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What is an APRN?
An advanced practice registered nurse (APRN) is a graduate- or postgraduate-prepared healthcare professional with a specialized license or certification expanding their role and expertise in their field. In some cases, APRNs may function as independent and autonomous medical providers.
The U.S. Bureau of Labor Statistics projects 28% job growth for APRNs between 2018-2028 — a much higher growth rate than most career fields. There are several different types of APRNs including clinical nurse specialists (CNS), certified nurse practitioners (CNP), Certified Registered Nurse Anesthetists (CRNA) and Certified Nurse-Midwife (CNM).
APRNs assume all the roles of registered nurses including patient assessment and education and combine this with advanced responsibilities within their specialty. All of these specialized roles require graduate or post-graduate education and board exams beyond the registered nurse licensure. CNP, CRNAs and CNMs may be credentialed as licensed independent providers (LIPs) which allows them to function as autonomous practitioners, but CNSs cannot assume this role.
Specific requirements of APRN licensure vary based on type of specialty. APRN programs require an RN license and a Bachelor’s of Nursing (BSN) or higher; however, combined BSN-MSN APRN programs do exist. The majority of programs want candidates to have years of experience as a registered nurse before application to ensure applicants have a basis for their advanced study. Previous RN experience is believed to help aid the transition into the CNP role. But, it is possible to progress directly from a bachelor’s in nursing into an advanced practice role without working as an RN.
Each type of APRN (CNS, CNP, CNM and CRNA) has a different track for education preparation, certification requirements and role. All require a graduate or postgraduate degree from an accredited program within their desired specialty as well as a higher-level board certification beyond a registered nursing license.
Types of APRNS
Clinical Nurse Specialist
Role: Integrates care and provides mentorship and expertise beyond that of a regular nurse in a specialty. Focuses on evidenced-based practice to improve patient outcomes. Often practices as a high-level expert nurse within their specialty in a leadership or in a care coordination role.
Education: Requires a graduate or postgraduate degree in desired CNS specialty. Programs typically cost $35,000-60,000+ and take 2 years to complete.
Licensing: Must maintain RN license and sit for a certified nurse specialist exam in specialty (examples: adult, pediatric, neonatal or critical care)
Scope of Practice: Varies by state. May be able to perform specialized procedures like vascular access. Otherwise, scope-of-practice is aligned with a highly experienced registered nurse.
Continuing education: Must maintain license with continuing education contact hours. A CNS who wants to become an LIP needs to first complete a postgraduate NP or doctorate of nursing practice program (DNP).
Average salary: $90,420
Certified Nurse Practitioner
Role: Able to independently manage medical treatment and care decisions of patients within their specialty.
Education: Master’s or doctoral degree from an accredited nurse practitioner program. The average cost of a CNP program is $35,000-60,00+ and average length is two to four years years.
Licensing: Must maintain RN license and sit for a certified nurse practitioner exam in degree field
Scope of Practice: Can perform all the responsibilities of RN and CNS within specialty. CNP can make medical diagnoses, dictate treatment, prescribe medications and order diagnostic tests. Each state has different regulations about specific scope-of-practice. All CNPs may bill under their own national provider identifiers (NPIs).
Continuing education: Contact hours of continuing education vary from state to state and licensing board. But continuing education is a requirement to maintain license. NPs may choose to enroll in a PhD program if they wish to go into research-based practice.
Average salary: $117,154
Certified Nurse Midwife
Role: Perform independent obstetric and gynecological care during reproductive years and beyond.
Education: Must attend a master’s-level certified nurse midwifery program. The average cost of a program is $35,000-60,000+ and the average length of program is two years.
Licensing: Must maintain RN license and sit for a certified nurse midwifery exam.
Scope of practice: Provides obstetric and gynecological care.
Continuing education: Requires at least 20 contact hours per licensure cycle to maintain license. CNMs may choose to enroll in a PhD program if they wish to go into research-based practice.
Average salary: $105,932
Certified Registered Nurse Anesthetist
Role: Manage anesthesia for surgical procedures, often autonomously. In some rural facilities they are the sole providers of anesthesia.
Education: Must attend master’s or doctoral level CRNA program. Programs cost $30,000-60,000+ on average and take three years to complete.
Licensing: Must sit for the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) exam.
Scope of Practice: Independently manages anesthesia in a surgical setting. Some states require more physician oversight for reimbursement purposes, but many CRNAs function as autonomous providers.
Continuing education: A large number of CE credits are required to maintain licensure on a 4-year cycle. These consist of self-study and in-person learning.
Average salary: $186,645
Because of the aging population and the demand for cost-effective medical treatment, APRNs are an important part of the future of healthcare in the United States. APRN training is less expensive than medical training and requires less time. Nurse-managed care is associated with good outcomes particularly in primary and ambulatory care settings. The CNP role specifically demonstrates propulsive growth in recent years. “In the period 2010–17 the number of NPs in the US more than doubled from approximately $91,000 to $190,000,” indicating that CNPs may be the future for certain types of medical care.
What can APRNs do?
Federal programs looking to improve access to primary care services encourage the CNP role. Many of the barriers impacting independent practice of APRNs come at the state level or from medical organizations. But, due to acute needs, many governing bodies are recognizing the importance of allowing APRNs independence. For example, seventeen states have opted out of mandates that would make it more difficult for CRNAs to practice without a supervising medical anesthesiologist. Tension does exist over the APRN role. In 2017, the American Medical Association (AMA) came out with a resolution opposing independent APRN practice. But with rampant healthcare shortages in certain communities, some believe it is important to allow APRNs the full ability to function as their education and licensure allows.
The APRN role is expanding, so there are many benefits to investing time and money into obtaining a higher-level nursing degree. With several available APRN fields and many pathways and specialties within each one, advanced practice nursing offers a remarkable number of ways to grow one’s income and expertise.