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Advanced Clinical Nurse Specialists (Level 7)

Most Clinical Nurse Specialists (CNSs) work at an Advanced Practitioner level of practice (Level 7). Advanced Clinical Nurse Specialists have a wider scope of practice than CNSs at level 6 and will manage greater complexity (CNOD 2021).

Across NHSGGC there are over 300 nurses working at this level of practice in ACNS roles. They work in a wide variety of areas including:

Breast Care Nursing, Burns, Oncology, Cardiology, Mental health, Urology, Dermatology, Diabetes, ENT, Emergency Medicine, Epilepsy, Gastroenterology, Haematology, Multiple Sclerosis, Neurology, Nutrition, Gerontology, Ophthalmology, Orthopaedics, Pain, Palliative Care, Parkinson’s Disease, Plastic Surgery, Renal, Respiratory, Rheumatology, Sexual Health, Tissue Viability, and Vascular. The recently published CNO’s Transforming Roles Paper 8 provides an updated definition. Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland – (


“The Advanced Clinical Nurse Specialist (ACNS) is an experienced and highly educated registered nurse working within a specific field of practice. They manage, deliver, advise on and support the care for people within a specialist area. Educated to at least Postgraduate Diploma level in an appropriate subject, they are assessed as clinically competent in their defined specialty. They have a wider scope of practice than the clinical nurse specialist at Level 6 and will manage greater complexity.

As a clinical leader they have the autonomy to act and accept responsibility and accountability for their actions, acting as an expert advisor or resource for others. This includes specialist assessment and treatment using a holistic approach to managing complex, multidimensional situations. This may require management of care over a prolonged period of time. They have the authority to refer, admit and discharge within appropriate clinical areas. Their practice is characterised by a high level of clinical decision making based on in-depth, expert knowledge in their specialism of care delivery.

Working as part of the multidisciplinary team, they can work in or across all settings, including non-clinical areas, dependent on their area of expertise.” (CNOD 2021).


ACNSs train in post for the role. Trainee ACNSs are usually CNSs before they embark on deepening and broadening their knowledge for an ACNS role. Trainee ACNSs are increasingly being formally employed in training posts (using Annex 21 from Agenda for Change) while they learn. Trainee ACNSs are supervised whilst they learn additional skills and will also undertake appropriate post-registration education at postgraduate level at university to support their learning. Trainee ACNSs will build a portfolio of evidence to demonstrate they are competent to practice which is formally assessed at the end of their training.

Competency Framework

Transforming Roles Paper 8 sets out the core competencies for any ACNS. To these additional specialist competencies are added. The competency framework needs to be completed before a new ACNS can be regarded as appropriately prepared.

Agenda for Change

ACNS are paid at a minimum of Band 7

ANPs in General Practice