Advanced Practice Roles for Nurses: What They Are and How to Become One

Nurses are essential members of the health care team, providing care and support to patients and their families in various settings and situations. However, some nurses may wish to advance their careers and expand their scope of practice by becoming advanced practice registered nurses (APRNs). APRNs are nurses who have completed a graduate-level degree, such as a master’s or a doctorate and have specialized training and certification in one of the four recognized APRN roles: clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), nurse practitioner (NP), or certified nurse-midwife (CNM). In this article, we will explore what each of these roles entails, what are the educational and licensure requirements, and what are the benefits and challenges of becoming an APRN.

What are the APRN Roles and What Do They Do?

According to the APRN Consensus Model, there are four roles that an APRN can hold, each with its scope of practice, responsibilities, and settings. They are:

  • Clinical nurse specialist (CNS): A CNS is an APRN who provides expert clinical care, consultation, education, research, and leadership in a specific area of nursing practice, such as pediatrics, oncology, or critical care. A CNS can work in various settings, such as hospitals, clinics, or schools, and can collaborate with other healthcare professionals and patients to improve the quality and outcomes of healthcare.
  • Certified registered nurse anesthetist (CRNA): A CRNA is an APRN who administers anesthesia and provides pain management for patients undergoing various surgical, obstetric, or diagnostic procedures. A CRNA can work in various settings, such as hospitals, ambulatory surgery centers, or dental offices, and can practice independently or under the supervision of an anesthesiologist.
  • Nurse practitioner (NP): An NP is an APRN who provides primary or specialty health care services to patients of all ages, genders, diseases, and body systems. An NP can perform physical exams, diagnose and treat common illnesses and injuries, prescribe medications and other therapies, order and interpret lab tests and diagnostic studies, perform minor procedures, provide health education and counseling, and refer patients to specialists when needed. An NP can work in various settings, such as clinics, hospitals, schools, nursing homes, or home health agencies, and can practice independently or collaboratively with other healthcare professionals.
  • Certified nurse-midwife (CNM): A CNM is an APRN who provides reproductive and gynecological health care services to women, as well as prenatal, labor, delivery, and postpartum care to mothers and newborns. A CNM can also provide primary and preventive care, family planning, and sexual health education to women of all ages. A CNM can work in various settings, such as hospitals, birth centers, or private practices, and can practice independently or collaboratively with other healthcare professionals.

What are the Educational and Licensure Requirements for APRNs?

To become an APRN, one must first become a registered nurse (RN) by completing an associate’s or bachelor’s degree in nursing and passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Then, one must obtain a master’s or doctoral degree in nursing, with a focus on one of the four APRN roles and one of the six population foci, which are: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender-related, or psychiatric-mental health. The graduate program typically takes 2-4 years to complete and includes both classroom and clinical components. The program covers topics such as advanced pharmacology, pathophysiology, health assessment, research methods, health policy, and nursing theory and practice.

After completing the graduate program, one must obtain a state license and a national certification as an APRN. The license requirements vary by state but usually include passing a criminal background check, submitting transcripts and fees, and completing continuing education hours. The certification requirements vary by organization but usually include passing an exam, submitting proof of education and experience, and renewing the certification every few years. Some of the organizations that offer APRN certification are the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners Certification Board (AANPCB), the American Association of Nurse Anesthetists (AANA), and the American Midwifery Certification Board (AMCB).

What are the Benefits and Challenges of Becoming an APRN?

Becoming an APRN has many benefits, such as:

  • High demand: According to the Bureau of Labor Statistics (BLS), the employment of APRNs is projected to grow by 45% from 2019 to 2029, much faster than the average for all occupations. This is due to the increasing demand for health care services, especially in rural and underserved areas, where APRNs can provide accessible and affordable care to patients who may not have access to physicians. APRNs can also help address the shortage of primary and specialty care providers, as they can perform many of the same tasks as physicians, but with less education and training costs.
  • High income: According to the BLS, the median annual wage for APRNs was $117,670 in 2020, which is more than twice the median annual wage for all workers. The income of APRNs may vary by factors such as education, experience, location, setting, and specialty, but generally, APRNs can earn a comfortable and competitive salary. APRNs can also enjoy various benefits, such as health insurance, retirement plans, paid leave, and tuition reimbursement.
  • High autonomy: APRNs can enjoy a high level of autonomy and responsibility in their practice, as they can diagnose and treat patients, prescribe medications and therapies, and make referrals without the direct supervision of a physician. The scope of practice of APRNs may vary by state, but generally, APRNs can practice independently or collaboratively, depending on their preference and the needs of the patients and the health care system. APRNs can also have more flexibility and control over their schedule, workload, and career path, as they can choose to work full-time or part-time, in various settings and specialties, and pursue further education and certification.
  • High satisfaction: APRNs can enjoy a high level of satisfaction and fulfillment in their career, as they can provide holistic and patient-centered care to individuals and populations across the lifespan, and help them improve their health and well-being. APRNs can also develop long-term and trusting relationships with their patients and families, and provide them with education, counseling, and support. APRNs can also collaborate and network with other healthcare professionals, and contribute to the advancement of the nursing profession and the health care system.

However, becoming an APRN also has some challenges, such as:

  • High stress: APRNs can face a high level of stress and pressure in their practice, as they have to deal with complex and challenging cases, make critical and timely decisions, manage multiple and competing demands, and cope with the emotional and physical demands of caring for patients and populations. APRNs can also face the risk of burnout, compassion fatigue, and moral distress, as they may encounter ethical dilemmas, conflicts, and frustrations in their practice. APRNs can also face the risk of malpractice, lawsuits, and complaints, as they may make errors, mistakes, or omissions in their practice.
  • High barriers: APRNs can face some barriers and challenges in their practice, such as the lack of recognition, respect, and support from some physicians, patients, and policymakers, who may question their competence, authority, and value. APRNs can also face a lack of consistency, clarity, and standardization in their scope of practice, regulations, and reimbursement, which may vary by state, setting, and specialty. APRNs can also face a lack of resources, infrastructure, and technology, which may limit their access, quality, and efficiency of care.
  • High expectations: APRNs can face high expectations and demands from their patients, families, colleagues, employers, and regulators, who may expect them to provide high-quality, safe, and cost-effective care, and to keep up with the changing and evolving needs and trends of the health care system. APRNs can also face high expectations and demands from themselves, as they may strive to achieve excellence, professionalism, and leadership in their practice, and to balance their personal and professional roles and responsibilities.

Conclusion

APRNs are nurses who have completed a graduate-level degree and have specialized training and certification in one of the four recognized APRN roles: CNS, CRNA, NP, or CNM. APRNs can provide advanced and specialized healthcare services to patients and populations across the lifespan and can practice independently or collaboratively with other healthcare professionals. Becoming an APRN has many benefits, such as high demand, high income, high autonomy, and high satisfaction, but also some challenges, such as high stress, high barriers, and high expectations. To become an APRN, one must complete a rigorous and rewarding educational and licensure process, and to maintain and enhance their competencies and roles in the health care system.