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Last Updated: January 17, 2022

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:

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? 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?

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

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? 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?

Nursing degree courses