The term advanced practice nursing covers a range of nursing specialties: certified nurse practitioner, certified clinical nurse specialist, certified nurse anesthetist and certified nurse midwife. An advanced practice registered nurse (APRN) is someone who works in a specialized field that requires additional training and certification – and, often, a Master of Science in Nursing.
Advanced practice nurses work in hospitals, clinics, private offices and as travel nurses. They are qualified to assess, diagnose and treat patients. They can order medical tests and prescribe medication.
In the United States, the scope of practice for advanced practice registered nurses is determined by the state where the nurse is licensed to practice. The individual state and territorial boards of nursing develop regulations and licensure requirements that are designed to best meet the healthcare needs of the population of the state or territory.
That said, one issue confronting the community of APRNs is regulatory limitations on scope of practice that are not consistent with the level of education and training required to become an APRN. To combat those inconsistencies, 48 APRN nursing organizations around the country established the APRN consistency model in 2008.
This model for consistent APRN regulation across the country is intended, according to the National Council of State Boards of Nursing (NCSBN), to help alleviate the shortage of healthcare professionals in certain parts of the United States. The U.S. Department of Health and Human Services reports that more than 66 million people live in rural and other areas where healthcare services are inadequate.
According to the NCSBN, the APRN consensus model establishes the following basic requirements in every jurisdiction:
- A graduate degree from an accredited nurse education program
- Certification from a national nursing certification body
- Licensure by a state or territorial board of nursing
- Use of the APRN title, followed by an indication of the specialization (CNP, CNS, CRNA, CNM)
- Accreditation of APRN programs by an accrediting organization recognized by the U.S. Department of Education and/or the Council for Higher Education Accreditation
The depth of implementation of the APRN consensus model varies by state. The NCSBN regularly updates its catalog of participating states with a consensus model implementation status map, with numerical grades based on a points system.
The four advanced practice nursing specializations are built around training and experience in specific healthcare fields:
Certified Nurse Practitioner (CNP) – These advanced practice nurses are trained and licensed to provide healthcare independent of physicians. They are responsible for promotion of health, prevention of disease, patient education and counseling, diagnosis of acute and chronic diseases and treatment. A CNP can practice primary care or acute care, depending on competencies and certifications.
Clinical Nurse Specialist (CNP) – A CNP is certified to provide diagnosis and treatment of acute and chronic illness or injury, often in an ongoing patient management role. CNPs also monitor and seek to improve best practices with a healthcare organization and work to ensure the best possible outcomes for patients.
Certified Registered Nurse Anesthetist (CRNA) – A CRNA provides anesthesia care for patients, often in surgical settings.
Certified Nurse Midwife (CNM) – A CNM provides pregnancy and childbirth care, as well as gynecological care, family planning services, preconception care, pre- and post-natal care and care for newborns. Duties can include diagnosing and treating sexually transmitted diseases for men and for women at hospitals, ambulatory care settings and public health clinics.
Job Outlook for Advanced Practice Nurses
The U.S. Bureau of Labor Statistics (BLS) tracks employment data for CNAs, CNMs and CNPs. According to the BLS, those three advanced practice nursing positions are expected to add jobs at a 31% rate between 2016 and 2026.
The BLS reports that job growth in this area will occur “primarily because of an increased emphasis on preventive care and demand for healthcare services from an aging population.” Offices of physicians employed 46% of CNAs, CNMs and CNPs in 2016, according to the BLS. The rest were employed by hospitals (28%), outpatient care centers (8%), educational services (4%) and offices of other health practitioners (3%).
In 2017, the median annual salary for these three jobs was $110,930, according to the BLS. The BLS also explains that registered nurses who seek to become an APRN must earn a Master of Science in Nursing (MSN), become licensed by their state of residence and pass a national certification exam.