What Is an Advanced Practice Nurse

An Advanced Practice Nurse is a highly qualified nurse who has chosen to continue their education and specialize in a specific area such as anesthesia or midwifery. The full title of this kind of nurse is Advanced Practice Registered Nurse or APRN.

There are a few different job titles that fall under the umbrella of advanced practice nursing, including:

• Clinical nurse specialist
• Nurse practitioner
• Certified nurse midwife
• Certified registered nurse anesthetist

To become an advanced practice nurse, a person must first earn the title of Registered Nurse, then earn a master’s degree in their chosen area of specialization. They’ll also need to pass a number of certifications relating to that specialization.

Advanced nursing practice fills an important role in the world of health care, with these nurses delivering highly skilled medical care to their patients.  The rules on the scope of practice of nurses vary from state to state, but APRNs enjoy more freedom to work without direct supervision. In some parts of the United States, nurse practitioners have prescriptive authority, which means they can diagnose and prescribe, filling the main parts of a general practitioner role. In other parts of the country, nurse practitioners fill a more general, physician assistant’s role.

Advanced practice nurses can command high salaries due to the level of study and training required for the role. According to the Bureau of Labor Statistics, the average salary for advanced practice nurses is $117,670 per year, with those who choose to become certified registered nurse anesthetists earning as much as $183,580 per year. For comparison, registered nurses earn a median annual wage of $75,330.

Types of advanced practice nurses

Advanced Practice Registered Nurses can till a variety of roles, and there are many different specializations, giving nurses the freedom to choose the areas of their work that they’re most interested in, such as:

• Pediatric primary care nurse practitioner
• Psychiatric-mental health nurse practitioner
• Neonatal nurse practitioner
• Certified registered nurse anesthetist
• Nurse midwife
• Clinical nurse specialist
• Adult-gerontology nurse practitioner

What are the major differences between types of advanced practice nursing?

The main difference between these nursing jobs is the area that the nurse has focused on. All Registered Nurses receive the same general education inpatient care and are given an overview of how nursing works.

Nurses who are registered to bachelor’s degree level are trained in critical thinking skills and evidence-based care. They work in hospitals and clinics providing day-to-day care for patients in a variety of situations.

Most nurses earn their RN license, then get some clinical experience in a variety of different aspects of health care, before deciding what it is they’d like to study. Once they’ve found the area of practice they’d like to focus on, they have the opportunity to earn clinical experience under the supervision of an advanced practice nurse with the relevant certifications.

A would-be APRN can then enroll in a master’s degree, specializing in their desired practice area. It’s possible to study for a master’s degree part-time, while continuing to work in a health-care setting, giving them the chance to offset the cost of their education, and build up real-world experience, ready to transition to advanced-practice roles as soon as they’re certified.

Each type of advanced practice nurse works with a specific type of patient or focuses on a specific health condition or working environment. They spend a lot of time learning the procedures and concepts surrounding their area of focus, whether that’s anesthesia, midwifery, or acute care.

Some advanced nursing practice roles have sub-specializations. For example, a Nurse Practitioner is a form of advanced practice nurse who can take on a lot of the duties of a primary care physician, including having prescriptive authority and independent practice rights in some states.

Some nurses opt to become a general nurse practitioner, but others choose a narrow focus such as mental health, pediatrics, or adult-gerontology. This gives them a greater understanding of those specific roles. Specialization in these areas is important because health conditions manifest themselves in different ways depending on the population, and treatments may vary too. Treatments that work for adults could be unsafe for children, for example.

What is the difference between advanced practice nursing and advanced nursing practice?

Advanced practice refers to a level of practice, rather than a specific job or type of practice. Advanced nurse practitioners are the people who perform advanced practice nursing. These nurses are educated to master’s degree level in clinical practice. They use their skills to serve a specific population or work in a specific health care environment.

The distinction is important because a nurse-midwife is qualified to perform advanced practice nursing in that area, and call themselves an advanced practice nurse. They would not be qualified to do the job of a certified registered nurse practitioner or vice-versa.

Role of advanced practice nurses

The roles of advanced practice nurses vary, depending on what they’re specialized in. For example:

Clinical nurse specialist

Clinical nurse specialists are highly experienced, jack-of-all-trades nurses who fill several roles in the world of health care. They serve as teachers, consultants, managers, and researchers, and may also do some hands-on clinical care too. They’re often found in universities and colleges with a teaching hospital attached to them, or working in hospitals to support young nurses in their training.

A clinical nurse specialist who wants to focus on consulting may join a hospital, deliver patient care, and work with staff in a department to review and improve current practices, train staff in more effective and efficient ways of doing things, and improve the overall performance of the ward.

These nurses may also educate patients and their loved ones on the best way to manage their conditions, and devise treatment plans for those who have long-term or complex health issues. Where registered nurses focus on day-to-day treatments, a clinical nurse specialist has the expertise to manage patient health and well-being in the longer term.

Certified registered nurse anesthetist

These are the highest-paid advanced practice nurses, perhaps in part due to how critical their role is. These nurses work alongside surgeons and in other environments where anesthesia is used. They earn an average salary of $189,190 per year.

Certified registered nurse anesthetists can prepare and administer anesthetic, and are responsible for managing the well-being of patients both before, during and after surgery. In most states, they’re able to work in their scope of practice without supervision. They have a lot of autonomy and respect from others in the medical profession.

Nurse practitioner

Nurse practitioners are nurses who have completed extensive additional training and are now qualified to diagnose and prescribe in a similar way to a primary care physician. Their scope of practice is not identical to that of a doctor, but there is a lot of overlap, and in some states, nurse practitioners are allowed to open their own practice.

Because of the growing demand being placed on the health care profession, and the way many areas now have a shortage of doctors, nurse practitioners are often used to ease the strain and reduce waiting lists in under-served areas, helping patients get seen and triaged more quickly. Nurse practitioners have the skills to treat basic ailments and offer advice and counseling about general health issues.

Many nurse practitioners who are working in the profession today are educated to master’s degree level. However, as the scope of practice of nurse practitioners increases, there is a shift towards nurse practitioners needing to have a Doctor of Nursing Practice or Ph.D. qualification. This means students who are considering their long-term career plans should aim towards the DNP if they’d like to work as a nurse practitioner in the future.

Nurse practitioners can expect to earn an average salary of $111,680 per year. Exact salaries will vary depending on whether the nurse practitioner is working in a general role or a specialization such as mental health or pediatrics. The working environment also impacts salary, with nurses who work in hospitals typically commanding higher salaries than those who work in clinics or outpatient centers.

Certified nurse midwife

A nurse-midwife is a registered nurse who has received additional training in how to support women in the periods before, during, and immediately after pregnancy. They work in clinics, birthing centers, and hospitals and take a holistic approach to childbirth, meaning that expectant mothers who are able to do so can have a low-tech birth, often in the comfort of their own home.

Certified nurse-midwives are trained in managing holistic births, keeping the parent and unborn child safe, and advising on when a birth is not progressing safely and the assistance of an obstetrician might be required.

The role of these health care professionals is not limited to childbirth. They provide counseling to women who are hoping to get pregnant, offer advice during pregnancy so that parents can avoid issues such as gestational diabetes, and also help with aftercare following the birth. They may stay in touch with the mother and baby during the first few months of the child’s life, educating the mother on how to provide care and making sure that the child is developing at a normal rate.

Certified nurse-midwives have all the knowledge of midwives, and all the knowledge of registered nurses, meaning they can provide a high level of care throughout the process. These advanced practice registered nurses can expect to earn an average salary of $111,130 per year.

What skills help you in your role as an advanced practice nurse?

Advanced practice nurses need a combination of medical training, scientific understanding, and soft skills to allow them to thrive in the profession. They are usually on the frontlines of health care, which means they will be dealing with patients and their loved ones at the same time as working alongside doctors, surgeons, and other specialists. They may also find themselves supervising other, more junior, nurses.

Nurses who work in advanced nursing practice roles provide care directly and may be expected to make a diagnosis, order treatments, or perform hands-on care tasks themselves.

They need to have:

• An understanding of evidence-based practice
• Awareness of current best practices in patience care
• Willingness not learn
• Scientific aptitude
• Strong communication skills
• The ability to perform well under pressure
• Empathy
• Attention to detail

Nurses at every level need the above skills, to some extent. However, for nurses who work in the world of advanced practice, these attributes are even more important because the responsibility that an APRN has to each patient is greater.

Education and certification requirements for advanced practice nurses

To become an advanced practice nurse, a registered nurse must have a valid license, be educated to master’s degree level, and have completed the certification requirements for their chosen specialization.

What are the educational requirements for advanced practice nurses?

The exact educational requirements for an advanced practice nurse will depend on the specialization that the nurse is hoping to move into. In general, all advanced practice nurses start their careers as a registered nurse who has passed the National Council Licensure Examination (NCLEX-RN).

Once a nurse is licensed, the next step is to choose a specialization and earn a master’s degree. This typically takes one or two years of study, depending on whether they are studying part-time or not. Most nurses will study part-time while working in a health care setting, so they can earn valuable clinical experience.

During the master’s degree, a student will have the opportunity to earn some supervised experience in the department or job role they’re hoping to specialize in. They may also complete internships or externships where they can earn even more experience. The master’s degree will prepare the student for any additional licensing examinations they’ll need for their career.

How to become a certified registered nurse anesthetist

A nurse who wishes to become a certified registered nurse anesthetist would need to study for a master’s degree accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. Upon completion of the degree, the nurse would then need to pass the certification examination offered by the National Board of Certification and Recertification for Nurse Anesthetists.

How to become a certified nurse midwife

The pathway for nurse midwives is similar. A certified nurse-midwife will need a master’s degree, and to earn the Certified Nurse-Midwife credential by passing the examination set by the American Midwifery Certification Board. This certification qualifies the nurse with advanced practice state licensure in all jurisdictions, unlike the Registered Nurse certification which is portable between some, but not all, states.

How to become a clinical nurse specialist

Clinical nurse specialists are nurses who have a master’s degree or higher qualification in nursing, are licensed as registered nurses, and have completed a certification program in their desired specialization. There are many different specializations to choose from, such as the Adult-Gerontology Clinical Nurse Specialist Specialization, or the Neonatal care certification. The American Association of Critical Care Nurses offers a wide variety of certifications for early-career and advanced practice nurses, helping those nurses to offer a higher standard of care and improve their career prospects.

How to become a nurse practitioner

Historically, all a person needed to become a nurse practitioner was an RN license and a master’s degree. Today, however, it’s far more common for nurses to have a Doctor of Nursing Practice. Once a nurse has completed their education, they’ll be required to pass a national certification examination. There are several different accrediting bodies, depending on whether the nurse wishes to certify as a pediatric nurse practitioner, general nurse practitioner, or in some other area.

The scope of practice and certification requirements for nurse practitioners can vary depending on the state they work in, as well as which specialization the nurse has chosen.

What certifications help further the career of an advanced practice nurse?

A nurse who is looking to further their career and earn the skills they need to work in a different department or explore a specialization should consider earning some certifications from the American Association of Critical-Care Nurses. The AACN offers a variety of certifications in adult, pediatric and neonatal care, cardiac medicine, acute care, CNS wellness, and progressive care knowledge.

These certifications are not required for licensure, however, they provide nurses with the knowledge and experience they need to serve patients from all walks of life. These certifications may stand a nurse in good stead when they come to apply to a master’s or DNP program, or if they’re looking to move to a new hospital or department for promotion.

How much of an advanced practice nurse’s education can be completed online?

Advanced practice registered nursing is a highly regulated profession, and nurses are required to have extensive clinical experience before they can earn their certifications. This means online education options are limited.

It is often possible to study general education courses online, and for nurses to do a lot of their continuing education via online courses. However, a registered nurse who has an RN license and wants to pursue a master’s degree or complete training in a specific area such as pediatric nursing would need to do a lot of face-to-face training.

Most advanced practice roles require a nurse to have a minimum of 500 hours of clinical experience in that specific area of specialization. This means the nurse will have to spend time working in a hospital, clinic, or other healthcare setting. A significant amount of the work a nurse does on a course will be practical and will need supervision.

Many institutions do allow asynchronous online learning for theoretical aspects but ask students to attend weekend sessions or a summer school so they can practice clinical skills under supervision. They may also have arrangements with teaching hospitals where a nurse educator can oversee the work of a student.

A nurse’s education is not over once they’ve earned their APRN certification. Most certifications are valid for five years, and the nurse is expected to

How to become an advanced practice nurse

To become an advanced practice nurse, a person must first earn a Registered Nurse license. This permits a nurse to work in a variety of settings and fill many basic health care roles. After earning the RN license, a nurse can work their way up to becoming an APRN.

What are the steps to becoming an advanced practice nurse?

Before a person can become an APRN, they must first hold a valid RN license. This means passing the NCLEX-RN. It’s possible to prepare for this examination by studying for an associate’s degree, but in most states nurses with a four-year degree are preferred.

Some states require nurses who hold an ADN to upgrade their qualification to the BSN within ten years of licensure because BSN-prepared nurses deliver a higher standard of patient care and produce better patient outcomes.

Most nurses earn the BSN and their RN license, then gain some experience in a clinical setting before deciding what sort of advanced practice nurse they’d like to be. The RN license allows nurses to work in a variety of settings, meaning they have the opportunity to experience being a physician assistant, working in ICU, providing neonatal care, or helping out in surgery or on an oncology ward.

Nursing is a diverse profession, and it’s common for people who enter the profession to find they really enjoy working in some areas of health care but dislike others. Some may find the pressure of ICU too much to deal with or hate being on call if they’re attached to the cardiology department. Some nurses find end-of-life care emotionally difficult, others struggle to work with children because they aren’t good at building a rapport with that age group.

Once you have an idea of what area of nursing you’d like to specialize in, you can look for an accredited master’s degree and focus on getting as much experience as possible in that area. The AACN offers some entry-level certifications for Registered Nurses that can provide the skills a nurse needs to work under supervision in a variety of roles. This may help accelerate the process of earning the required clinical practice hours for licensing as an APRN.

Most APRN roles require a master’s degree, but those who wish to become a Nurse Practitioner may need to earn a Doctor of Nursing Practice. This takes many years of study, and entry into doctoral-level programs is very competitive.

How long does it take to become an advanced practice nurse?

Exactly how long it will take to become an advanced practice nurse depends on the route you take into nursing practice in general. In most cases, the pathway looks something like this:

• 4 Years for a BSN and the NCLEX-RN
• 2 Years for the MSN and extra certifications
• 2 Years (post-MSN) to earn a Doctor of Nursing Practice

This means a total of 6 years for some APRN positions, or 8 years if you would like to become a Nurse Practitioner.

In the real world, progress through the ranks of the nursing profession is not always that fast. Some programs and certifications expect a nurse to have a minimum of three years of clinical experience for advanced practice work, meaning a nurse would be expected to spend some time in more general RN roles before they started looking at advanced nursing practice.

Not all nurses take this ‘optimal’ route into the profession, either. Some earn an ADN then upgrade it to a BSN part-time. Those who discovered nursing later in life may even spend some time as a vocational or practical nurse before pursuing the RN license.

It’s also common for nurses who hold a BSN to spend several years working as a Registered Nurse before deciding they’d like to move up the ranks. At that point, they may look to enroll directly into a DNP, rather than earning a master’s degree first. Bridge programs that take a student from the BSN to a Doctoral-level qualification will include all of the science and nursing theory offered at master’s level, ensuring the student leaves the course armed with a knowledge of nursing ethics, best practices, and evidence-based medicine.

Completing the program of education required to become an advanced practice nurse can be demanding both intellectually and financially. Fortunately, there are many scholarships available. The American Association of Nurse Practitioners runs a scholarship program, which is open to applications from nurses who are currently enrolled in a master’s degree or doctoral-level qualification in a nursing-related discipline.

Many hospitals will also offer support to those who are looking to upgrade their qualifications, in return for ongoing employment. However a nurse chooses to fund their studies, they should find the increased earning potential means the investment pays for itself within a few years. Plus, the increased scope of practice, independence, and variety of work APRNs enjoy makes the study worthwhile.