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What is an Advanced Practice Nurse?

April 10, 2021 | Staff Writers

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An Advanced Practice Nurse or Advanced Practice Registered Nurse (APRN) is a nurse who has earned their master’s or doctoral degree and can therefore take on more responsibility within the health care industry. 

These are specialist nurses who take on specific specialties in different advanced practice nursing professions and therefore use their highly specialized skills and knowledge to provide the community with nursing services either independently or with minimal supervision from doctors. 

Currently, there is a shortage of physicians in most parts of the world, including the United States. As such, APRNs are being called upon to play a critical role in bridging that gap in many medically underserved locations. 

According to the Bureau of Labor Statistics, the employment of APRNs will rapidly increase by about 31%, creating more than 47,600 new positions in the sector before the year 2022. 

This field, therefore, is ideal for people who are interested in advancing their careers in the field of nursing beyond being a registered nurse. There is a great deal of demand for APRNs today and in the future. Here is everything you need to know about the field. 

What Kind of Education Do You Need to be an Advanced Practice Nurse?

To understand what it takes to become an APRN, you first must understand everything that being an APRN entails and what kind of options you have in the field. That means looking into the different types of APRNs in the world and understanding how they operate. 

In 2008, there was an APRN Consensus Model designed to help coordinate the licensure, certification, accreditation, and education requirements of all nurses in the country. This model was designed to bring uniformity to the scope of regulations that govern the practice of nursing. 

This turned out to be excellent news, not only for the hundreds of aspiring APRNs but also for the millions of patients depending on them for their day-to-day medical care. 

Owing to this, the Department of Veteran Affairs granted APRNs the autonomy to practice to the fullest extent of their training, education, and certification in 2015. This is despite the practice regulations imposed by individual states. This essentially gave APRNs the authority to diagnose diseases and come up with workable treatment plans. They also have prescriptive authority, meaning they can prescribe medications without a physician’s supervision. 

Under this model, there are four main recognized APRN roles. These include:

  • Nurse practitioner (NP)
  • Clinical nurse specialist (CNS)
  • Certified nurse-midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)

Within these roles, additional patient population focus areas that an NP or a CNS can be certified. These population focus areas include:

  • Pediatric/child health
  • Acute patient care
  • Gerontology health
  • Adult health
  • Psychiatric/mental health
  • Family health
  • Oncology
  • Women’s health 

Although this isn’t required, an APRN could choose a specialization in hematology, HIV/AIDS, emergency, occupational health, endocrinology, dermatology, and cardiology. 

How to Become an Advanced Practice Registered Nurse

While most of the education and certification you would need to become an APRN, there are still some general yet specific steps that every aspiring APRN must complete. These include:

  • Graduate with a Master of Science in Nursing (MSN) degree. This degree has to be specific to one of the patient population focus areas and one of the four APRN roles. 
  • Attain national certification in any of the APRN roles as well as population focus areas
  • Get licensed by the state

Here is a bit more about how to become an Advanced Practice Registered Nurse:

Graduate with an MSN Degree

The first step you need to take towards becoming an APRN is completing a Master of Science in Nursing degree (MSN). This degree has to be in one of the four main APRN roles and your choice’s population focus. 

Furthermore, the MSN degree needs to be from an accredited program. This ensures that the program meets the requirements necessary for state licensure and national certification. 

These programs are often accredited by any one (or even more than one) of the following accreditation agencies:

Typical MSN programs for nurses who have completed a bachelor’s degree in their specific field are more commonplace. However, some programs are available for students who have a degree in other fields as well. 

For instance, if you are a registered nurse with an associate degree in nursing, you can easily complete an RN-MSN degree program to get you started on this path. 

However, if you already have a master’s degree in a different field but want to become an APRN, all you would have to do is complete a post-master’s certificate program. This will allow you to either become an APRN or even change preferred APRN roles. 

Other MSN programs are known as direct-entry, or entry-level master’s degrees formulated to help nursing students who already have a bachelor’s degree in other fields but need to earn both an MSN and their RN licensure. 

Here are some of the most popular programs through which you can become an APRN:

  • RN-MSN: This is a program that’s perfect for licensed registered nurses who already have an associate’s degree in nursing.
  • BSN-MSN: This is a program designed for licensed registered nurses who have a bachelor’s degree in nursing.
  • Direct or Entry-level Master’s Degree: This is for students who have a bachelor’s degree in other fields. This program’s components include undergraduate and graduate requirements, which will allow the student to go on and earn their RN and MSN. 
  • Post-Master’s Certificate Programs: This is designed for registered nurses who already have a master’s degree but want to become an APRN or change their role and population focus. 

Because many of these students would probably be already working and therefore under strict schedules, many MSN programs try to take that into account. As such, you will find that many of them combine online classes with in-person classes. 

Many are mostly online-based as well as part-time programs. You can even find accelerated programs to accommodate busy professionals looking to fast-track their careers. 

What Are the Admission Requirements for Most APRN MSN Programs?

As you would imagine, a highly competitive and sort-after field such as the one APRNs operate within isn’t easy to get into at all. As such, most MSN programs tend to be just as competitive. Students are looking to get into them being required to submit letters of recommendation, admission essays, and even complete personal interviews as part of the acceptance process. There are other specific requirements as well. These include:

  • RN-MSN: You would need to have an associate degree in nursing and current RN licensure. Some programs will also require you to attain a minimum GRE or GPA score and complete some specific prerequisite courses such as microbiology, human biology, nutrition, ethics, and statistics. 
  • BSN-MSN: You need to have a bachelor’s degree in nursing. Some programs also need you to attain a minimum GRE or GPA score. 
  • Entry-Level/Direct-Entry MSN: You need to have a bachelor’s degree from an accredited university or college. Some programs will also need you to have attained a minimum GRE score or undergraduate GPA.
  • Post-Master’s Certificate Program: You will need to have attained a minimum GPA score in graduate nursing degrees and have a current RN license. Some programs will require you to have a few years of nursing experience under your belt. 

To become an APRN, you need to do much more than just go to school. You also need to:

Get Certification from a Specialty Nursing Board

As an APRN candidate, you will need to get certification from a specialty nursing board before you can practice in your capacity. This certification can be received from several national bodies, but you should strive to get one that reflects your specialization, such as mental health, gerontology, pediatrics, and so on. Several organizations can offer these certifications:

To get certified by any of these (and the other boards), an applicant needs to show evidence of clinical work, they need to pay an application fee, they also need to have met the academic requirements as well as sit and pass a standardized examination. 

Get State APRN Licensure

This is where things get a little bit tricky. Depending on the state in question, there are a number of different requirements for nurses to get state licensure. 

You may need to include an application, show proof that you have a collaborative agreement with a licensed physician in the state, highlight acknowledgment of board standards and pay a standard fee. 

In many cases, you’ll find that these licenses require renewal periodically, which means that you will need to continue your education or show proof of recertification by any of the above-mentioned national certification organizations. 

What Does an Advanced Practice Nurse Do?

As mentioned earlier, APRNs have attained an incredibly high level of education and certification. Because of this, they often have an opportunity to work in various clinical patient care settings without the constant supervision of a physician. This means that they operate with a reasonably high degree of responsibility as well as independence. This makes them quite important throughout the healthcare system as they can:

  • See a patient without necessarily being supervised by a doctor
  • Order diagnostic tests
  • Make clinical diagnosis
  • Make other important medical decisions regarding their patients and the practice

That being said, there are some differences between what a doctor and an APRN are licensed to do in every state. However, considering that there are so few doctors in the world, the chances that APRNs will be taking on a lot more responsibility are quite high. This means that the chances of more patients seeing an APRN than a doctor has increased on a day-to-day basis. 

Types of Advanced Practice Nurses

We mentioned earlier that there are four main APRN roles. These include:

  • Nurse Practitioner (NP)
  • Certified Nurse-Midwives (CNM)
  • Certified Registered Nurse Anesthetist (CNRA)
  • Clinical Nurse Specialists (CNS)

Every APRN has attained an incredible amount of specialized training in their specific roles and, as such, are fully trained and licensed to practice within that specific APRN role. Here is what you need to know about these different types of APRNs:

Nurse Practitioner (NP)

A Nurse Practitioner (NP) is fully equipped to see patients in every outpatient setting. Most people see an NP for their regular medical check-ups, and any preventive care needs that they may have. NPs are often a patient’s primary health care provider in almost every setting. 

In this capacity, the Nurse Practitioner will see patients for their routine health maintenance needs and the random health problems that tend to come up from time to time. Nurse Practitioners are also the people who administer most routine tests on patients as part of a hospital’s health care. 

Certified Registered Nurse Anesthetist (CNRA)

A Certified Registered Nurse Anesthetist or (CNRA) typically works in a surgical operating room. Their primary role is to provide patients with care during surgical operations. For the most part, these duties include:

  • Administering extremely powerful painkillers to prevent pain that may occur during surgery
  • Putting the patient to sleep during surgery by administering medication
  • Keeping an eye on the patient’s vital signs during the entire surgical operation

In many cases, Nurse Anesthetists are also involved in the immediate post-surgical care of the patient. 

Certified Nurse-Midwives

As the name would suggest, Certified Nurse-Midwives are nurses who are equipped to provide the best prenatal care to expectant mothers through the entire pregnancy. A nurse midwife also provides care to the babies, a process that goes back to the child’s delivery. These nurses tend to work in teams that include the nurses themselves as well as doctors or a team that is comprised of just other nurse-midwives. 

Clinical Nurse Specialists

Clinical Nurse Specialists are pretty much a big part of the engine that runs most hospitals. These are multidisciplinary individuals who work in concert as part of a larger medical team. Their duties often include rounding on patients in most medical facilities and making certain diagnostic and medical care calls or decisions. 

A Clinical Nurse Specialist might be a general care nurse practitioner who provides a wide range of medical care to patients. They may be a specialized nurse who provides specialized care in any one of the patient population areas. 

There is a very good chance that most patients interact with a clinical nurse specialist at some point during their medical care. You will find that a clinical nurse specialist is part of a patient’s post-operative procedure in most hospitals. This means that the nurse in question will be responsible for paying close attention to any post-operative patient even after being discharged from the hospital. 

In many cases, you will find that this particular nurse was part of the patient’s pre-operative care team from the start. They are the professional who was responsible for duties such as:

  • Managing and administering pre-operative procedures and testing
  • Keeping the patient informed and explaining what needs to be done before the surgery

Since a clinical nurse specialist is also very likely to be part of a patient’s post-operative care team, their duties usually involve explaining to the patient what they need to do to remain healthy during their recovery period. 

They also articulate to the patient what to expect and run frequent yet thorough evaluations on the patient’s healing process and progress. These are the professionals who are the patient’s first line of defense when it comes to dealing with post-operative complications and management.

How Much Do APRNs Make?

While there are people who choose a career based on the level of personal fulfillment they will get, they want to know that they make a difference. The truth is that most of us choose our careers based on how much we can potentially earn and what kind of lifestyle it can afford us. 

The beauty of becoming an APRN is that not only do you get to make a real difference in people’s lives, but you also get to earn a decent living while at it. 

Here are some realistic salary projections you might expect to earn with the different APRN roles:

Certified Registered Nurse Anesthetist (CNRA)

According to the Bureau of Labor Statistics, a nurse anesthetist can expect to earn an average annual salary of around $181,000 per annum, which translates to about $87 per hour. Of course, much of this depends on the organization you work for and the state in which you practice. Nurse anesthetists in the top 10th percentile can make upwards of $208,000 per annum. 

Some of the highest paying states and cities for Nurse Anesthetists include:

  • Toledo, OH, with an average salary of $266,260
  • San Francisco, CA, with an average salary of $254,860
  • Columbus, GA, with an average salary of $247,540
  • Fairfield, CA, with an average salary of $240,820
  • Sacramento, CA, with an average salary of $236,400

Why Are Nurse Anesthetists Paid So Well?

One of the main reasons why Nurse Anesthetists are paid so well is because to become one, you have to attain an extremely high level of education and expertise. As mentioned, Nurse Anesthetists work very closely with surgeons. 

They are typically responsible for ensuring that the patients are well taken care of, not only during the surgical operation but also during the period before as well as after the procedure is complete. 

Another big issue is that, due to the various complexities that encompass their jobs, Nurse Anesthetists tend to get sued a lot more than usual, making their jobs a bit riskier than most. 

What Does It Take to Become a Nurse Anesthetist?

To become a Nurse Anesthetists, you must complete and attain a master’s degree from a reputable or an accredited program (nurse anesthesia). You also have to take and pass the NCLEX before getting certified as a CRNA. You also need to get at least one year of experience working in a clinical setting as an RN. 

What’s the Job Outlook for CRNAs?

According to the Bureau of Labor Statistics, the job outlook for CRNAs is very positive, with potential growth of 45% through to 2029. 

Clinical Nurse Specialist (CNS)

The average salary for a CNS (Clinical Nurse Specialist) stands at around $108,000 per annum, which translates to about $52 per hour. Just as is the case with every profession, the pay greatly depends on the organization for which you work. The top 10th percentile in this field makes around $127,000 per annum. 

Why Are Clinical Nurse Specialists Paid this Much?

A lot rests on the shoulders of clinical nurse specialists, also known as ICU (Intensive Care Unit) nurses. These professionals need to have both the speed of thought and action to ensure that patients in the ICU receive the best possible direct patient care whenever they need it and even in emergencies. 

These nurses must have excellent decision-making capabilities and forethought to catch what would be critical conditions before they become too far gone in both the ICU and the general hospital. 

What Does It Take to Become a Clinical Nurse Specialist?

To become a Clinical Nurse Specialist, you must attain a Master of Science in Nursing (MSN) degree with a clear focus on clinical nursing. You also must pass the NCLEX-RN Certification Exam.

What’s the Job Outlook for CNS?

Since the medical field is generally understaffed, the job outlook for Clinical Nurse Specialists is very positive going into the future. 

Nurse Practitioner

A General Nurse Practitioner or just NP earns about $112,000 per annum, which translates to about $53 an hour. In many cases, how much you earn as an NP will depend on the organization for which you work and the state you practice, with the top 10th percentile of NPs earning about $152,000 per annum or more. 

Some of the best paying states include:

  • Vallejo, CA, with an average salary of $175,060
  • Spokane, WA, with an average salary of $160,110
  • San Francisco, CA, an average salary of $157,150
  • Longview, WA, an average salary of $150,520
  • Sumter, SC, an average salary of $147,210

Why Do Nurse Practitioners Get Paid So Much?

Nurse Practitioners are an integral part of any medical facility dealing directly with patients, such as hospitals. These professionals can make long-lasting connections with the patients who come into any facility, making them best placed to provide them with excellent preventive health care. 

NPs work in family practices, pediatrics, women’s health, and almost any other facility that provides health care for the community. They mostly get paid so well because they have to be extremely knowledgeable and versatile. 

What Does It Take to Become a Nurse Practitioner?

You would have to start by attaining an MSN (Master of Science in Nursing) before choosing a specific field to focus on as an NP. 

What’s the Job Outlook for NPs?

The job outlook for NPs is very positive, with the Bureau of Labor Statistics reporting that the field will experience a 45% growth through 2029.

Certified Nurse-Midwives

Research by the Bureau of Labor Statistics shows that Certified Nurse-Midwives make about $108,000 per annum, which translates to about $52 per hour. However, the highest-paid Nurse Midwives can earn up to $159,000 or even more depending on where they work. 

Why Do Certified Nurse-Midwives Earn So Much?

Certified Nurse-Midwives are critical to patient care and comfort during a period when the patient needs them to be both knowledgeable and understanding. A Nurse Midwife will quite hold a pregnant woman’s hand through the entire pregnancy, the birth, and after post-natal care. They play a very integral part in the continuity of the species.

What Does It Take to Become a Certified Nurse-Midwife?

To become a Certified Nurse-Midwife, you need to first earn an MSN. After this, you would have to complete a program from an institution approved by the Accreditation for Midwifery Education (ACME) before you can get your certification. 

What’s the Job Outlook for Certified Nurse-Midwives?

The job outlook in this field is very positive. You can quite literally assume that as long as human beings are giving birth, there will always be a need for Certified Nurse-Midwives. 

Regardless of the specific role, APRNs are in great demand not only in the country but also globally. This profession has a very positive job outlook for the future and promises great rewards in both financial and personal fulfillment terms. As long as you have what it takes, becoming an APRN is a wonderful idea.

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