What is Advanced Practice Registered Nursing?
Defining advanced practice nursing has been a challenge for the nursing community for decades. The terms advanced practice nurse and Advanced Practice Registered Nurse (APRN) contribute to this confusion. With some sources these terms are used interchangeably, while with others they signify different types of nurses. The American Association of Colleges of Nursing (AACN) refers to Advanced Practice Registered Nurses (APRNs) as masters or doctorate prepared nurses who provide direct clinical care and require certification and licensure to practice. APRNs are Certified Nurse Practitioners (CNPs), Certified Nurse Midwives (CNMs), Certified Registered Nurse Anesthetists (CRNAs), and Clinical Nurse Specialists (CNSs). The AACN also defines advanced practice nursing as any nursing role with a master’s degree nursing or higher that influences the health outcomes of patients or populations. These roles can include Clinical Nurse Leaders (CNLs), Nurse Educators, and Nurse Administrators.
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Direct Patient Care Roles
Direct patient care roles encompass CNPs, CNMs, CRNAs, and CNSs. These APRN roles provide direct hands on care to patients. As a CNP, CNM, CRNA, and/or CNS you will perform physical exams and depending on your role make diagnoses and prescribe medications.
What is a Certified Nurse Practitioner?
CNPs, commonly referred to as Nurse Practitioners (NPs) are the largest group of APRNs in the U.S. As an NP you provide comprehensive patient care, often focusing on prevention, to 6 population foci. When you complete an NP program, you will focus on one of these 6 populations, and this will be the population of people you will care for. The 6 population foci are:
Within these population foci you can further specialize in areas such as palliative care, oncology, infectious disease and more. If you are an Adult/gerontology NP or a Pediatric NP you can also specialize in acute or primary care. Specialization may require additional certification. For example Emergency Nurse Practitioners must be focused in the family population. After certifying as a Family Nurse Practitioner (FNP) they can further specialize as an Emergency Nurse Practitioner by taking another certification exam focusing on emergency care. Depending on the prescriptive authority of the state where you practice NPs can also prescribe medications and diagnose patients.
- Where Do Nurse Practitioners Work: Private practices, community health clinics, urgent care, specialty clinics, hospitals, military bases, prisons, and more
- How to Become Nurse Practitioner: Becoming an NP requires first becoming a registered nurse (RN) and then earning a master’s degree or doctorate in nursing practice (DNP) degree from a university accredited through the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You then must become certified within your population foci and licensed in the state where you choose to practice. See our Nurse Practitioner guides for more detail.
- Educational Pre-requisites for Practitioners: Despite what many websites will tell you, you do not need a BSN or RN licensure before you can enter an NP program. Due to the need for primary care providers, many different pathways into the NP role have been developed. Direct Entry programs (may have a different name depending on the school) allow non-nurses to become NPs. If you are not an RN and do not have a BSN, you only need a bachelor’s degree in something else, and will have to take a certain number and type of science courses in order to apply for a Direct Entry Master’s in Nursing program. These pre-requisite courses may include but are not limited to general chemistry, organic chemistry, developmental psychology, and anatomy and physiology. Whether you are an RN with or without a BSN or not, some programs may prefer if you have clinical experience before applying, but usually this is not required.
What is a Certified Nurse Midwife?
CNMs are APRNs that provide comprehensive primary healthcare to women throughout their lifespan including during pregnancy and when giving birth. They are independent practitioners who have prescriptive authority in all 50 states.
- Where Do Certified Nurse Midwives Work: Private practices, community health clinics, labor and delivery floors, birthing centers, prisons, military bases, and more
- How to Become Certified Nurse Midwife: First you must become an RN. Then you must earn a master’s degree in midwifery from a university that is accredited by Accreditation Commission for Midwifery Education (ACME). You must also become certified by the American Midwifery Certification Board (AMCB) and then apply for licensure in the state where you want to practice. See our Certified Nurse Midwife – CNM guide for more detail.
What is a Certified Registered Nurse Anesthetist?
A CRNA is an APRN that provides anesthesia and pain care independently and in collaboration with other healthcare providers. CRNAs are legally allowed to provide anesthesia unsupervised in all 50 states.
- Where Do CRNA’s Work: Operating rooms, obstetrical delivery rooms, dental offices, military bases, ambulatory surgical practices, ophthalmology practices and more
- How to Become a CRNA: First you must become an RN. Then you must earn a master’s degree in nursing anesthesia from a university that is accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. You must also become certified by the National Board for Certification and Recertification of Nurse Anesthetists (NBCRNA) and then apply for licensure in the state where you want to practice. See our Certified Registered Nurse Anesthetist – CRNA guide for more detail.
What is a Clinical Nurse Specialist?
A CNS is an APRN that provides direct patient care in a specialty area such as oncology, medical-surgical, pediatric, or critical care. As a CNS you are a clinical expert in your practice area.
- Where Do CNS’s Work: hospitals, private practices, community health settings and more
- How to Become a CNS: First you must become an RN. Then you must earn a master’s degree from a CNS program that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You must also become certified by either the American Association of Critical Care Nurses (AACCN) or the American Nurses Credentialing Center (ANCC). You will only apply for state licensure if you are seeking prescriptive authority. See our Clinical Nurse Specialist – CNS guide for more detail.
Indirect Patient Care Roles
Clinical Nurse Leaders, Nurse Educators, and Nurse Administrators are important members of the healthcare team that support patient care through improving patient safety, managing clinic costs, providing education to staff, and being leaders in the healthcare environment.
What is a Clinical Nurse Leader?
According to the Clinical Nurse Leader Association a CNL is a master’s prepared nurse that works to integrate the healthcare team and oversee and facilitate care. As a CNL you will focus on implementation of evidence based practice, patient safety, risk reduction, and cost management.
- Where Do Clinical Nurse Leaders Work: hospitals, private practices, community health settings and more
- How to Become a Clinical Nurse Leader: First you must become an RN. Then you must earn a master’s degree from a CNL program that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You must also become certified by either the Commission on Nurse Certification (CNC). See our Clinical Nurse Leader – CNL guide for more detail.
What is a Nurse Educator?
Nurse Educators are masters prepared nurses that help prepare the nursing work force by preparing nurses to enter certain practice settings as well as providing continuing education. As a Nurse Educator you must be clinical and content expert.
- Where Do Nurse Educator’s Work: Clinical and academic settings
- How to Become a Nurse Educator: First you must become an RN. Then you must earn a master’s degree from a nurse educator program that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You must also become certified by either the National League of Nursing (NLN). See our Nurse Educator guide for more detail.
What is a Nurse Administrator?
Nurse Administrator is a broader term that encompasses the nurse executive, supervisor, director, and manager roles. As a Nurse Administrator you will be responsible for creating and leading an effective work environment.
- Where Do Nurse Administrator’s Work: Hospitals, private practices, community health settings, universities, prisons and more
- How to Become a Nurse Administrator: First you must become an RN. Then you must earn a master’s degree from a nurse administrator program that is accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You must also become certified by either the ANCC or the American Organization of Nurse Executives (AONE). See our Nurse Administrator guide for more detail.
Education Costs for Advanced Practice Nursing
It is no surprise that education in the U.S. can be pricey. For APRN programs this is no different. Based on tuition rates for various nursing programs, getting an MSN or DNP will cost you about $30,000 to $50,000 per year, or $1,300 to $1,700 per credit. Cost will depend on if you are at a private or state university and if you are a resident of that state. Considering cost of living is another important factor when choosing an APRN program. Cost of living can vary dramatically by city and state. To help cut your costs you can look at part-time teaching and research assistant positions through your school. There are also many scholarship opportunities for nursing students.
Salary Expectations Advanced Practice Nursing
Depending on what type of advanced practice nursing you choose to go into your salary will vary. Additionally, where you work and how much experience you have and your specialty will influence how much money you make. According to the Bureau of Labor Statistics advanced practice nurses make a median of the following per year:
- CNP: $100,900
- CNM: $99,770
- CRNA: $160,270
- CNS: $68,000 to $101,000
- Clinical Nurse Leader and Nurse Administrator: $87,420 to 96,540
- Nurse Educator: $69,130
A career in nursing also gives you the opportunity for loan forgiveness. There are various programs that depending on the types of loans you have or if you work with medically underserved populations will help you pay back your student debt. The Nurse Corps Loan Repayment Program, Public Service Loan Forgiveness Program, and Perkins Loan Forgiveness are a few examples. These programs combined with the competitive salaries of advanced practice nurses can make the financial cost of education worth it.
Advanced Practice Nursing Resources
- American Association of Colleges of Nursing
- American Association of Nurse Anesthetists
- American College of Nurse Midwives
- American Midwifery Certification Board
- American Nurses Credentialing Center
- National Board for Certification and Recertification for Nurse Anesthetists
- National Council of State Boards of Nursing
- National League for Nursing
- The National Organization of Nurse Practitioner Faculties
Denisco, S. M., Barker, A. M., (2016). Advanced practice nursing: Essential knowledge for the profession. Burlington, MA: Jones and Barlett Learning.
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Lauren is a Registered Nurse and Women’s Health Nurse Practitioner who works in an OB/GYN clinic in the Boston area. She completed a Direct Entry MSN program at Boston College in May 2017 after obtaining a BS in Forensic Science and a BS in Biology from the University of New Haven, so she has special awareness of how confusing the many paths to nursing can be! She is passionate about enhancing and clarifying the nursing role globally as well as combatting human trafficking from a public health standpoint. In her free time Lauren enjoys writing and traveling.
Sources: 50 State Boards of Nursing, University Websites, U.S. Department of Education, Bureau of Labor Statistics. Ranking Methodology.