Pediatric clinical nurse specialists (PCNS) provide primary and ongoing care for their pediatric patients and families throughout the lifespan, while providing consultation and support for nurses providing bedside peri-operative care.
Thanks to the work of these advanced practice nurses, infants, children and adolescent patients and their families enjoy a highly specialized system of care that results in the best possible outcomes. Whether they’re improving care at the bedside or leading change through the design and implementation of new initiatives, pediatric clinical nurse specialists are elevating nursing practice and healthcare systems as a whole.
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The expertise they bring to both direct patient care and systems/organizational roles allows them to foster a collaborative, comprehensive system of care for both healthy children and adolescents, and those with any number of acute or chronic illnesses or diseases.
Whether they’re working in pediatric intensive care units, pediatric clinics, schools, or in home-based settings, these pros are focused on clinical decision making, systems thinking, empowering and mentoring nurses, collaborating and coordinating care with the interdisciplinary healthcare team, and providing culturally sensitive, family-focused healthcare.
PCNSs effect change in pediatric units and pediatric agencies, where they integrate care across the continuum. Rather than a top down approach, they work to effect change from within. Much of their work is also focused on education – for patients and their families and for the nursing staff. Their efforts are often seen through the development of quality improvement and outcome monitoring initiatives designed to improve the safety of the pediatric population that a hospital or other medical facility serves.
Becoming a Pediatric Clinical Nurse Specialist: Education and Certification Requirements
To become a pediatric clinical nurse specialist, you’ll need to be nationally certified and licensed in the state in which you practice. But before you can do this, you’ll need to complete an MSN or DNP degree in the CNS role and pediatric population focus. While the MSN remains the minimum educational requirement needed to sit for the appropriate national certification exam, in recent years there has been a clear shift toward the DNP as a path to advanced practice.
The DNP offers what many APRNs are looking for: advanced preparation and professional recognition. The DNP falls in line with many of the other doctorate-level professions within the interdisciplinary healthcare team (physical therapists, audiologists, occupational therapists, pharmacists, etc.), so many CNSs choose to earn this highest clinical nursing degree for the respect and recognition it demands. The DNP, for many CNSs, also means a bigger paycheck and more professional opportunities.
In response to the increased demand for the DNP, many colleges and universities have begun offering this degree, and many more have developed a number of entry points to the DNP:
- MSN-DNP: This traditional DNP program features about two years of study and 36 credits.
- BSN-DNP: This DNP program is designed for the BSN-prepared RN who wants to earn both the MSN and DNP through one, combined course of study. It consists of about three years of study and 73 credits.
- Direct-Entry DNP: The direct-entry DNP is designed specifically for students who have completed a bachelor’s degree from an accredited college or university in a non-nursing major. Students of this program earn their RN license, MSN, and DNP in about four and a half years.
The DNP is a unique blend of classroom and clinical experiences that meets the AACN’s 8 DNP Essentials and satisfies the requirements for national certification. Through the DNP, students complete about 500 hours of clinical experiences (in addition to the 500 they completed through their MSN program) and a DNP final project – an opportunity to create a real-world project designed to produce meaningful change in the practice of nursing.
Some of the courses unique to the PCNS program include:
- Advanced Primary Care of the Child
- Pediatric Acute Care
- Assessment and Interventions for Children and Youth with Special Healthcare Needs
- Primary Care: Assessment of Health and Care of Well Children
Once you’ve graduated, you’ll be eligible to sit for one of the following exams:
American Association of Critical-Care Nurses (AACN)
- Clinical Nurse Specialist: Wellness through Acute Care (Pediatric) (ACCNS-P)
American Nurses Credentialing Center (ANCC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
Practice Autonomy and Prescriptive Authority: Practice Rights for Pediatric Clinical Nurse Practitioners
Your practice rights as a pediatric clinical nurse specialist vary according to the state in which you practice. Like so many other APRNs, clinical nurse specialists have long fought for the right to practice independent of a physician. In some states, they’ve achieved this position; in others, they must continue to practice under physician oversight. And in a few states, these expert nurses are not recognized as APRNs and must therefore practice under a limited scope:
- 28 states allow CNSs independent practice authority, although just 19 of these states grant CNSs prescriptive authority.
- 13 states require CNSs to practice under a collaborative physician agreement or some other type of physician oversight.
- 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.
Salary Expectations for Pediatric 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 – thanks to opportunities to earn overtime pay. This salary survey found that those with the DNP earned about $2,000 more annually than those with an MSN as their highest degree.