Clinical Nurse Specialist (CNS) pay sits between the RN median and the nurse practitioner median – for most CNSs, somewhere in the $105,000–$120,000 range. That figure comes with an important caveat: the Bureau of Labor Statistics does not publish CNS as a separate occupation, so no official CNS median exists. CNSs are counted under either SOC 29-1141 (Registered Nurses, national median $97,550) or SOC 29-1171 (Nurse Practitioners, national median $132,300), depending on how a given state classifies CNS practice and how an employer codes the role.
Those two BLS figures are the defensible bookends. Anything presented as a precise national CNS median – including the numbers on salary aggregator sites – is an estimate built on self-reported job-title data, not a government wage series. This guide labels every estimate as such and shows you the BLS data underneath it, so you can see which parts are measured and which are inferred.
CNS salary ranges are wide in practice. A critical care CNS in California with hospital-side income and shift differentials can reach $150,000–$165,000. A new CNS in a restrictive practice state working in a long-term care consulting role may earn $88,000–$95,000. The data below gives you the full picture.
CNS salary at a glance
| Metric | Value | Source |
|---|---|---|
| CNS national median (estimated) | ~$105,000–$120,000 | Estimate – falls between the two BLS codes CNSs are counted under |
| Registered nurses – national median | $97,550 | BLS OEWS SOC 29-1141, May 2025 (measured) |
| Nurse practitioners – national median | $132,300 | BLS OEWS SOC 29-1171, May 2025 (measured) |
| Nurse practitioners – 10th percentile | $101,340 | BLS OEWS SOC 29-1171, May 2025 (measured) |
| Nurse practitioners – 25th percentile | $117,990 | BLS OEWS SOC 29-1171, May 2025 (measured) |
| Nurse practitioners – 75th percentile | $156,700 | BLS OEWS SOC 29-1171, May 2025 (measured) |
| Nurse practitioners – 90th percentile | $174,420 | BLS OEWS SOC 29-1171, May 2025 (measured) |
| CNS hourly (median estimate) | ~$50–$58/hour | Estimate – derived from the annual range at 2,080 hours |
| New CNS graduate (entry-level) | ~$85,000–$95,000 | Estimate – job-posting and aggregator data, not a BLS series |
| Top CNS earners | $150,000–$175,000+ | Estimate – critical care CNS, high-cost states, senior roles |
Why CNS salary data is complicated
The data problem is worth explaining before the numbers, because it affects how you should interpret any CNS salary figure you encounter – on this page or anywhere else.
The Bureau of Labor Statistics categorizes healthcare workers by job function, not by credential. Clinical Nurse Specialists are assigned to different SOC codes depending on state practice law and how each state defines CNS scope:
- SOC 29-1171 (Nurse Practitioners): States that recognize CNS as a distinct APRN practice category typically include CNSs in this code. The BLS national median for SOC 29-1171 is $132,300 (May 2025).
- SOC 29-1141 (Registered Nurses): States that classify CNSs as RNs with specialty training – rather than as APRNs – count CNSs in the RN code. The BLS national median for SOC 29-1141 is $97,550 (May 2025).
Most CNSs in hospital systems with full APRN recognition fall into the SOC 29-1171 bucket and earn toward the upper part of the range. CNSs in states with weaker CNS practice legislation tend to sit closer to the RN median.
It is worth being explicit about what does not exist. The main national CNS data collection is the NACNS CNS Census, a biennial survey run in 2014, 2016, 2018, 2020 and 2022, with a 2026 round fielded in May and June 2026. The Census captures demographics, practice settings, time allocation, prescriptive authority and reimbursement models – it does not collect individual salary data. There is no authoritative national CNS compensation survey, and any source presenting a precise CNS median with a decimal point behind it is reporting an aggregator’s estimate from self-reported job titles.
For the salary data in this guide: state figures are the BLS OEWS SOC 29-1171 medians, which are measured and citable, presented alongside an estimated CNS range for that state. The estimated ranges are anchored between each state’s RN median and its NP median, on the reasoning that CNSs are counted in one of those two codes. They are clearly labeled as estimates. Where a figure is a BLS measurement, this guide says so; where it is an inference, it says that too.
CNS salary by state
The table below shows BLS OEWS May 2025 state-level NP median salary (SOC 29-1171), which is measured data, alongside an estimated CNS range for that state. The estimated ranges sit below the state NP median, reflecting that CNS roles are typically salaried without the independent billing revenue that supports NP compensation. Critical care and acute-care CNS roles commonly sit at the top of the estimated range or above it.
| State | NP median (BLS, May 2025) | Estimated CNS salary range |
|---|---|---|
| Alabama | $105,750 | $85,000–$101,000 |
| Alaska | $155,170 | $129,000–$147,000 |
| Arizona | $134,420 | $111,000–$128,000 |
| Arkansas | $125,660 | $104,000–$119,000 |
| California | $168,520 | $140,000–$160,000 |
| Colorado | $132,930 | $110,000–$126,000 |
| Connecticut | $138,470 | $115,000–$132,000 |
| Delaware | $131,040 | $109,000–$124,000 |
| District of Columbia | $135,880 | $113,000–$129,000 |
| Florida | $129,510 | $107,000–$123,000 |
| Georgia | $129,430 | $107,000–$123,000 |
| Hawaii | $135,570 | $112,000–$129,000 |
| Idaho | $132,540 | $110,000–$126,000 |
| Illinois | $130,680 | $108,000–$124,000 |
| Indiana | $128,830 | $107,000–$122,000 |
| Iowa | $130,160 | $108,000–$124,000 |
| Kansas | $126,650 | $105,000–$120,000 |
| Kentucky | $122,870 | $102,000–$117,000 |
| Louisiana | $125,600 | $104,000–$119,000 |
| Maine | $130,260 | $108,000–$124,000 |
| Maryland | $131,110 | $109,000–$124,000 |
| Massachusetts | $142,440 | $118,000–$135,000 |
| Michigan | $131,450 | $109,000–$125,000 |
| Minnesota | $133,260 | $110,000–$127,000 |
| Mississippi | $124,730 | $103,000–$118,000 |
| Missouri | $129,930 | $108,000–$123,000 |
| Montana | $137,210 | $114,000–$130,000 |
| Nebraska | $132,130 | $110,000–$125,000 |
| Nevada | $140,670 | $117,000–$134,000 |
| New Hampshire | $137,550 | $114,000–$131,000 |
| New Jersey | $159,310 | $132,000–$151,000 |
| New Mexico | $137,520 | $114,000–$131,000 |
| New York | $153,510 | $127,000–$146,000 |
| North Carolina | $128,990 | $107,000–$123,000 |
| North Dakota | $130,070 | $108,000–$124,000 |
| Ohio | $124,870 | $104,000–$119,000 |
| Oklahoma | $133,390 | $111,000–$127,000 |
| Oregon | $155,680 | $129,000–$148,000 |
| Pennsylvania | $130,140 | $108,000–$124,000 |
| Rhode Island | $135,970 | $113,000–$129,000 |
| South Carolina | $123,290 | $102,000–$117,000 |
| South Dakota | $128,840 | $107,000–$122,000 |
| Tennessee | $117,590 | $97,000–$112,000 |
| Texas | $131,670 | $109,000–$125,000 |
| Utah | $130,920 | $109,000–$124,000 |
| Vermont | $134,740 | $112,000–$128,000 |
| Virginia | $127,810 | $106,000–$121,000 |
| Washington | $156,100 | $130,000–$148,000 |
| West Virginia | $127,320 | $106,000–$121,000 |
| Wisconsin | $131,980 | $110,000–$125,000 |
| Wyoming | $132,200 | $110,000–$126,000 |
Note: NP median figures are BLS OEWS SOC 29-1171, May 2025 – measured data. CNS figures are estimates, not BLS measurements, and are presented as ranges for that reason. Critical care CNS and acute-care hospital CNS roles in each state may earn at or above the NP median shown. States that classify CNSs under the RN code (SOC 29-1141) would show lower figures; those CNSs tend to earn below the estimates above.
California leads at $168,520 for NPs, with an estimated CNS range of $140,000–$160,000 – a reflection of both the state’s premium healthcare wage structure and its strong CNS practice authority. New Jersey, Washington, Oregon, Alaska and New York follow, all with NP medians above $150,000. Alaska and Oregon are worth flagging: both climbed sharply in the May 2025 data, and small-state estimates carry wider sampling error than the large-state figures.
Tennessee sits at the bottom of the advanced practice range at $117,590, with Alabama below it at $105,750, reflecting lower healthcare wage structures across much of the South.
CNS salary by specialty
Specialty is one of the most significant drivers of CNS compensation – more so than for many NP specialties, because CNS roles map closely to hospital service lines where pay scales vary significantly.
| CNS specialty | Estimated salary range | Notes |
|---|---|---|
| Critical care / acute care CNS | $115,000–$165,000 | Highest-paid CNS specialty; ICU, cardiac care, trauma. Current AACN credential is ACCNS-AG (also ACCNS-P, ACCNS-N); the older CCNS is renewal-only |
| Cardiac / cardiovascular CNS | $108,000–$145,000 | Heart failure clinics, cardiac ICU; high demand in large health systems |
| Oncology CNS | $105,000–$140,000 | Cancer center expansion driving demand; ONCC's AOCNS has been renewal-only since March 2022 |
| Neonatal CNS | $103,000–$138,000 | NICU settings; smaller supply of trained CNSs creates premium in many markets |
| Adult-gerontology CNS | $98,000–$130,000 | Broad hospital application; aging population demand increasing |
| Pediatric CNS | $95,000–$128,000 | Children's hospital systems; competitive for experienced pediatric RNs |
| Psychiatric-mental health CNS | $95,000–$130,000 | Inpatient psychiatry, community mental health; prescriptive authority varies by state |
| Wound/ostomy/continence CNS | $90,000–$120,000 | Specialty certification (CWOCN); strong demand in long-term care and home health |
| Infection control CNS | $95,000–$125,000 | Post-pandemic demand; hospital epidemiology and quality roles |
Critical care CNSs consistently command the highest salaries – a pattern driven by several factors. Hospital systems compete intensely for clinical experts who can reduce ICU complications, drive sepsis protocol compliance, and reduce length of stay in their highest-cost units. A single ICU CNS who reduces catheter-associated UTI rates or decreases ICU length of stay generates far more cost savings than her salary represents. That calculus keeps critical care CNS compensation competitive.
Oncology CNS salaries are also strong and trending upward as large cancer center networks expand. Cancer centers are competing for specialized clinical experts who can support complex chemotherapy protocols, manage infusion safety programs, and provide expert nursing consultation to oncology teams.
A note on which certification to pursue. Several CNS credentials that appear in older salary guides and job postings are closed to new candidates. AACN’s CCNS and ONCC’s AOCNS are both renewal-only – existing holders can maintain them, but the exams are no longer offered for initial certification. If you are certifying now, the current options are AACN’s ACCNS-AG, ACCNS-P and ACCNS-N (exam fee $275 for AACN members, $385 for nonmembers) and ANCC’s AGCNS-BC. Verify against the certifying body’s own site before you pay for a review course keyed to a retired exam.
CNS salary by work setting
| Work setting | Estimated CNS annual salary range | Notes |
|---|---|---|
| Inpatient hospital – critical care | $115,000–$165,000 | Highest-paying setting; ICU, cardiac care, trauma; shift differentials add to base |
| Inpatient hospital – general acute care | $100,000–$130,000 | Med-surg, step-down, oncology, surgical; most common CNS setting |
| Academic medical center | $105,000–$135,000 | Often includes teaching, research, and clinical components; joint faculty appointment possible |
| Outpatient specialty clinic | $98,000–$125,000 | Heart failure clinic, oncology infusion, wound care; direct patient contact plus protocol management |
| Long-term care / SNF | $85,000–$108,000 | Lower base pay; NHSC loan repayment often available at qualifying facilities |
| Home health / community | $88,000–$112,000 | Per-visit or salaried structures vary; growing area for wound care and psychiatric CNSs |
| Independent consultant | $95,000–$150,000+ | Regulatory compliance, Magnet preparation, infection control; highly variable based on specialization |
| Government / VA / federal | $100,000–$140,000 | GS pay scale plus locality pay; strong benefits; APRN recognition within VA generally strong |
| Health system administration | $110,000–$155,000 | Director-level roles; Director of Professional Practice, VP of Nursing Quality |
The hospital-based acute care CNS role is where the credential has the most structured pay infrastructure. Hospital CNS positions are typically classified under clinical ladder systems, and experienced CNSs with specialty certification and demonstrated quality outcomes negotiate well within those structures.
Independent consulting stands out as a high-ceiling option for experienced CNSs with specialized expertise. CNSs who develop deep knowledge in infection control, regulatory compliance (Joint Commission preparation), Magnet program development, or healthcare technology clinical advisory can command daily consulting rates that translate to $130,000–$175,000 annually without the shift-work burden of hospital roles.
CNS vs NP vs RN salary comparison
| Credential | National median (or estimate) | BLS source / basis | Primary setting |
|---|---|---|---|
| CRNA (Certified Registered Nurse Anesthetist) | $236,590 | BLS OEWS SOC 29-1151, May 2025 | OR, ASC, hospital |
| CNM (Certified Nurse Midwife) | $134,040 | BLS OEWS SOC 29-1161, May 2025 | OB/GYN, birth center, hospital |
| NP (all specialties) | $132,300 | BLS OEWS SOC 29-1171, May 2025 | Clinic, hospital, primary care |
| CNS (Clinical Nurse Specialist) | ~$105,000–$120,000 est. | Estimate – no BLS series; counted under 29-1141 or 29-1171 | Hospital, academic, outpatient |
| RN (Registered Nurse) | $97,550 | BLS OEWS SOC 29-1141, May 2025 | Hospital, clinic, community |
| LPN / LVN | $64,400 | BLS OEWS SOC 29-2061, May 2025 | LTC, clinic, home health |
CNSs earn more than RNs. Against the measured RN median of $97,550, the estimated CNS band of $105,000–$120,000 implies a premium of roughly $7,500 at the low end and $22,500 at the high end, with the midpoint near $15,000. That premium reflects the MSN credential and APRN designation, and it is an inference from the estimated band rather than a measured differential. The gap between CNS and NP median compensation is real, though narrower than the headline BLS numbers suggest for CNSs in acute hospital settings. The gap is widest in primary care and outpatient settings, where NPs billing independently generate practice revenue that CNSs typically do not.
The CRNA figure at $236,590 sits in a different tier entirely – nurse anesthesia is a separate APRN specialty requiring a doctoral degree and is not a comparison point for CNS career planning.
Factors affecting CNS salary
State practice authority
States that grant full APRN recognition to CNSs – including prescriptive authority without mandatory physician collaboration – enable CNSs to fill roles with higher billing potential and negotiate compensation closer to NP benchmarks. States with weaker CNS practice statutes or that classify CNSs under the RN scope limit CNS earning potential structurally.
The most recent count NACNS cites, drawn from NCSBN data, is 24 states allowing independent CNS prescribing and a further 15 allowing prescribing under a collaborative agreement with a physician. That count dates from 2021 and state legislatures revisit APRN scope regularly, so treat it as a starting point. New graduates planning CNS careers should verify their target state’s current CNS practice authority with that state’s board of nursing before committing to a program or accepting a job offer.
Specialty and acuity level
Critical care, cardiac, and oncology CNSs consistently earn more than general adult-gerontology or psychiatric CNSs in comparable states. The premium reflects both the complexity of the specialty and the degree to which hospital systems can quantify the CNS’s clinical and financial contribution. ICU quality metrics are highly visible to hospital administrators; CNS contributions to ICU outcomes are easier to document and monetize than contributions in settings where outcomes are harder to measure.
Setting and employer type
Large academic medical centers and integrated hospital systems – particularly those with Magnet designation or pursuing Magnet status – tend to pay CNSs more than smaller community hospitals. The ANCC Magnet Recognition Program does not mandate CNS staffing as such; its five model components are transformational leadership, structural empowerment, exemplary professional practice, new knowledge and innovation, and empirical quality results. What the framework does reward is exactly the work CNSs are trained for: nurse-led quality improvement, evidence-based practice implementation, and documented clinical outcomes. Organizations building toward or maintaining Magnet status often invest in CNS roles for that reason, which creates demand and negotiating leverage in those environments.
Years of experience
CNS salary follows a predictable arc: rapid growth in the first five years as clinical credibility and quality improvement outcomes accumulate, steady growth from year five to fifteen, then a plateau unless the CNS moves into administrative or consultancy roles. Experienced CNSs who can demonstrate measurable cost savings or quality outcomes – reduced hospital-acquired infection rates, decreased ICU length of stay, improved nursing staff competency scores – have strong negotiating leverage regardless of the market rate.
Doctoral degree (DNP)
A DNP does not guarantee a salary premium but improves negotiating position at academic medical centers and large health systems, where advanced degree differentials are built into pay scales. Research suggests a $5,000–$12,000 advantage for DNP-prepared CNSs in institutional settings compared to MSN-prepared peers in equivalent roles.
The CNS career ladder: salary progression
CNS salary growth follows a different trajectory than NP salary growth because CNS advancement is tied to system-level impact rather than volume of patient encounters.
| Career stage | Years of CNS experience | Estimated salary range | Key advancement drivers |
|---|---|---|---|
| New CNS (entry) | <1 year | $82,000–$95,000 | Employer type; specialty; state practice authority |
| Early career | 1–3 years | $92,000–$108,000 | Quality project outcomes; specialty certification; clinical credibility with staff |
| Mid-career | 3–7 years | $105,000–$125,000 | Documented cost savings; leadership of major quality initiatives; Magnet coordinator roles |
| Experienced | 7–12 years | $118,000–$140,000 | Multiple specialty certifications; program directorship; independent consulting |
| Senior / director level | 12+ years | $130,000–$175,000+ | Director of Professional Practice; VP Nursing Quality; independent consulting practice |
The leverage point for experienced CNSs is documentation: CNSs who maintain outcome data – cost savings from quality projects, reduction in hospital-acquired conditions, staff competency improvements – build a negotiating portfolio that RNs and many NPs cannot match. A CNS who can demonstrate she reduced central line-associated bloodstream infections by 40% over two years, saving the hospital an estimated $800,000 in avoidable costs, has a compensation conversation grounded in numbers rather than market comparisons.
Frequently asked questions
How much does a clinical nurse specialist make an hour? Based on the estimated median annual band of $105,000–$120,000 used throughout this guide and a standard 2,080-hour work year, the median CNS hourly wage is approximately $50–$58/hour. Critical care CNSs in high-cost states earning $140,000–$160,000 reach $67–$77/hour. Hospital CNSs who receive shift differentials for evening or weekend work add to that base.
Is CNS salary lower than NP salary? For most specialties and settings, yes. Set the estimated CNS band of $105,000–$120,000 against the measured NP median of $132,300 and the gap works out at roughly 9% at the top of the CNS band and about 21% at the bottom. The gap narrows significantly for critical care and acute-care hospital CNSs. The gap exists primarily because NPs in outpatient practice can bill independently for patient encounters, generating practice revenue that supports higher salaries; hospital-based CNSs are typically salaried without direct billing revenue.
What state pays CNSs the most? California consistently ranks at the top for APRN compensation, and the CNS data aligns – estimated CNS range in California is $140,000–$160,000, against a state NP median of $168,520. Other high-paying states for CNSs include Nevada, New Jersey, Massachusetts, New York, and Oregon. The Pacific Coast and the Northeast cluster at the top; the South and lower Midwest cluster at the bottom.
Does CNS pay increase with a DNP? In academic medical centers and large hospital systems, typically yes – a $5,000–$12,000 advantage is common. In smaller community hospitals and outpatient settings, the DNP premium is less consistent. If your long-term goal is a Director of Professional Practice or CNO-support role at a major health system, the DNP investment has clearer payoff.
A note on the data: CNS-specific estimates are derived by anchoring each state’s CNS range between its RN median and its NP median (see methodology above) – not from any NACNS compensation survey, which does not exist. BLS does not report CNS as a standalone occupational category – the data complexity is acknowledged and explained above. Individual salaries vary by employer, contract terms, and geographic cost of living.
References
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Nurse Practitioners (SOC 29-1171),” May 2025. National median annual wage $132,300.
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Registered Nurses (SOC 29-1141),” May 2025. National median annual wage $97,550.
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Nurse Anesthetists (SOC 29-1151),” May 2025. National median annual wage $236,590.
- National Association of Clinical Nurse Specialists (NACNS), “CNS Census,” fielded biennially (2014–2022, 2026 round May–June 2026). Collects demographics, practice settings, time allocation, prescriptive authority and reimbursement models – does not collect individual salary data; no authoritative national CNS compensation survey exists.
- American Nurses Credentialing Center (ANCC), “Adult-Gerontology Clinical Nurse Specialist Certification (AGCNS-BC),” 2025.
- American Association of Critical-Care Nurses (AACN), “ACCNS-AG/ACCNS-P/ACCNS-N Certification for Acute and Critical Care Clinical Nurse Specialists,” 2025. CCNS is renewal-only for existing holders; not offered for initial certification.
- American Association of Colleges of Nursing (AACN), “The Essentials: Core Competencies for Professional Nursing Education,” 2024.
Related guides: How to become a clinical nurse specialist – RN salary – Nurse practitioner salary – Family nurse practitioner salary – How to become a nurse practitioner – MSN programs