Becoming a Clinical Nurse Specialist

Five Tips to Help You Find the Right CNS Program

Written by Esther Rathjen APRN-CCNS Burn and Wound Center & Endoscopy

As young person, I always knew that I wanted to be somewhere in the medical field. Nursing was sort of an automatic route for me, as I can't recall a specific moment when I made a conscious just always seemed to be the natural choice.

During the course of obtaining my Bachelors Degree in Nursing, I had already begun to think about becoming a Clinical Nurse Specialist. After graduating, I was extremely fortunate to find a position as a Registered Nurse near my home with an environment rich in experienced Clinical Nurse Specialists.

I chose one of them as my mentor, which was a formal process in our organization. I took some time during my first year of employment to job shadow my mentor, and what I found was not for me. At this time the CNS's had NO patient contact and it seemed to me that they barely knew what the nurses in the hospital did on a daily basis, what they went through, or what their concerns were.

I asked myself, "How do I advocate for change and improved quality, when I have no idea how this directly impacts those who do the work?" At that time I could not answer that question. I put it to the back of my mind, and went back to work. Fortunately, for me, I enjoyed my position in the Burn and Wound Center where I was working a great deal, and stayed within the organization.

Over the next 10 years, the organization I worked for grew and changed. Along with that change, a new model of the Clinical Nurse Specialist evolved. As a result of the changes, along with my dedication to the Burn Unit, something remarkable happened.

I was able to create my dream position as a CNS in the Burn and Wound Center.

With direct responsibilities to ensure clinical quality in my home unit, and half time direct patient care, this mixture was perfect. Not only could I elevate the quality of care of the population of patients I am passionate about and support my nursing colleagues... but I could also continue to hone my bedside skills. Knowing this blend was the future track for the CNS in our organization, I enthusiastically moved forward.

Looking back, one thing I probably did not do, that I should have done, was to really compare CNS programs prior to applying. That said, I was in a GREAT program, but it was NOT focused on the Clinical Nurse Specialist, but rather on the Nurse Practitioner role and scope of practice. I learned a great deal of new nursing knowledge when it came to assessment, diagnosis, treatment, ordering, writing H&P's, and all the components needed to care for patients. However, in my state, these are not functions that are performed by a Clinical Nurse Specialist.

While I learned a great deal of extremely valuable information, that is applicable to my practice as an Advanced Practice Registered Nurse (APRN), this is not what being a CNS is about.

When searching for CNS programs, I failed to look at programs that were outside of my local area. In this digital age, it would not have been a challenge to attend a distance program that was more focused on the CNS role.

Can I tell you I would have chosen a different program, had I researched more thoroughly? I'm not sure. Probably not, but this would have been a wise thing for me to do initially. And it could have made a big difference in the focus of the instruction I received while becoming a Clinical Nurse Specialist.

In retrospect, there are a few other things I can say about choosing a program to become an APRN, whether you are looking at CNS programs, or another Graduate level nursing program. I'll leave you with the following final thoughts and points of advice to consider when applying for MSN programs:

Five Tips to Help You Find the Right CNS Program

1. Cost is not everything. Ensure you can afford the program, but don't automatically rule out a program out on this alone.

2. Don't forget what you already know! It is crucial that you always remember your foundation, anatomy, physiology, and basic nursing care. Everything builds on previous knowledge. The thought should not be "all I need is a C to pass".

3. I strongly encourage you to practice as a bedside RN for at least 2 years prior to entering any Master's level Nursing program From Midwives to Informatics Nurses, all Advanced Practice Registered Nurses (APRN) need a strong foundation of basic nursing knowledge.

4. Know your individual state scope of practice for a CNS. Believe it or not, they vary widely by just crossing borders. The National Association of Clinical Nurse Specialists is working to create a consensus model across states with the CNS role but this has proven to be a very challenging endeavor.

5. Consider programs both near and far. Technology is a great help with an excellent program that you can't physically access. But, with this know yourself. If you are prone to distractions (the doorbell rings, the dishes need to be done, maybe you have children at home) this may not be the program for you. With these programs you need to be dedicated and on task.

To learn more about the role of Clinical Nurse Specialists, and to find programs, please visit our CNS page, where we have provided some excellent resources for you to learn more. From there, you can request information from several different schools offering CNS programs across the nation. You can also visit the National Association of Clinical Nurse Specialists webpage at for additional resources and information.

Photo Credit: National Association of Clinical Nurse Specialists

Esther Rathjen began her nursing career as a CNA and worked her way through the Bachelors of Science in Nursing program at the University of Nebraska Medical Center (UNMC) in Lincoln, NE. Upon graduation in December of 2001, she began working as an RN at the Saint Elizabeth Regional Burn and Wound Center in Lincoln, NE. Supported by her loving family and an especially supportive organization, she earned her Masters Degree in Nursing from UNMC in May of 2011.

Esther currently serves as a Clinical Nurse Specialist in a variety of settings within her organization, including: Inpatient and Outpatient Burn Centers; Outpatient Wound Center; Diabetes Center; and Endoscopy Services. In addition to her CNS role, acts in several different capacities throughout the organization and is involved in the Safety 1st core team, documentation team, electronic medical record transition team, and the Diabetes Certification team.

Esther is grateful for the many opportunities she has to promote and support the profession of nursing, and says, in her own words, "I am extraordinarily lucky to have the support of my family and my organization, in job I truly love. And I am privileged to be asked by to guest write!"