As the bedrock of our health care system, nurses strive each day to provide patients with quality care that results in positive health outcomes. When they progress into leadership positions, nurses can have a tremendous effect on not only their profession but also our health care system as a whole. As a 2021 report in the Journal of Professional Nursing noted, nurse leaders possess the vision and strategic thinking skills that can enable them to innovate while working in a host of challenging environments.
Nurse leadership comes in many forms. Becoming an advanced practice registered nurse (APRN), for example, is one of the best ways to move into a leadership role in nursing. APRNs in some states have full authority to assess and treat patients; some can even prescribe medication. However, individuals who aren’t familiar with the APRN role may find the topic perplexing — especially when the role of nurse practitioner (NP) is introduced into the mix. Individuals who may attempt to compare APRN vs. NP roles should keep in mind that several categories of APRNs exist, and an NP is simply one of those categories.
Nurses who’ve been considering enrolling in an online Bachelor of Science in Nursing (BSN) to Doctor of Nursing Practice (DNP) program with an eye to advancing into nursing leadership can benefit from exploring the various APRN roles and what each entails.
Defining the Role: What Is an APRN?
In forming an understanding of APRNs, starting with the basics is important. What is an APRN, exactly? The National Council of State Boards of Nursing (NCSBN) describes APRNs as registered nurses who’ve earned a master’s degree or post-master’s degree and who provide a specific population with a specific type of health care. NCSBN explains that, through their education and certifications, APRNs have the skills and expertise to:
- Assess and diagnose patients
- Manage patients’ health issues
- Order tests
- Prescribe medication (depending on the state)
A key to understanding the APRN role is becoming familiar with the four categories of APRNs. According to NCSBN, an APRN can be a:
- Certified registered nurse anesthetist
- Certified nurse-midwife
- Clinical nurse specialist
- Nurse practitioner
Job Growth Projections for APRNs Are Promising
The job outlook for APRNs is bright. For the period from 2020 to 2030, the U.S. Bureau of Labor Statistics (BLS) has projected 45% job growth for APRNs who are NPs, certified registered nurse anesthetists, and certified nurse-midwives. That growth rate is significantly higher than the 8% job growth rate that the BLS has projected for all occupations during the same time period.
APRNs Proved Their Mettle During the COVID-19 Pandemic
APRNs rolled up their sleeves and worked tirelessly applying their skills during the COVID-19 pandemic. According to a 2020 article in Nursing Forum, states enacted emergency temporary changes to policies and regulations that expanded the health care that APRNs could provide. This enabled APRNs to make significant contributions to the pandemic response; it also provided an opportunity for individuals who weren’t familiar with APRNs to learn more about the role and expertise that they possess.
APRNs Are Helping to Address Ongoing Shortages of Health Care Professionals
With their unique skills and educational backgrounds, APRNs are helping to alleviate staff shortages of care providers, particularly in the area of primary care. In 2022, a total of 80 million Americans lived in areas that suffered from a shortage of primary care professionals, according to The American Journal of Managed Care. As the fastest-growing primary care professional group in the country, NPs in particular are prepared to offer primary care in those areas. In areas with a shortage of primary care professionals, the health care services that NPs provide have been critical in managing and coordinating patient care, and this has resulted in lower medical costs, reduced hospitalizations, and fewer visits to emergency departments.
Drilling Down: What Is an NP?
As one category of APRN, NPs have the opportunity to specialize in different types of health care and serve various patient populations. In defining what is an NP, considering these specializations is valuable. According to the American Association of Nurse Practitioners (AANP), some of the most popular choices for NPs are:
- Adult-gerontology acute care nurse practitioner (AGACNP)
- Adult-gerontology primary care nurse practitioner (AGPCNP)
- Family nurse practitioner (FNP)
- Neonatal nurse practitioner (NNP)
- Pediatric nurse practitioner (PNP)
- Psychiatric mental health nurse practitioner (PMHNP)
- Women’s health nurse practitioner (WHNP)
AANP also offers the following background information on NPs that helps to define the NP role. For example, in 2020:
- A total of 88.9% of NPs were certified in some form of primary care.
- A total of 42.5% of full-time NPs had hospital privileges.
- A total of 59.4% of NPs saw three or more patients each hour.
- The average NP had been in practice for 11 years.
The scope of practice for an NP varies by state. As AANP explains, as of April 2022, NPs could have one of the following types of practice authority:
- Full practice authority. Twenty-six states and the District of Columbia have granted NPs full practice authority. With this type of authority, NPs can evaluate and diagnose patients, order and interpret tests, and begin and manage patient treatments. These NPs can also prescribe medication.
- Reduced practice authority. Thirteen states have granted NPs reduced practice authority. Under this type of authority, the ability of an NP to engage in at least one element of practice is reduced. In some states with reduced practice authority, NPs need to establish a collaborative agreement with another health care provider to be able to provide health care services. Other states with reduced practice authority limit the permitted settings for at least one element of NP practice.
- Restricted practice authority. Eleven states have granted NPs restricted practice authority. Under this type of authority, an NP’s ability to engage in at least one element of practice is restricted; NPs must also receive formal supervision, team management, or delegation authority from other health care providers to be able to provide patient care.
For individuals who are just learning what an NP is, clarifying that an NP differs from a physician assistant is important. While the two positions can share some similar responsibilities, they play different roles in health care.
Finding a Rewarding Place in Health Care: APRN Careers
For nurses who desire an advanced clinical role, APRN careers offer a tremendous opportunity to specialize in the types of health care that suits their skills and preferences. The variety of APRN and NP career opportunities is extensive. Discussed in more detail in the following sections are three examples — certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), and clinical nurse specialist (CNS) — that help to illustrate that point. However, while their responsibilities differ significantly, the steps involved in becoming qualified for these three positions are similar. To become a CRNA, CNM, or CNS, an individual must:
- Become a registered nurse
- Earn a graduate nursing degree — specifically, a Master of Science in Nursing (MSN) or a DNP degree — that offers the requisite courses in the preferred specialty, including completion of the required number of clinical hours
- Pass the relevant certification exam of a credentialing entity
- Obtain state licensure
A Career as a Certified Registered Nurse Anesthetist
According to the American Association of Nurse Anesthesiology (AANA), CRNAs provide patients with anesthetics for any type of procedure or surgery. Examples of their responsibilities include:
- Conducting preanesthetic evaluations
- Performing anesthetic techniques
- Selecting and inserting patient monitoring equipment
- Facilitating patients’ emergence from anesthesia
- Providing patients with pain management services
CRNAs can practice in any setting in which a patient requires anesthesia, such as:
- Hospital surgical units
- Obstetrical departments
- Critical care hospitals
- Ambulatory surgery centers
- Dental offices
To obtain CRNA certification, an individual must pass the examination from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
A Career as a Certified Nurse-Midwife
The responsibilities of a CNM extend beyond the act of delivering babies. The American Midwifery Certification Board (AMCB) categorizes their responsibilities into:
- Antepartum tasks, such as evaluating patients for indications of pregnancy, ordering lab tests and sonography, assessing the need for genetic counseling, and preparing patients for labor
- Intrapartum tasks, such as determining fetal position and condition, administering local anesthesia, performing episiotomies, and delivering infants
- Postpartum tasks, such as conducting postpartum exams, offering lactation support, and screening patients for depression
- Newborn tasks, such as promoting adequate newborn respirations, evaluating newborn well-being, and ordering newborn immunizations
A CNM can provide care in a home, birthing center, or hospital setting.
To obtain CNM certification, an individual must pass the examination from AMCB.
A Career as a Clinical Nurse Specialist
According to the National Association of Clinical Nurse Specialists (NACNS), a CNS is a nurse who not only provides clinical care to patients but also helps to develop the skills of other nurses and serves in a leadership role in improving care. Similar to other types of APRNs or NPs, a CNS can specialize in a particular patient population, health care setting, disease, or type of care. Examples of CNS responsibilities are:
- Providing direct patient care, such as conducting patient assessments, developing diagnoses, and educating patients about plans of care
- Advancing the nursing profession in areas such as developing evidence-based policies and procedures, strengthening practice standards, and developing population health profiles to identify necessary changes to nursing practice
- Improving health care systems through efforts such as leading safety and quality improvement initiatives and identifying ways to provide cost-effective health care
According to medical staffing firm Incredible Health, a CNS usually works in acute care settings (e.g., hospitals) but also can work in settings such as:
- Long-term care facilities
- Outpatient clinics
- Private practices
- Public health agencies
To obtain CNS certification, an individual must pass the examination from the American Nurses Credentialing Center (ANCC), the American Association of Critical Care Nurses (AACN), or the Pediatric Nursing Certification Board (PNCB).
Career opportunities in the fourth category of APRN — NPs — are discussed in the next section.
Offering a Variety of Fulfilling Roles: NP Careers
Nurses can choose from various NP careers that suit their skills and interests. The key to selecting an NP specialty is to identify the role that best fits your skills and interests.
While NPs can pursue a number of specialties, the steps in becoming any type of NP are similar. Specifically, to become an NP, an individual must:
- Become a registered nurse
- Earn a graduate nursing degree — specifically, an MSN or a DNP degree — offering the requisite courses in the preferred specialty, including completion of the required number of clinical hours
- Pass the certification exam of a credentialing entity
- Obtain state licensure
A Career as an Adult-Gerontology Acute Care Nurse Practitioner
According to AANP, AGACNPs provide health care services to patients who have acute, complex conditions, such as diabetes, heart failure, and hypertension. Their patients include geriatric patients, as well as young adults. They have responsibilities such as:
- Performing complex monitoring of patients
- Creating multifaceted plans of treatment
- Preventing future complications from their patients’ health conditions
- Diagnosing and managing complex health conditions
Examples of AGACNP work settings are:
- Acute, trauma, or intensive care units
- Specialty clinics
- Long-term care facilities
To obtain AGACNP certification, an individual must pass the examination from ANCC or the AACN.
A Career as an Adult-Gerontology Primary Care Nurse Practitioner
According to AANP, AGPCNPs provide primary health care to adults of all ages. They can also be found promoting health in their communities and working with culturally diverse and at-risk populations. Examples of their responsibilities include:
- Obtaining health histories
- Performing exams
- Ordering and interpreting tests
- Administering nonpharmacological and pharmacological therapies
- Managing patient transitions between health care settings
- Educating patients and caregivers
AGPCNPs can work in settings such as:
- Long-term care facilities
- Hospital clinics
- Private medical practices
To obtain AGPCNP certification, an individual must pass the examination from the American Academy of Nurse Practitioners Certification Board (AANPCB) or ANCC.
A Career as a Family Nurse Practitioner
AANP reports that the FNP certification is the most popular type of certification for APRNs who are NPs.
According to Incredible Health, FNPs focus on providing health care services in a family practice, and they treat both children and adults. Much of their work concentrates on preventive health care and maintaining patient health. Examples of their responsibilities include:
- Introducing patients to wellness programs
- Assessing and diagnosing patients
- Ordering and interpreting tests
- Developing and managing treatment plans for patients
FNPs typically work in settings such as family medical practices; they can also choose to focus on underserved communities by working in settings such as community health clinics.
To obtain FNP certification, an individual must pass the examination from AANPCB or ANCC.
A Career as a Neonatal Nurse Practitioner
As AANP explains, NNPs focus on providing health care to ill and premature infants. While they generally care for very young infants, they can care for infants suffering from long-term health conditions up to the age of 2. Their responsibilities can include the following:
- Treating the effects of low birth weight
- Addressing complications related to prematurity
- Providing health care related to infections, abnormalities in the heart, or other conditions
- Educating and supporting the families of high-risk infants
NNPs can work in:
- Neonatal intensive care units
- Emergency departments
- Delivery departments
- Outpatient clinics that offer follow-up care to infants
To obtain NNP certification, an individual must pass the examination given by the National Certification Corporation (NCC).
A Career as a Pediatric Nurse Practitioner
For APRNs who are NPs and have a desire to work with children, becoming a PNP could be a good option. According to Incredible Health, PNPs concentrate on providing health care to children of all ages. Examples of their responsibilities include:
- Treating common childhood illnesses and injuries
- Conducting well-child exams and school physicals
- Providing immunizations
- Performing developmental screenings
PNPs can work in settings such as:
- Health care clinics
- Private physician offices
- Children’s hospitals
To obtain PNP certification, an individual must pass the examination from ANCC or PNCB.
A Career as a Psychiatric Mental Health Nurse Practitioner
According to AANP, PMHNPs focus on improving their patients’ mental health. In addition to providing therapy and prescribing medication, they can perform responsibilities such as:
- Conducting psychosocial assessments
- Providing emergency psychiatric care
- Performing evaluations of treatment effectiveness
- Treating patients for addiction
PMHNPs can work in settings such as:
- Private practices
- Addiction and behavioral health clinics
- Psychiatric facilities
To obtain PMHNP certification, an individual must pass the examination from ANCC.
A Career as a Women’s Health Nurse Practitioner
AANP describes WHNPs as NPs who provide obstetric, reproductive, or gynecological health care. They treat women throughout their lives, and examples of their responsibilities include the following:
- Conducting well-woman exams
- Providing breast cancer screenings
- Performing Pap smears
- Providing contraceptive care
- Testing for pregnancy
- Conducting prenatal visits and providing after-pregnancy care
WHNPs can work in settings such as private medical practices and group practices.
To obtain WHNP certification, an individual must pass the examination from NCC.
Earning a Living in Advanced Nursing: APRN Salary Information
APRN salary information indicates that compensation for these roles can be attractive. According to Payscale, as of July 2022:
- The median annual salary of a CRNA was about $166,700
- The median annual salary of a CNM was about $100,000
- The median annual salary of a CNS was about $94,700
Salaries for APRNs who are NPs are discussed in the next section.
Compensating NPs for Their Expertise: NP Salary Information
As the following information shows, NP salary levels are an attractive aspect of working in the role. According to Payscale, as of July 2022:
- The median annual salary of an AGACNP or AGPCNP was about $102,900
- The median annual salary of an FNP was about $98,400
- The median annual salary of an NNP was about $110,900
- The median annual salary of a PNP was about $94,200
- The median annual salary of a PMHNP was about $113,600
- The median annual salary of a WHNP was about $96,800
APRNs Play a Critical Role in Health Care
Whether working as CRNAs, CNMs, CNSs, or NPs, APRNs use their leadership skills and expertise to strengthen our health care system each day. Making contributions in a host of health care settings, providing various different types of health care, and serving many patient populations, APRNs are a vital element of our health care system.
Nurses who have an interest in moving into a leadership role such as APRN should explore Hawai‘i Pacific University’s online BSN to DNP program to learn more about how the program can help them in pursuing their professional goals. With a focus on compassionate care, professional knowledge, and community awareness, HPU’s program can be a path to nursing leadership. Start on that path today.
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American Association of Nurse Anesthesiology, Certified Registered Nurse Anesthetists Fact Sheet
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American Association of Nurse Anesthesiology, Scope of Nurse Anesthesia Practice
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Payscale, Average Nurse Anesthetist (CRNA) Salary
Payscale, Average Pediatrics Nurse Practitioner (NP) Salary
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