What Is an Advanced Practice Registered Nurse?
March 15, 2021
If you're looking for a nursing career with a lot of responsibility and income to match, consider earning an MSN and becoming an advanced practice registered nurse (APRN). APRNs perform many of the same tasks doctors perform (in 22 states, without physician oversight).
Now is a great time to consider a career in nursing. The job market for nurses is growing at twice the rate of the market for all jobs. A projected nursing shortage through at least 2026 suggests that trend won't change any time soon. Nurses also enjoy a liveable incomethat increases with experience and specialization.
In addition, nurses do essential work: they help people get and stay healthy. Perhaps that's why, for close to two decades, nursing has topped a long-running Gallup poll charting the most trusted and ethical professions. The appeal of the work is clearly apparent to the more than 165,000 people who graduate with ADNs and BSNs each year.
Deciding to become a registered nurse isn't just a matter of completing nursing school and passing the National Council Licensure Examination (NCLEX) exam, however. The field of nursing consists of many roles and specialties that require different amounts of schooling and different national certifications—and pay very differently, too. Advanced practice registered nurses (APRNs) make up only a small percentage of the entire population of nurses in the United States. They hold master's degrees or doctorates in nursing and provide advanced preventative, acute, chronic disease, and specialty care. In 22 states, APRNs have full practice authority, which means they can work independently, without the oversight of a physician. They are the highest-paid clinical nurses.
This role isn't for everyone. Deciding to become an APRN means committing to many years of schooling and being comfortable taking on a lot of responsibility. So, what is an advanced practice registered nurse? In this article, we'll cover:
- What is an advanced practice registered nurse?
- What do advanced practice registered nurses do?
- Where advanced practice registered nurses work
- Types of advanced practice registered nurses
- The education required to become an advanced practice registered nurse
- How to choose an APRN education path
- Certifications for APRNs
- Is this the right career for me?
What is an advanced practice registered nurse?
An APRN is a registered nurse who has amassed years of experience providing clinical care and earned a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) degree. They have more responsibility than the typical RN, but what those responsibilities look like depends on where they work and what specialty area they've chosen. APRNs can and do provide the same kinds of patient care that RNs do, but they can also:
- Create care plans
- Transfer patients
- Prescribe medication
- Serve as primary care providers
In about half of US states, advanced practice registered nurses are required to work in collaboration with doctors and medical specialists. However, in states that allow it, many APRNs work without physician oversight and even open their own practices.
What do advanced practice registered nurses do?
What an APRN does each day depends on their specialty, but advanced practice nurses can handle any and all the following tasks:
- Performing physical exams
- Ordering diagnostic tests
- Diagnosing patients
- Referring patients to specialists
- Prescribing medication
- Dispensing medications
- Performing minor medical procedures
- Performing other types of examinations (e.g., psychological and developmental)
- Developing treatment and care plans
- Evaluating patient progress
- Providing counseling to patients and their families
- Coordinating patient discharge in outpatient and inpatient facilities
- Managing registered nurses and medical assistants
- Consulting with doctors and specialists
An APRN's other duties depend on the populations they serve. The needs of pediatric patients are very different from those of geriatric patients, which again are different from the needs of patients undergoing surgery. Certified nurse midwives—who are advanced practice registered nurses—provide prenatal care, perform gynecological exams, and offer family planning services. Nurse anesthetists administer anesthesia.
Where advanced practice registered nurses work
Advanced practice nurses work in numerous settings. They can be found in an increasing number of settings because they provide high-quality medical care at a reduced cost outside of hospitals. The increasing need for long-term and palliative care for an aging population may also contribute to the growth and wider distribution of APRN practice.
Most advanced practice registered nurses work in:
- Outpatient clinics
- Community care clinics
- Doctor's offices
- Emergency rooms
- Surgery centers
- Birth centers
- Obstetrics practices
- Veteran's hospitals
- Nursing homes
- Hospice care centers
Types of advanced practice registered nurses
There are four types of advanced practice registered nurses:
Certified Nurse Practitioners
These nurses, who are sometimes called CNPs, treat patients in primary care settings and acute care settings in much the same way doctors do. They talk to them, examine them, diagnose them, and create and oversee comprehensive treatment plans. Most nurse practitioners are certified in one or more patient areas like:
- Adult health
- Family health
- Gerontological health
- Pediatric health
- Women's health
- Psychiatric health
Some CNPs choose a specialty area like:
- Emergency medicine
NPs are the largest APRN group. The typical nurse practitioner salary falls between $100,074 and $117,158.
Clinical Nurse Specialists
These advanced practice nurses also choose a population and a specialty (from among those open to CNPs), but in addition to providing patient care, many CNSs also handle administrative duties and are qualified to teach, conduct research, and manage teams of healthcare providers. How much direct patient care a CNS actually does relative to a CNP depends on employers. Some jobs for clinical nurse specialists are nearly identical to those for CNPs, though it's worth noting that CNSs are only allowed to prescribe medication in some states. The average clinical nurse specialist salary falls between $95,340 and $115,505.
Certified Registered Nurse Anesthetists
CRNAs provide full-spectrum pre-op, operative, and post-op anesthesia care for surgical patients, along with care for patients undergoing non-surgical diagnostic, obstetrical, and therapeutic procedures. Historically, the administration of anesthetics was handled by nurses, but today, only some states allow CRNAs to administer local and general surgical anesthesia in hospitals and outpatient settings without supervision from physicians. Nurse anesthetists are frequently the principal anesthesia providers for hospitals and medical practices in rural and underserved areas. The typical nurse anesthetist salary falls between $110,526 and $137,520.
Certified Nurse Midwives
Known as CNMs, certified nurse midwives provide a full range of care services for women, including:
- Gynecologic care
- Family planning services
- Preconception care
- Prenatal care
- Postpartum care.
They're also qualified to oversee childbirth and provide basic newborn care. Some CNMs also provide care for men with reproductive health issues or sexually transmitted diseases. CNMs work in hospitals, birth centers, OB/GYN practices, and public health clinics. In some states, CNMs can also provide care at home births. Certified nurse midwife salaries typically fall between $100,079 and $123,334.
The education required to become an advanced practice registered nurse
Becoming an APRN may cost a lot less than going to medical school and completing a residency, but the educational commitment is still substantial. Currently, most APRNs have master's degrees, but the American Association of Colleges of Nursing has recommended upgrading requirements to enter one of the four advanced practice registered nurse specialties to a doctoral degree. Furthermore, the Council on Accreditation of Nurse Anesthesia Educational Programs has declared that all master's degree-level nurse anesthesia programs will have to transition to doctorate programs by 2022 or lose accreditation. The goal line is moving, although how quickly and how decisively remains an open question.
Regardless of future changes to the terminal degree required to become an APRN, the first thing an aspiring advanced practice nurse must do is become an RN. There are two ways to do this:
- Completing an associate's degree in nursing (ADN)
- Earning a Bachelor of Science in Nursing (BSN)
In both instances, you must graduate from a school accredited by the American Association of Colleges of Nursing or the National League for Nursing. Students in these programs take courses in:
- Health assessment
- Care coordination
- Emergency care
- Public health nursing
- Patient-centered care
After completing an associate's or bachelor's degree program, nurses must pass the NCLEX-RN exam and apply for an RN license from the state nursing board. At that point, nurses are qualified to work in doctor's offices, hospitals, surgical centers, long-term care facilities, and the ER. This is important because most master's degree programs for nurses will only accept applicants who have a certain number of years of experience working in clinical care.
All APRNs have a master's degree (the highest level of education required for most APRN specialties), and many Master of Science in Nursing programs require applicants to have a bachelor's degree in nursing. Nurses who are already working with an ADN can get the prerequisites they need in RN-to-BSN programs that take just one or two years to complete. Schools offering this program include:
- Sacred Heart University
- University of Louisiana at Lafayette
- University of Oklahoma - Health Sciences Center
- University of South Alabama
- The University of Texas at Arlington
- The University of West Florida
Master of Science in Nursing programs differ quite a bit from school to school and specialty to specialty. There are online nurse practitioner programs, like Duke University's highly ranked program. There are also on-campus programs, like those at Columbia University and Johns Hopkins University. MSN programs for nurse anesthetists are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs, while the Accreditation Commission for Midwifery Education handles accreditation for nursing master's degree programs for aspiring CNMs.
There are some master's programs for nurses that don't require applicants to have completed a BSN. These RN-to-MSN programs let aspiring nurse practitioners, clinical nurse specialists, and nurse midwives earn a master's degree in less time—usually four years instead of six. Some programs confer a BSN midway through, while others only confer an MSN. You can find RN-to-MSN programs at schools like:
- California State University - Fullerton
- Duke University
- Georgetown University
- Ohio State University
- University of Michigan - Ann Arbor
If you're interested in becoming a certified nurse anesthetist, check out the DNAP programs at:
- Columbia University School of Nursing
- Drexel University
- Duke University
- University of Iowa
- University of Pennsylvania
- Wayne State University
How to choose an APRN education path
What an APRN's education looks like depends on their chosen specialty (and what population they want to work with if their goal is to become an NP or CNS). Program accreditation at the bachelor's degree and master's degree levels is important across the board, however, because non-accredited programs may not be recognized by employers. MSN and DNP programs often won't accept applicants who attended non-accredited schools.
All advanced practice nurses need to study foundational courses like advanced pharmacology, advanced pathophysiology, patient-centered care, and advanced health assessment. All quality master's degree programs for nurses, on-campus or online, should offer these. Be wary of any program that doesn't include coursework in those areas. Finally, the best schools for APRNs will have a lot of support for clinical placements to provide future advance practice nurses comprehensive training in different practice areas.
Keep in mind that while the two-year MSN is the current standard for NPs, CNSs, and CNMs, there's a good chance that DNP degrees will be required for practicing advanced practice nurses in the future.
Certifications for APRNs
Once a nurse passes the post-MSN NCLEX-RN exam (which is more stringent than the exam for BSN holders) and has worked in their advanced practice specialty area for a specified number of years (which varies depending on specialization), they will be eligible for role-specific certification. Different certifying bodies exist for different APRN roles. For instance, nurse practitioners can apply for certification in the following areas from from the American Nurses Credentialing Center:
- Adult-Gerontology Acute Care NP (AGACNP-BC)
- Adult-Gerontology Primary Care NP (AGPCNP-BC)
- Family Nurse Practitioner (FNP-BC)
- Pediatric Primary Care NP (PPCNP-BC)
- Psychiatric Mental Health NP (PMHNP-BC)
- Emergency Nurse Practitioner (ENP-BC)
There are other certifications for nurse practitioners. The American Academy of Nurse Practitioners Certification Board offers Family NP, Emergency NP, and Adult-Gerontology Primary Care NP certifications. The Pediatric Nursing Certification Board offers certifications like the Certified Pediatric Primary Care NP (CPNP-PC) and the Certified Pediatric Acute Care NP (CPNP-AC).
Clinical nurse specialists can obtain certification through the American Association of Critical Care Nurses, which offers certifications like:
- Acute Care Clinical Nurse Specialist in Adult-Gerontology (ACCNS-AG)
- Acute Care Clinical Nurse Specialist in Pediatric (ACCNS-P)
- Acute Care Clinical Nurse Specialist in Neonatal (ACCNS-N)
CNMs are certified through the American Midwifery Certification Board and CRNAs are certified through the National Board of Certification and Recertification for Nurse Anesthetists.
Is this the right career for you?
That depends on what you're looking for out of your nursing career. It's possible to have a rewarding and enjoyable career working as a clinical registered nurse with just an ADN or BSN. A lot of people are driven to look into advanced practice nursing because they want to make more money, and you can indeed make more in any of the four APRN roles than as an RN. However, you'll be required to shoulder a lot more responsibility in those roles, so be sure you actually want that responsibility before applying to MSN or DNP programs.
If you are sure, here's some good news: APRNs are generally happy with their careers. US News & World Report ranks nurse practitioner and nurse anesthetist among the best professions in the country. While the salaries attached to APRN roles are probably a factor in the high levels of job satisfaction, it's not just about the money. According to the 2017 Medscape Nurse Career Satisfaction Report, most NPs, CNSs, and CNPs think that helping people and making a difference in people's lives are the best things about their careers.
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