GOAL AND OBJECTIVES
The goal of this continuing education program is to provide information on the four types of advanced practice registered nurses (APRNs) and offer strategies for pursuing advanced graduate nursing education. After studying the information presented here, you will be able to:
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Discuss the four types of APRNs
Differentiate among requirements for each role at the educational institution, state board of nursing, and certifying body
3 Identify resources available to pursue a career as an APRN by Nicolette Estrada, PhD, MAOM, RN, FNP A
re you a registered nurse contemplating returning to school to advance your career? The current healthcare environment offers new opportunities and a growing demand for advanced
practice registered nurses, also referred to as advanced practice nurses (APNs). Although the terms are often used interchangeably, APRN will be used in this CE module. The following information is intended for guidance in returning to academia to attain an advanced degree and transition to one of the four types of APRNs.
What Is an APRN?
APRNs are registered nurses who have at least a master’s degree who provide direct clinical care. The American Association of Colleges of Nursing describes the types of APRNs as follows:1
• Certified nurse practitioners (NPs) deliver front-line primary and acute care in community clinics, schools, hospitals, and other settings, and perform such services as diagnosing and treating common acute illnesses and injuries; providing immunizations; conducting physical exams; and managing high blood pressure, diabetes, and other chronic problems.
• Certified nurse-midwives (CNMs) provide prenatal and gynecological care to healthy women; deliver babies in hospitals, private homes, and birthing centers; and continue with follow-up postpartum care.
• Certified registered nurse anesthetists (CRNAs) administer more than 65% of all anesthetics given to patients each year and are the sole providers of anesthesia in approximately one-third of U.S. hospitals.
• Clinical nurse specialists (CNSs) provide care in a range of specialty areas, such as cardiac, oncology, neonatal, pediatric, and obstetric/gynecological nursing.
Depending on state requirements, NPs, CNMs, and CRNAs require
either a separate license or certification beyond the RN and master’s degree. The CNS is master’s prepared but will need separate licensing only if applying for prescriptive authority if granted by the state board in the state in which he or she is applying to practice.
The scope of practice for APRNs varies from state to state. A review of each type state by state reveals that differences in practice can range from complete independence to required strict supervision or collaboration. The lack of uniformity causes confusion and inhibits practice across state lines. Each state Board of Nursing governs the rules and regulations. Because of the different regulations in each state, The APRN Consensus Work Groups and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee worked exten- sively to develop a report of recommendations called the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, which was published in 2008.2
APRNs and professional
organizations are working diligently for passage of updated laws in each state to gain recognition and grant full practice authority for APRNs as licensed independent practitioners. The NCSBN offers an Implementa- tion Status Map that follows progress of each state’s consensus model implementation status and includes updates.3
The Consensus Module
was recognized and supported further in the landmark report “The Future of Nursing: Leading Change, Advancing Health,” in which the Institute of Medicine recommended that nurses should practice to the full extent of their education and training.4
Professional specialty nursing organizations offer valuable resources for further exploration of each type of APRN and guidance for RNs when selecting a choice compatible with their career goals. Even though membership is required for full access to the sites, a wealth of information is available as open access. Most organizations are willing to answer questions about their specialty area:
• The American Association of Nurse Practitioners (AANP) is a national professional membership organization for nurse practi- tioners of all specialties.
• The American College of Nurse-Midwives (ACNM) represents cer- tified nurse-midwives and certified midwives in the United States.
• The American Association of Nurse Anesthetists (AANA) is the professional association representing CRNAs.
• The National Association of Clinical Nurse Specialists (NACNS) serves to meet the needs and promote the value of clinical nurse specialists.
• Johnson & Johnson in The Campaign for Nursing’s Future pro- vides information to explore specialties, including APRNs.
It may also be beneficial to find an APRN working in an area that
interests you. Besides answering questions you may have, the APRN may allow you to shadow him or her. It may require special permission, but would be well worth your time.
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Becoming an APRN offers both extrinsic and intrinsic value. In 2015, the median pay for NPs, CNMs, and CNAs was $104,740 per year ($50.35/hour). Employment growth is projected to be 31% by 2024, much faster than for other occupations, indicating strong potential for job security. The Bureau of Labor Statistics offers resources to explore data maps for employment and wages by state and area for NPs, CNMs, and CNAs. According to the website
ExploreHealthCareers.org, the clinical nurse specialist salary range is between $65,000 and $110,000, depending on specialty and geographic location.5
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