Advanced Practice Registered Nurse - APRN

Advanced Practice Registered Nurse are registered nurses that have completed an accredited graduate-level degree or post-graduate-level degree program in their respective concentration along with passing the required certification exam for that field. The APRN certification and license are managed and granted by the individual national organization but the scope of practice for the APRNs and their responsibilities are decided at the state level. So, an APRN who can work as a nurse educator in one state might not be able to do so in another state.

Four types of APRNs

An APRN will belong to one of the four categories below:

1. Certified Registered Nurse Anesthetist (CRNA)
2. Certified Nurse-Midwife (CNM)
3. Clinical Nurse Specialist (CNS)
4. Certified Nurse Practitioner (CNP)

Population Foci

In terms of the scope of practicing, each APRN practices in their respective field in at least one of the four population foci listed below:

1. Family/Individual Across Lifespan
2. Adult Gerontology
3. Neonatal
4. Pediatrics
5. Women’s health and gender-related
6. Psychiatric-mental health

In the day-to-day verbiage, the APRNs are known by their specialization title like CRNA, CNM, CNS, or the most popular CNP (or NP), instead of their rightful title, APRN.

Steps to becoming an APRN

The steps to become an APRN can be broadly summarized by the abbreviation LACE, used backward:

• Licensure: APRN license is obtained from the corresponding national body to be able to practice nursing at the advanced level.
• Accreditation: The nursing degree or the certification program has to be accredited by the national body granting the license.
• Certification: Obtaining the certification after successfully completing the advanced practice nursing degree and meeting all the requirements of the program.
• Education: Enrolling in an advanced practice nursing graduate or post-graduate program.

Education Requirements

APRN have to complete at least a graduate level degree from an accredited program along with the necessary clinical requirements. The program should include at a minimum, three separate comprehensive graduate-level courses, which are also called the APRN Core courses:

1. Advanced physiology/pathophysiology includes general principles that apply across the lifespan
2. Advanced health assessment includes assessment of all human systems, advanced assessment techniques, concepts and approaches
3. Advanced pharmacology includes pharmacodynamics, pharmacokinetics and pharmacotherapeutics of all broad categories of agents.

Types of APRN

There are four types of APRN:

Certified Registered Nurse Anesthetist (CRNA)

Certified Registered Nurse Anesthetists are advanced practice registered nurses that specialize in pain management for patients. They administer anesthesia to the patients before, during, and after the surgery. They also monitor the patients to make sure the patients are responding well to the anesthetics.

What are the duties of a CRNA?

• Preoperative care of the patient. Checking the patient's vitals and medical history in terms of allergies etc. to determine the best type and dosage of anesthesia to administer to the patient. Also, educating the patient about the anesthesia process and making sure the patient is comfortable and calm before the surgery.
• Care during the surgery. Administering anesthesia to the patient appropriately as required by the surgery and monitoring the patient during the entire surgical procedure.
• Postoperative care of the patient. Checking if the patient is recovering well from the anesthesia as expected.
• Providing pain relief. CRNAs also work in hospice facilities to provide pain relief to terminally ill patients.

How to become a CRNA?

According to The American Association of Nurse Anesthetists, a Registered Nurse has to have a minimum of 1-year of experience working in a critical care setting, though an experience of 3 years is preferred. Then they are expected to complete a Master's or a higher-level education in nurse anesthesia. The program has to be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). The duration of the program can be more than 4 years. After completion of the program, registered nurses have to clear the National Certification Examination (NCE) administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

The median salary of a nurse anesthetist is $190,000 per year.

What are the popular CRNA subspecialties?

• Critical-care CRNA
• Cardiovascular CRNA
• Chemotherapy CRNA
• Pediatric CRNA
• Neurosurgical CRNA

Certified Nurse-Midwife (CNM)

Certified Nurse-Midwife are advanced practice registered nurses that specialize in giving birth to babies. They are highly involved in the gynecological care of the soon-to-be moms during pregnancy, labor, and post-pregnancy care. In most cases, they act as the primary physician for pregnant ladies. Additionally, they are also qualified to take care of newborns for up to 28 days.

CNMs are the first choice for moms who are looking for a more holistic approach for birthing their babies, since CNMs are known for using less invasive methods and rely on the natural birthing process.

CNMs work in varied settings, most popular being physician offices and hospitals and birthing clinics, but they may also deliver babies in the mother's home like the old-fashioned way. They may assist a physician or with experience, may go on to open their own private practice. The scope of duties of a CNM varies from state to state.

All the CNMs are trained to handle any emergencies that might arise during the process of giving birth, for example, neonatal resuscitation. They have a process set in place should an emergency, requiring professional help at a higher level is needed.

What are the duties of a CNM?

• Guidance to the couple to help conceive. The certified nurse-midwives give guidance and educate the couple to be able to conceive. Their duties begin long before the pregnancy.
• Providing prenatal care. The certified nurse-midwives provide prenatal care to the expectant mom which includes prescribing prenatal vitamins, monitoring the health of the fetus and the mom, performing physical exams, and practically acting as a gynecologist.
• Performing delivery. The certified nurse-midwives are usually the only professionals performing the delivery and monitoring the labor. In other instances, they are assisting the OB/GYN.
• Handle any emergency situations. The certified nurse-midwives are trained to handle any emergencies that might arise during labor. In case they cannot resolve the situation on their own, they have collaborations with other specialists to assist them. Some of the cases where the certified nurse-midwives will need additional help would be performing C-sections or administering epidurals.
• Post-partum care. The certified nurse-midwives also take care of the mom and the baby after the delivery. They are trained in taking care of the newborns and helping the mom recover post-delivery.

How to become a CNM?

To become a CNM, an RN is required to have practical experience of 1 or 2 years based upon the graduate course they would like to pursue. A master's in midwifery nursing is generally a 2-year program, while a doctorate will be a 4-year program. Upon completion of an ACNM ACME (American College of Nurse-Midwives - Accreditation Commission for Midwifery Education) accredited graduate-level program in midwifery, the RN has to take the National Certification Examination (NCE) administered by the AMCB (American Midwifery Certification Board). Upon successfully being certified as a Certified Nurse-Midwife, a CNM can then practice as an APRN in all the 50 US states as well as the District of Columbia and the US territories. The scope of practice is determined by individual states.

The median salary of a CNM is $115,000 per year.

Clinical Nurse Specialist (CNS)

Clinical Nurse Specialists are advanced practice registered nurses that specialize in providing supervisory services like managing the nurses and researching ways to improve patient care. They work in a variety of settings and are specialized to work in a certain population foci. They are specialized in working in a particular population foci, most popular of them being adult-gerontology, neonatal, and pediatrics.

What are the duties of a CNS?

• Training the nurses. CNS train the nurses in their field to achieve better patient care.
• Improving patient care. The CNSs are required to do extensive research to optimize the workflow.
• Doing extensive research. CNSs are required to do extensive research to improve patient care, reduce redundancy and reduce costs.
• Focus on patient satisfaction. Being specialized in their field, the CNSs are responsible for patient comfort and satisfaction and reducing medical or workflow complications.
• Design plans for contingencies. Since CNS are tasked with training the nurses and researching for ways to improve the workflow, they have to come up with plans to handle any medical contingencies or unforeseen situations that might arise.

How to become a CNS?

To become a CNS, an RN has to complete either a Master's or Doctorate in a clinical nurse specialty. A Master's degree would typically take around 2 years to complete while a Doctorate might take 4 years or more. A Master's degree will require a minimum of 500 hours of clinical experience while a Doctorate will require a minimum of 1,000 hours of clinical experience. The candidate should have pursued a graduate-level advanced practice education program in their chosen CNS specialization. Choosing a specialization is a very important step in becoming a CNS because the certification that the candidate will take will define their career. The certifications are divided based upon the population that the RN wants to work in. The American Nurses Credentialing Center and American Association of Critical-Care Nurses provide various certifications for different CNS specializations.

The median salary of a CNS is $100,000 per year.

What are the popular CNS subspecialties?

• ANCC Adult-Gerontology Clinical Nurse Specialist Certification
• ACCNS-AG (Adult-Gero)
• ACCNS-P (Pediatric)
• ACCNS-N (Neonatal)

The CNS can further specialize in critical care and renew their license to earn a more refined critical care certification:

• CCNS Adult
• CCNS Pediatric
• CCNS Neonatal

Certified Nurse Practitioner

Certified Nurse Practitioners are advanced practice nurses whose duties are the closest to that of the doctors. They have advanced qualifications to treat and diagnose patients. The CNP or NP are specialized in a certain field treating a certain type of population. Based upon this there are many types of NPs who might go ahead to specialize in a sub-specialty. The scope of services provided by an NP varies from state to state. They either work under the supervision of a doctor or may go ahead to open their own practice. In 25 states of the US, the NPs are allowed to work independently.

What are the duties of a CNP?

• Diagnose and treat a patient. Most often a CNP acts as a patient's PCP and is the first point of contact for the patient. The CNP can treat and diagnose a patient.
• Prescribe medications. CNP can prescribe medications to the patients after diagnosing them, just like a doctor would.
• Order diagnostic tests. CNPs can order tests like MRI, X-ray, and CT scans if the patient's condition so requires.
• Advising the patient. CNPs can counsel patients on treatment plans, health care and advise them on a healthy lifestyle.
• Providing health-related information. The CNP also advises the patients on how to prevent diseases and lead a healthier life.

How to become a CNP?

To become a CNP, an RN needs to have a Master's or a Doctorate in Nursing. They will then have to take the certification exam for Nurse Practitioner and get the license. The most important step here would be to choose a specialty and population foci. The license to be taken and the requirements depend upon the state where the CNP wants to work. There is no standard national certification. Most popular certifications are offered either by the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC).

The median salary of a certified nurse practitioner is $120,000 per year.

What are the popular CNP subspecialties?

• Family Nurse Practitioner
• Pediatric Nurse Practitioner
• Adult-Gerontology Nurse Practitioner
• Women's Health Nurse Practitioner
• Psychiatric-Mental Health Nurse Practitioner
• Emergency Nurse Practitioner
• Allergy and Immunology Nurse Practitioner
• Sports Medicine Nurse Practitioner