CNS · pathways
Where Clinical Nurse Specialists practice without a supervising physician, and what it takes
Three groups: full authority from licensure, conditional authority after a defined transition period, and supervision for the life of the practice.
Full practice authority (24)
Independent from licensure. A physician relationship is optional here.
Conditional independence (16)
Authority arrives after a transition period the statute defines. The conditions below are the feed's summary; each state page has the full rule and its source.
| State | Conditions for independent practice |
|---|---|
| Arkansas | ≥6,240 hours of practice under a collaborative practice agreement; Full Independent Practice Credentialing Committee (FIPCC) approval — same process as CNP |
| Connecticut | ≥3 years licensed and practicing as an APRN; ≥2,000 hours performing advanced-practice nursing activities in collaboration with a physician (§20-87a(3)) |
| Delaware | ≥2 years of collaborative practice; ≥4,000 hours of clinical practice with a physician or experienced APRN |
| Illinois | ≥4,000 hours of clinical practice under a written collaborative agreement after first attaining national certification; ≥250 hours of continuing education/training; a notarized full-practice-authority attestation filed with IDFPR |
| Kentucky | same ≥4-year CAPA-NS and ≥4-year CAPA-CS thresholds as general NPs (KRS 314.042) — no non-prescribing independence carve-out like VA's was found |
| Louisiana | Same unconfirmed hours-based CPA exemption referenced in the general `np` entry (LA Admin. Code tit. 46 §7911.A.5, which secondary sources describe as also covering CNS) — exact hour threshold and resulting scope not confirmed in this research pass. |
| Maryland | practicing within the psychiatric-mental-health population focus — the only CNS population focus Maryland has granted independent practice authority; this is a scope/specialty fact, not an hours/experience threshold |
| Nebraska | Inferred by analogy to the general APRN 2,000-hour transition-to-practice framework created by LB 107 (2015) — NOT independently confirmed against primary statute text specific to CNSs in this research pass |
| New Jersey | practicing within a population focus that maps to S2996's qualifying list (e.g., adult-gerontology CNS, psychiatric/behavioral-health CNS) — whether NJ's CNS population-focus categories cleanly map onto S2996's NP-oriented list (family/individual across the lifespan, adult-gerontology, pediatrics, women's health, behavioral health) was not confirmed in this research pass; >5,000 hours of licensed, active advanced nursing practice within that focus |
| Nevada | ≥2,000 hours of practice under a collaborative agreement — same general APRN threshold as NP (NRS 632.237) |
| Ohio | Same SCA framework as `np`/`cnm` (Ohio Rev. Code §4723.431/§4723.43(D)) — no hours- or experience-based exit exists; unlike `cnm`, the CNS's collaborator may be a physician OR a podiatrist |
| Oklahoma | ≥6,240 hours of supervised clinical practice, then Board of Nursing approval — secondary sources describe CNS as covered by the same H.B. 2298 (2025) framework as CNP/CNM |
| Virginia | does not prescribe controlled substances or devices |
| Vermont | ≥2 years and ≥2,400 hours of practice under a collaborative agreement (≥1,600 hours over ≥12 months if adding a second APRN certification) |
| Wisconsin | ≥3,840 hours of professional RN practice over ≥24 months; ≥3,840 hours of advanced practice in the CNS's Recognized Role while working with a physician or dentist immediately available for consultation, over ≥24 months |
| West Virginia | for prescribing specifically: ≥3 years in a documented collaborative relationship with granted prescriptive authority, then Board of Nursing approval |
Supervision required (12)
No experience- or hours-based pathway. The physician agreement lasts for the life of the practice.