Question: What Is an Advanced Practice Nurse?

Answer: Advanced practice nurse is a less formal designation for Advanced Practice Registered Nurses (APRNs), a professional title for Registered Nurses (RNs) who have advanced training in a clinical specialization. The APRN designation indicates that an RN has completed a master’s or post-graduate program in one or more of four APRN specializations: Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). After completing a Master of Science of Nursing (MSN), Doctor of Nursing Practice (DNP), or post-graduate certificate program in an APRN specialization, RNs apply for professional certification and state licensure to practice in that area of specialization.

Types of Advanced Practice Registered Nurses (APRNs)

APRN describes a Registered Nurse (RN) who has completed the advanced clinical and didactic training required for certification and/or licensure in a specific role related to four clinical specializations: Nurse Practitioner (NP); Clinical Nurse Specialist (CNS); Certified Registered Nurse Anesthetist (CRNA); and Certified Nurse Midwife (CNM). Each specialization has its own training and certification requirements, and there are different organizations that offer accreditation to APRN programs and provide professional credentials to RNs who graduate from those programs.

Nurse Practitioners (NPs)

NPs are clinical specialists who have more autonomy and authority than RNs. This often includes the ability to independently prescribe various medications, although prescriptive privileges are governed by state licensing boards. Some states extend what the American Association of Nurse Practitioners (AANP) designates as full-practice prescriptive authority to NPs, which means NPs can prescribe a range of medications without the oversight of a physician. Other states put restrictions on the scope of an NP’s prescriptive authority. Many states allow NPs to independently assess, diagnose, and treat patients in a range of clinical settings, while others place tighter limits on what NPs can do in the absence of physician.

In order to practice professionally, NPs must obtain state licensure. Most states require graduates from NP training programs to first gain certification in their area of specialization before applying for licensure, although this process varies by state, and several states do not require NPs to hold professional certifications. The National Council of State Boards of Nursing maintains a central resource for nurses who want to obtain state-by-state information regarding licensure requirements, and the American Medical Association’s Advocacy Resource Center has a chart detailing Nurse Practitioner Prescriptive Authority by state.

NP certifications are administered by several professional organizations, including:

• The American Nurse Credentialing Center (ANCC)
• The American Association of Critical Care Nurses (AACN)
• The American Academy of Nurse Practitioners Certification Board (AANPCB)
• The National Certification Corporation (NCC)
• The Pediatric Nursing Certification Board (PNCB)
• The Oncology Nursing Certification Corporation (ONCC)
• The Orthopaedic Nurses Certification Board (ONCB)

There are NP certifications available in the following areas of specialization:

• Adult-Gerontology Acute Care NP
• Adult-Gerontology Primary Care NP
• Emergency NP
• Family NP
• Neonatal NP
• Oncology NP
• Orthopedic NP
• Pediatric Acute Care NP
• Pediatric Primary Care NP
• Psychiatric-Mental Health NP
• Women’s Health Care NP

Clinical Nurse Specialist (CNS)

CNSs are APRNs whose role differs somewhat from NPs. While NPs generally focus on providing direct patient care in a range of clinical settings, CNSs are trained to work in roles where they educate, consult with, and supervise nursing staff in the clinical environment. Whereas NPs may choose to work in private practice, CNSs are typically stationed in acute care settings, such as hospitals and other medical centers. Like NPs, CNSs are licensed by the state in which they practice. There are also professional certifications available to CNSs through the AACN, the ANCC, and the ONCC in the following specializations:

• Acute/Critical Care (Adult)
• Acute/Critical Care (Neonatal)
• Acute/Critical Care (Pediatric)
• Adult-Gerontology CNS
• Acute Care Clinical Nurse Specialist Adult-Gerontology
• Acute Care Clinical Nurse Specialist Pediatric
• Acute Care Clinical Nurse Specialist Neonatal
• Advanced Oncology Clinical Nurse Specialist

Certified Registered Nurse Anesthetist (CRNA)

Anesthesiology is a highly specialized field, with its own training programs for nurse anesthetists and a separate credentialing body: the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA). Nurse anesthetist programs are also accredited by a specific body: the Council on Accreditation of Nurse Anesthesia Training Programs. CRNAs are trained to provide anesthesia services during surgical procedures. Once certified and licensed, CRNAs are qualified to work in surgical settings, providing care to patients before, during, and after surgical procedures that require anesthesia.

Certified Nurse Midwife (CNM)

Nurse-midwifery is commonly thought of as specialization focused solely on working with women during pregnancy. However the nurse midwife role encompasses a broader range of patient care services, and many nurse midwives work with women through all stages of their lives, providing well-woman exams and gynecological care. Nurse-midwifery graduate programs are accredited by the Accreditation Commission for Midwifery Education (ACME). Graduates from these programs become eligible to apply for professional certification as a CNM from the American Midwifery Certification Board (AMCB). Most states require AMCB certification as a condition for licensure, and many employers require nurse midwifes to hold AMCB certification before extending full practice privileges.

Advanced Practice Nursing Pathways

RNs interested in becoming APRNs can pursue programs at the master’s, post-master’s, and doctoral level depending on their educational background. These programs target specific APRN fields and provide general advanced clinical training in nursing, specific training in an APRN specialization, and supervised clinical training relevant to that specialization.

MSN Programs with APRN Specializations

There are MSN programs for CNSs, CRNAs, and CNMs, as well as MSN programs that focus on the various NP subspecialties. Eligibility for most programs is restricted to RNs who hold a valid and unencumbered state license. However, there are direct entry MSN programs that provide APRN training to graduates of bachelor’s degree programs in fields other than nursing who have not yet attained RN licensure.

The pathways to earning an MSN in an APRN specialization for licensed RNs include: BSN-to-MSN programs, which accommodate RNs who have graduated from an accredited BSN program; and RN-to-MSN programs, which accept RNs who received their training in associates degree in nursing (ADN) and hospital-based nursing diploma programs but who have not completed the full BSN curriculum. Some programs also provide distinct pathways for RNs with an ADN plus a non-nursing bachelor’s degree.

RNs who have already completed an MSN degree program are generally eligible for post-graduate certificate APRN programs, which omit general MSN coursework and focus exclusively on master’s-level training in an APRN specialization. The number of required courses in these programs depends on the specialization of a student’s first MSN program.

DNP Programs with APRN Specializations

There are also DNP programs that provide APRN training as part of their curriculum. There are two basic pathways to earning a DNP with an APRN specialization: MSN-to-DNP-plus-APRN-certification programs and BSN-to-DNP programs. MSN-to-DNP programs with an APRN certification component accept graduates from accredited MSN programs and combine the DNP curriculum with the curriculum of an APRN certification program. These programs are designed for RNs or APRNs who want to earn their DNP and train for a new or second specialization. BSN-to-DNP programs provide RNs who hold a BSN degree with a direct path to earning their DNP while pursuing master’s level training in an APRN specialization.

In addition, there are a small number of RN-to-DNP programs with an APRN specialization that accept students who have completed an ADN program. Some of these programs require students to have completed a bachelor’s degree in a non-nursing field in addition to an ADN.

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