Evidence-based practice, collaboration, education, consultation, mentoring and change leadership—the neonatal clinical nurse specialist leads clinical practice, coordinates the clinical activities of neonatal nurses, and ensure the highest quality care in the most cost-effective manner.
Neonatal clinical nurse specialists are making extraordinary changes in healthcare for our nation’s youngest patients through improvements in nursing care and the systems in which the care is delivered. From public health clinics to inpatient neonatal intensive care units and beyond, neonatal CNSs are called upon to ensure outstanding, innovative care for neonates, from simple wellness check-ups all the way to the NICU.
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These advanced practice registered nurses (APRNs) attend to newborns and their families, while supporting the staff nurses providing care at the bedside. Outside of the clinical environment, they are leading new initiatives, supporting new technologies, and driving improvements in healthcare systems at every level.
Whether they’re assuming the title of clinician, clinical consultant, educator, program director, or leader, neonatal CNSs bring their expertise in research, clinical judgment, systems thinking, interdisciplinary collaboration, and care delivery models to advance the care of neonates.
These professionals are often important collaborators within an institution’s education department, where they oversee unit-wide and hospital-wide nursing education standards and development, both for new hires and for continuing education purposes.
They are a valuable addition to the kind of multidisciplinary teams found in major hospitals, working right alongside physicians, nurse practitioners, nurse managers, pharmacists and RNs, performing their jobs with an eye toward improving clinical and operational workflow.
Their work includes evaluating new and existing systems interventions to ensure clinical effectiveness, patient responses, cost effectiveness, customer satisfaction, ethical considerations, and more, and they do it all from the clinical perspective. Rather than a top down approach, clinical nurse specialists are unique in that they work to bring about improvements in both patient care and policy from within the clinical environment.
How to Become a Neonatal Clinical Nurse Specialist: Education and Certification Requirements
To become a neonatal CNS, you’ll need to become nationally certified and, in most cases, state licensed. The MSN is the minimum educational requirement necessary to become a neonatal CNS although, in recent years, there has been a clear trend toward the Doctor of Nursing Practice (DNP).
Along with recognition and respect among the doctorate-prepared interdisciplinary healthcare community (physical therapists, occupational therapists, pharmacists, audiologists, etc.), the DNP often means a bigger paycheck and more professional opportunities for CNSs.
Colleges and universities have responded to this shift toward the DNP by offering more of these programs than ever before.
Now, DNP programs are designed for students with a variety of educational backgrounds:
- MSN-DNP: The MSN-DNP is designed for both MSN-prepared APRNs and non-APRNs with a master’s in nursing, and features about 36 credits and two years of full-time study.
- BSN-DNP: The BSN-DNP, designed for BSN-prepared RNs combines the MSN and DNP into one, streamlined program; it includes about 73 credits and takes about three years to complete.
- Direct-Entry DNP: This unique degree is specifically designed for career-changers who hold a bachelor’s degree in a non-nursing field. It consists of about four and a half years of study and includes RN licensure, the MSN, and the DNP.
The Neonatal Clinical Nurse Specialist DNP consists of coursework and clinical experiences that meet the AACN’s 8 DNP Essentials and satisfy the requirements for national certification. Some of the courses specific to the Neonatal Clinical Nurse Specialist DNP include:
- Developmental Physiology Fetus/Neonates
- Neonatal Management
- Neonatal Pharmacotherapeutics
The DNP also includes about 500 hours of clinical experiences and a final DNP project – a real-world project highlighting the advancement of the nursing profession.
Graduates are eligible to take the Clinical Nurse Specialist: Wellness through Acute Care (Neonatal) (ACCNS-N) national certification exam through the American Association of Critical-Care Nurses (AACN).
Practice Autonomy and Prescriptive Authority: Neonatal Clinical Nurse Specialists and Their Scope of Practice
In 28 states, neonatal clinical nurse specialists enjoy independent practice authority and in 19 of those states, these APRNs also have prescriptive authority.
In another 13 states, CNSs must practice under a collaborative physician agreement or other type of physician oversight, and in California, Pennsylvania, Florida, Mississippi, Alabama, New York, New Hampshire, Michigan, and Virginia, CNSs are not recognized as APRNs and therefore have a limited scope of practice.
Salaries for Neonatal Clinical Nurse Specialists
A 2019 Medscape Compensation Report found that, in most cases, neonatal clinical nurse specialists earned well into the six figures. The report found that these APRNs earned a gross annual income of $103,000. Those paid hourly earned about $3,000 more annually, largely due to opportunities to earn overtime pay.
In addition, CNSs with the DNP earned about $2,000 more annually than those with the MSN as their highest degree.