Advanced Practice Registered Nurses (APRNs): What They Do, and How to Become One

APRNs are expected to play a huge role in the future of healthcare. With so much opportunity for growth, now is a great time to start one of these exciting and important careers.

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Advanced practice registered nurses (APRNs) are nurses with advanced education, training, and certification that allows them to provide more complex care to patients. APRNs often act as primary care providers and can assess, diagnose, and treat patients. The designation of APRN is actually an umbrella—not a single degree or job title. There are four APRN jobs that play a unique role in the healthcare field. The APRN umbrella includes:

Clinical nurse specialists (CNSs)

Nurse anesthetists (CRNAs)

Certified nurse midwives (CNMs)

Nurse practitioners (NPs)

APRNs have increased independence and responsibility beyond that of regular RNs. In fact, many states allow APRNs to prescribe medication, open their own offices, and see patients independently.

“APRNs work with patients in both inpatient and outpatient settings to provide a high level of care,” explains Nancy Brook, MSN, RN, CFNP, a nurse practitioner at Stanford Health Care in Palo Alto, California. “This may include the diagnosis, treatment, and management of patients across the lifespan.”

Your first step toward an advanced nursing career is an advanced degree. In addition to your RN licensure and education, you’ll need to earn at least a Master of Science in Nursing (MSN) if you’re interested in any of the four APRN careers.

You’ll also need certification from a national certifying board. Currently, an MSN is the minimum education requirement for all APRN roles, but this is shifting. There is an increasing focus on the Doctor of Nursing Practice (DNP) degree as a standard for APRNs. In fact, the DNP will be the entry-level standard for nurse anesthetists by 2025.

Intrigued? Now is a great time to get started on the path to an APRN career. APRN roles are growing in number and importance in the healthcare field.

“Currently the field is wide open for new graduates and growing, especially with a shortage of primary care doctors in the U.S.,” Brook said.

What Are APRN Jobs?

Each of the four APRN jobs has a different focus and role. While there is some overlap (for example, both NPs and CNSs can see patients and prescribe medicine), there are important differences as well.

Clinical Nurse Specialist

A CNS is an advanced nurse who specializes in a particular patient population. CNSs also act as leaders and hold high-level roles in healthcare settings. They mentor, manage, and advise other RNs as well as develop and implement new patient-care policies.

Required degree

You’ll need at least an MSN.

Prerequisites

The prerequisites will depend on your program. However, all programs will ask that you have an RN license in good standing. Some bridge programs will admit RNs who currently hold an ADN, but you’ll need at least a BSN before you begin others. Many MSN programs are competitive. They’re looking for nurses with solid GPAs, clinical experience, and strong recommendations.

Responsibilities

  • Diagnosing patients
  • Developing patient care plans
  • Treating patients
  • Ordering tests and treatments
  • Advising other nurses
  • Acting in a nursing leadership capacity
  • Researching and implementing new patient care policies

Where you’ll work

  • Hospitals
  • Large health systems
  • Private practice

Licenses and certification

You’ll need certification from the American Nurses Credentialing Center (ANCC) or the American Association of Critical-Care Nurses (AACN). Your certification will be in your area of specialization; the exact requirements will depend on your state.

Certified Registered Nurse Anesthetist

A CRNA administers anesthesia to patients before procedures. CRNAs play a vital role in healthcare. In fact, in rural communities, they might be the only available provider of anesthesia.

Required degree

You’ll need at least an MSN.
By 2025 all new CRNAs will need to hold at least a DNP.

Prerequisites

You’ll need to be an RN in good standing before you begin any CRNA program.  Most CRNA programs will also require at least a BSN. Requirements beyond that will depend on your program. CRNA programs are often competitive. You’ll likely need a very solid GPA, good recommendations, critical care clinical experience, and a solid GRE score.

Responsibilities

  • Analyzing a patient and their medical history to determine the appropriate course of anesthesia
  • Making a plan for anesthesia delivery
  • Educating patients and their families about anesthesia and its effects
  • Administering anesthesia
  • Monitoring patients during and after anesthesia
  • Performing additional treatments including epidurals
  • Responding to emergencies
  • Training nursing staff

Where you’ll work

  • Hospitals
  • Medical centers

Licenses and certification

Certification is mandatory for all CRNAs. It’s available from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

Certified Nurse Midwife

A CNM is a nurse who can provide obstetrics and gynecological (OB-GYN) care to patients. CNMs can treat patients from the early stages of pregnancy though labor and delivery. They can also provide any needed postpartum care.

Required degree

You’ll need at least an MSN to work as a CNM.

Prerequisites

The prerequisites will depend on your program. However, you’ll often need a solid GPA, high GRE scores, and experience working as a labor and delivery nurse. All programs will require that you hold an active RN license. There are bridge programs available that will allow you to start a CNM degree from an ADN. Other programs will require a BSN before you begin.

Responsibilities

  • Educating new and prospective parents on pregnancy, breastfeeding, and infant care topics
  • Testing for STDs
  • Providing care and administering pain medication during labor
  • Watching for complications that require a physician during labor
  • Proving postpartum care
  • Provide primary care for women

Where you’ll work

  • Hospitals
  • Medical centers
  • Birthing centers
  • Private practice

Licenses and certification

CNMs are certified by the American Midwifery Certification Board (AMCB). You’ll need to be certified to practice.

Nurse Practitioner

An NP is a nurse who provides primary care to patients. Nurse practitioners often work in private practice to treat patients. NPs are certified to work in certain settings or with certain populations. For example, family NPs can see patients of all ages, while geriatric NPs focus on seniors.

Required degree

You’ll need at least an MSN.
However, just like CRNAs, the DNP is becoming the entry-level standard. It’s currently being recommended as the entry-level standard by 2025.

Prerequisites

You’ll need an ADN or BSN before you can apply to an MSN program. Bridge programs will allow you to start with an ADN while other programs will require a BSN. Other requirements depend on the program. However, you’ll likely need a solid GPA and GRE scores.

Responsibilities

  • Assessing patients
  • Diagnosing patients
  • Developing care plans
  • Administering treatments
  • Prescribing medications
  • Educating patients
  • Ordering and conducting diagnostic tests
  • Keeping patient health records

Where you’ll work

  • Hospitals
  • Medical centers
  • Doctors’ offices
  • Private practice

Licenses and certification

The certification you need will depend on your practice focus and state. NPs are certified by the ANCC and the AACN, as well as the American Association of Nurse Practitioners (AANP), the National Certification Corporation (NCC), and the Pediatric Nursing Certification Board (PNCB).

APRN Job Outlook

The outlook for APRNs is bright. In fact, the U.S. Bureau of Labor Statistics (BLS) projects a staggering 45% growth in APRN roles as a whole by 2029. That’s an expected addition of well over 100,000 APRN jobs over the next several years.

52%

Nurse Practitioners
Projected Growth by 2029

14%

Nurse Anesthetists
Projected Growth by 2029

12%

Nurse Midwives
Projected Growth by 2029

7%

Clinical Nurse Specialists*
Projected Growth by 2029

*The BLS groups CNSs under the RN umbrella. Projection comes from RN data.

This growth is fueled by several factors:

  • The increasing care needs of the baby boomer generation as they age
  • An increasing emphasis on affordable, high-quality patient care
  • A move to deliver as much care in non-hospital settings as possible
  • The urgent need for primary care providers in rural areas as physicians retire

These changes in healthcare are creating a high demand for APRNs that seems to be here to stay.

“Today, (APRNs) have proven their effectiveness in delivering high-quality, lower-cost health care services,” Brooks says. “Health care consumers, recognizing the value of a good service, look to APRNs for numerous health care needs.”

While it remains unclear how health care reform will change health care delivery, “it is abundantly clear that (APRNs) will be a vital component of future American health care services,” she says.

The BLS, in its Occupational Outlook Handbook, backs up this assessment:

Overall, job opportunities for advanced practice registered nurses are likely to be excellent. APRNs will be in high demand, particularly in medically underserved areas such as inner cities and rural areas.

Working as an APRN will also provide opportunities to grow professionally. As an APRN you can be a leader in the healthcare field. You can make a difference in not only the lives of your patients, but also in your community at large. That makes APRN careers an excellent fit for people who are looking for a high impact career with a lot of job security.

“(APRNs) are fully accepted by health care consumers and other providers as a critical component of our modern-day healthcare system in the United States,” says Brook. “(They) have been providing care to patients across the lifespan for more than 50 years, making their presence essential. As Americans continue to age and healthcare reform occurs, it is expected that APRNs will become even more critical to our system.”


Written and reported by:

Stephanie Behring

Contributing Writer

nancy brook

With professional insight from:

Nancy Brook, MSN, RN, CFNP

Nurse Practitioner 1V, Stanford Health Care


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