Who comprises the definition of an Advanced Practice Nurse?

Registered nurses with a minimum of a Master of Science degree with a clinical focus in one of four categories can function as an Advanced Practice Registered Nurse (APRN). The APRN role categories include the clinical nurse specialists (CNS), nurse practitioner (NP), certified registered nurse anesthetists (CRNA) or certified nurse midwives (CNM). Each of the APRN categories treats clients in different areas beyond the level of care rendered by a registered nurse (RN).

How is the APRN different from a regular registered nurse?

APRNs must complete rigorous post-graduate education to obtain higher level skills (like medication prescription, adjusting insulin levels, problem solving difficult patient cases, etc.) than a registered nurse who receives a Bachelor of Science or lower. The concentration of learning activities required to receive an advanced degree includes assimilation of theory into the higher level of practice and diverse approaches to decision-making for the care of individual patients or groups of individuals to achieve the most effective outcomes.

What is the difference between the roles of the APRN?

All APRNs possess a higher degree of autonomy in judgments and prescribing interventions. Each of the categories of APRN operates in different areas or settings of practice. The clinical nurse specialists’ general function in a hospital setting is to help staff with complex or difficult patients and usually possess education and research roles as part of their job description. Nurse practitioners came on the scene after CNSs and started to function as independent practitioners alongside of physicians in outpatient settings. Family NPs, Pediatric NPs and Adult NPs all carry a load of patients for whom they prescribe treatments and medications. The certified registered nurse anesthetists function in the operating room to intubate, start invasive access lines, and deliver anesthesia. Last but not least, the certified nurse midwives take care of patients in the peri-natal or pregnancy situation and facilitate delivery of a baby.

Where do the APRNs function clinically?

All four categories of APRNs can function in hospital or outpatient settings. CNS and CRNAs initially functioned in hospitals only, the NP originally found employment in outpatient clinics, and the CNM delivered babies at home or in primarily rural healthcare facilities at the beginning of the advanced roles in the 1960s and 1970s (except for the CNM role that began many years before). Now, the four categories of APRNs function in both hospital and non-hospital settings. It took several years before physicians and administrators in the variety of settings to understand the role of the APRN and the improved care that these practitioners brought to the multiple healthcare settings.

Why employ APRNs in clinical settings?

The advanced practice roles developed for two primary reasons. First, physicians became unavailable or scarce in some settings, and nurses acted as physician extenders. Second, poor outcomes occurred for some patients, and a higher level of knowledge than a registered nurse background could mitigate the increased morbidity and mortality for some patients.

What career options exist for the APRNs?

The APRNs can work primarily in inpatient or outpatient settings, using their skills in independent, direct patient care for health maintenance, disease prevention, counseling, and patient education (e.g., family nurse practitioner, geriatric nurse practitioner, and critical care clinical nurse specialists). However, the advanced practice nurse’s education allows an array of other roles. The APRN can teach at the college level by taking additional classes in curriculum development, testing and measurements, and adult education theories. The APRN with an MBA can move into senior management roles in healthcare, or the advanced practice professional may obtain a PhD and pursue a job in research. So, in addition to the four basic categories, APRNs possess the foundation to be a value to healthcare consumers and to further expand their roles to benefit society in other ways.

In conclusion, the role of the advanced practice registered nurse really provides many occasions for the nurse to grow. These nurses can work as practitioners, professors, researchers, or administrators. The opportunities are limitless.