatal care.
- Collaborate with other health care professionals and service providers to ensure optimal patient care.
- Read current literature, talk with colleagues, or participate in professional organizations or conferences to keep abreast of developments in nursing.
- Develop, implement, or evaluate standards of nursing practice in specialty area, such as pediatrics, acute care, and geriatrics.
- Maintain departmental policies, procedures, objectives, or infection control standards.
- Instruct nursing staff in areas such as the assessment, development, implementation, and evaluation of disability, illness, management, technology, or resources.
- Develop and maintain departmental policies, procedures, objectives, or patient care standards, based on evidence-based practice guidelines or expert opinion.
- Evaluate the quality and effectiveness of nursing practice or organizational systems.
O*NET core tasks, ordered by reported importance.
Working conditions and hours
Nurses who work in hospitals and nursing care facilities usually work in shifts to provide round-the-clock coverage. They may work nights, weekends, and holidays. They may be on call, which means that they are on duty and must be available to work on short notice.
Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.
Where the work happens
- Indoors, in a climate-controlled space, every day
Working with people
- Face-to-face discussions every day
Pressure and stakes
- Handling conflict situations at least monthly
Autonomy
- A lot of freedom to make decisions without checking first
Schedules: BLS Occupational Outlook Handbook, 2024–2034 edition. Conditions: O*NET Work Context survey, showing only the signals people in the job report decisively one way or the other.
Where clinical nurse specialists work
| Hospitals; state, local, and private | 59% |
|---|---|
| Ambulatory healthcare services | 19% |
| Nursing and residential care facilities | 6% |
| Government, excluding state and local education and hospitals | 5% |
| Educational services; state, local, and private | 3% |
BLS Occupational Outlook Handbook, 2024–2034 edition.
Core skills
- Speaking4.1/5
- Reading Comprehension4.0/5
- Critical Thinking4.0/5
- Active Learning4.0/5
- Monitoring4.0/5
- Active Listening3.9/5
- Writing3.9/5
- Learning Strategies3.6/5
Transferable skills
- Social Perceptiveness4.0/5
- Service Orientation4.0/5
- Judgment and Decision Making4.0/5
- Coordination3.9/5
- Complex Problem Solving3.9/5
- Persuasion3.6/5
- Time Management3.6/5
- Instructing3.5/5
Tools and software
- Electronic mail software · in demand
- Medical software · in demand
- Office suite software · in demand
- Presentation software · in demand
- Spreadsheet software · in demand
- Word processing software · in demand
- Information retrieval or search software
- Internet browser software
“In demand” marks an O*NET Employer-Based Hot Technology, software named in real job postings for this occupation.
What personality type suits a Clinical Nurse Specialist?
Interest profile: O*NET Occupational Interests, scored 1–7
Realistic2.3
Investigativeprimary4.9
Artistic1.8
Socialprimary6.2
Enterprising3.7
Conventionalprimary4.0
Day to day this is work built around teaching, helping and working directly with other people, combined with investigating, analysing and solving problems with ideas and data.
Closest MBTI types
NueCareer fit scores: cosine similarity between each MBTI type's interest vector and this occupation's O*NET interest profile. Not a BLS or O*NET figure; the method is documented on our methodology page.
Clinical Nurse Specialist: frequently asked questions
How much do Clinical Nurse Specialists make?
Clinical Nurse Specialists earn a median of $97,550 a year (BLS OEWS, May 2025). That is 91% above the $50,980 median for all US occupations. That works out at $46.90/hr. The middle half earn between $80,330 and $112,350. The top 10% earn $137,470 or more.
Do you need a degree to become a Clinical Nurse Specialist?
Yes. BLS reports a bachelor's degree as the typical entry-level education for Clinical Nurse Specialists, and O*NET rates the preparation needed as considerable preparation. In O*NET's survey of people already doing the job, 85.7% hold master's degree.
Is Clinical Nurse Specialist a growing career?
Yes. Employment is projected to grow 4.9% over 2024–2034, faster than the 3.1% average for all occupations (BLS EP, 2024–2034). BLS still projects about 189,100 openings a year, mostly from workers retiring or moving to other work.
What does a Clinical Nurse Specialist do?
Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families. A core O*NET task: provide specialized direct and indirect care to inpatients and outpatients within a designated specialty, such as obstetrics, neurology, oncology, or neonatal care. Employers most often ask for Electronic mail software, Medical software, Office suite software.
Which states pay Clinical Nurse Specialists the most?
The highest state medians for Clinical Nurse Specialists are California ($140,270), Hawaii ($136,320), Oregon ($129,010) (BLS OEWS, May 2025).
What personality type suits a Clinical Nurse Specialist?
O*NET scores Clinical Nurse Specialists highest on the Social, Investigative and Conventional interest areas, so the work mixes teaching, helping and working directly with other people with investigating, analysing and solving problems with ideas and data. On NueCareer's MBTI-to-interest mapping the closest types are ESFJ, ENFJ. Personality is a fit signal, not a gate. The free NueCareer quiz scores your own profile against all 923 occupations in the bank.
How long does it take to become a Clinical Nurse Specialist?
Neither NACNS nor the accreditors publish a CNS-specific programme length, so any single figure would be invented. What is fixed is the credential level, a master's, doctorate or post-graduate certificate, and the 500 supervised clinical hours both certifying bodies require.
Do you need a license to work as a Clinical Nurse Specialist?
Yes, and it is issued by the state you work in, not nationally. This is the field where the CNS diverges most from the nurse practitioner, and it is worth checking before enrolling. On NCSBN's APRN Consensus Model by State table as of December 2024, Mississippi, New Hampshire, Pennsylvania and American Samoa did not include the CNS among their recognised APRN roles (Pennsylvania regulates CNSs through its education and certification elements while excluding the role from its roles element). California and New York recognised the CNS but specified neither independent practice nor prescriptive authority for it, while granting more to nurse practitioners. Full independent CNS practice and prescribing existed in 26 jurisdictions, including Alaska, Arizona, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Idaho, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Mexico, Oregon, Rhode Island, Utah, Vermont, Washington, West Virginia and Wyoming, while Georgia, Indiana, Louisiana, Michigan, Missouri, New Jersey, Ohio, Oklahoma, South Carolina, Tennessee and Texas required collaboration or supervision for both practice and prescribing. That table is the most recent regulator-published version and NCSBN has since taken its APRN maps offline, so confirm the current position with your own board. The APRN Compact has been enacted in four jurisdictions, Delaware, North Dakota, Utah and South Dakota, and will be implemented when seven have enacted it, so it is not yet available to anyone.
What exams do you have to pass to become a Clinical Nurse Specialist?
The AGCNS-BC (Adult-Gerontology Clinical Nurse Specialist certification) and the ACCNS-AG, ACCNS-P, ACCNS-N (Adult-Gerontology, Pediatric and Neonatal CNS certifications). 175 items of which 150 are scored and 25 are unscored pretest items, over 3.5 hours. Eligibility requires an active RN licence, a master's, post-graduate certificate or DNP in adult-gerontology CNS from a CCNE-, ACEN- or NLN CNEA-accredited programme, 500 faculty-supervised clinical hours, and three separate graduate courses in advanced pathophysiology, advanced health assessment and advanced pharmacology. The 2025 pass rate was 88 percent. Certification runs for 5 years.