Clinical educator, quality improvement director, unit leader, clinical coordinator, case manager, patient advocate… these are just a few of the titles that adult-gerontology clinical nurse specialists hold. The unique position CNSs occupy allows them to focus on improving patient care and achieving the best outcomes for adults from a direct patient care perspective, rather than a top-down executive-level perspective.
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The Adult Gerontology Clinical Nurse Specialist (AG-CNS) is focused on the care of vulnerable and complex adult and older adult populations. Involved in all levels of the healthcare system ranging from primary to acute care, AG-CNSs are called on to take the best evidence developed through research and incorporate it into practice, with a sole focus on improving patient outcomes and elevating nursing practice.
AG-CNSs provide both direct and indirect patient care, advocating for adult patients and working to optimize outcomes by assuring they get the best nursing care possible.
Unlike adult-gerontology nurse practitioners, who are on the frontlines serving as autonomous practitioners, AG-CNSs assume more collaborative, behind-the-scenes roles that involve designing and implementing plans of care for specific units and to address specific diseases and conditions.
Whether they’re providing highly specialized nursing care or assuming leadership roles, AG-CNSs are often found:
- Coaching and mentoring nurses
- Advising the interdisciplinary healthcare team
- Counseling professionals, organizations, patients, and families
- Coordinating/managing plans of care
Outside of direct care settings, AG-CNSs lead healthcare teams, conduct nursing research, and influence policy related to the entire adult- and older-adult patient population.
They may focus their practice on either primary or acute care:
- Those in acute care are responsible for improving outcomes for patients with acute and chronic health problems, making them highly valued in critical care units, subacute units, and other inpatient settings.
- AG-CNSs in primary care are responsible for overseeing the delivery of nursing care for well or ill patients in homes, hospitals, skilled nursing facilities, and specialty practices (cardiology, orthopedics, oncology, etc.).
Education and Certification Requirements to Become an Adult-Gerontology Clinical Nurse Specialist
Adult-gerontology clinical nurse specialists must, at a minimum, hold an MSN in their chosen role and population focus and certification through a nationally recognized certification board. Most states license AG-CNSs, but state licensing requirements vary among those states that don’t recognize these advanced nursing professionals as APRNs.
Although the MSN remains the minimum educational requirements to become a CNS, in recent years, there has been a consistent movement toward the Doctor of Nursing Practice (DNP) for these and other APRN professionals. In most cases, the DNP comes with more professional opportunities, a larger paycheck, and greater recognition and respect among other doctorate-level professionals within the interdisciplinary healthcare community, such as physical therapists, occupational therapists, audiologists, pharmacists, etc.
Fortunately, this shift toward the DNP has spurred many colleges and universities to expand their DNP offerings, and there are more DNP-CNS programs available than ever before. In addition, many institutions have begun offering a variety of DNP programs that best accommodate students with different backgrounds and educational degrees.
DNP programs are designed in one of three ways:
- MSN-DNP: This traditional DNP path takes about two years to complete and consist of about 36 credits.
- BSN-DNP: This path is for BSN-prepared RNs and includes the components of both the MSN and DNP; it takes about three years and 73 credits to complete.
- Direct-Entry DNP: This unique DNP program is designed specifically for students who hold a bachelor’s degree in a non-nursing major. The program includes the components necessary to earn RN licensure, the MSN, and DNP. It takes about four and a half years to complete and consists of between 65-80 credits.
The DNP includes courses and clinical experiences necessary to meet the AACN’s 8 DNP Essentials and qualify for national certification. It also culminates in a DNP project – a project unique to DNP programs that’s focused on improving patient outcomes.
Just some of the courses unique to an AG-CNS DNP program include:
- Quality and Safety for the Aging Adult
- Management: Adult/Gerontology Acute & Critical Illness
- Management of Complex Health Problems of the Acutely & Critically Ill
- Geriatric Health Theory
- Management of Adult Episodic/Chronic Health Problems in Acute Care Theory
Graduates are eligible to take one of the following certification exams to earn national certification as an AG-CNS:
American Association of Critical-Care Nurses (AACN)
- Clinical Nurse Specialist: Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
American Nurses Credentialing Center (ANCC)
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
Independent Practice Authority and the Adult-Gerontology Clinical Nurse Specialist
Clinical nurse specialists have fought for practice autonomy and prescriptive authority for decades. Their ability to practice as independent practitioners ensures outstanding care to patients and their families and support for nurses caring for patients at their bedside.
As of 2020, CNSs enjoy independent practice authority in 28 states. Of these states, 19 allow CNSs to prescribe independently.
Another 13 states recognize CNSs as APRNs but require them to practice under a collaborative physician agreement, while another 19 states require CNSs to enter into a physician collaborative agreement when prescribing drugs and durable medical equipment.
CNSs are not recognized as APRNs and therefore have a limited scope of practice in California, Pennsylvania, Florida, Mississippi, Alabama, New York, New Hampshire, Michigan, and Virginia. In Maryland, only psychiatric and mental health CNSs have been granted independent practice authority.
Salary Expectations for Adult-Gerontology Clinical Nurse Specialists
According to a 2019 Medscape Compensation Report, clinical nurse specialists earned a gross annual income of $103,000. Those who were paid hourly earned slightly more, at $106,000, largely due to opportunities to earn overtime pay. This salary survey found that those with the DNP earned about $2,000 more annually than their MSN-counterparts.