Advanced Practice Registered Nurses

An advanced practice registered nurse (APRN) is a licensed registered nurse (RN) with additional education and certification. The skill set, the scope of the course, and the level of autonomy in the APRN role differ depending on the type of certification achieved and the state in which the nurse practices. Generally speaking, advanced practice registered nurses engage in direct clinical practice with individuals, use in-depth knowledge to assess, diagnose, and manage problems, promote health, and sometimes have prescriptive authority for medications and treatments. 

The requirements to become an advanced practice nurse in the United States include education and certification. First, one must complete either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) program. To be accepted into an MSN program, the candidate must first have a Bachelor of Science Degree in Nursing (BSN) and have passed the NCLEX-RN licensure exam to become a registered nurse (RN). Many graduate programs require a nurse also to have at least a year of clinical experience to be accepted. A DNP program requires RN licensure, with some programs offering BSN to DNP programs and others requiring an MSN degree for admittance. However, some universities also offer a program where an individual can obtain an MSN and DNP simultaneously. 

A BSN program generally takes four years to complete if it is the individual’s first degree and 1.5 to 2 years for someone who has previously obtained a non-nursing bachelor’s degree. Most MSN programs can be completed in two years, while a DNP program can take 3 to 4 years. 

After completing a graduate degree from an accredited program, a nurse must pass a certification exam and apply through their state’s board of nursing for an advanced practice registered nurse license. The regulations are laid out in the Nursing Practice Act (NPA) of the state where the license is requested. Various certification exams are offered through different national certifying bodies, and the exam taken depends on the degree obtained and the desired certification. These national certifying bodies include The American Midwifery Certification Board, American Nurses Credentialing Center, American Academy of Nurse Practitioners Certification Board, American Association of Critical Care Nurses Certificate Program, and the National Board on Certification/ Recertification of Nurse Anesthetists.

The four types of APRNs are a certified nurse practitioner (CNP), a clinical nurse specialist (CNS), a certified nurse midwife (CNM), and a certified registered nurse anesthetist (CRNA). A certified nurse practitioner provides primary and acute care and can diagnose and manage acute and chronic conditions. They typically obtain certification in specialty areas based on the population they treat, with each area requiring a separate certification. These certifications include neonatal, pediatric, family practice, geriatric, psychiatric/mental health, and women’s health/gender-related populations. A nurse practitioner can prescribe medications and treatments and works with varying levels of autonomy according to their state’s nursing practice.

A clinical nurse specialist is an expert in their area of advanced education, which can be based on a population, setting, or specific disease or problem type (e.g., pediatrics, critical care, or oncology). They can provide clinical care, serve as consultants to care providers and nursing staff and work in nursing leadership roles to create policies and procedures that reflect evidence-based practices in their area of expertise. Unlike certified nurse practitioners, clinical nurse specialists do not typically prescribe.

A certified nurse midwife provides prenatal, labor and delivery, postpartum, and newborn care for pregnant individuals. They also offer family planning, gynecological, and menopausal care for people assigned female at birth and can work in hospitals, birth centers, clinics, and homes.

A certified registered nurse anesthetist provides anesthesia care to individuals of any age and in various settings, such as hospitals and outpatient centers. They can make independent decisions within their licensure scope of practice and provide all types of anesthesia. Nurse anesthetists play a significant role in providing anesthesia care in rural areas where they provide two-thirds of anesthesia needs in rural hospitals.

The salary of an advanced practice registered nurse varies based on the type of APRN and their type of employment. For example, according to the U.S. Bureau of Labor and Statistics, a certified nurse practitioner earned an average salary of $118,040 annually in May 2021. CNPs who were employed in physicians’ offices, however, earned an average of $114,870 per year.

According to the same source, a certified nurse midwife earned an average salary of $114,210 per year in May 2021, with variations ranging from $104,670 per year for those employed in local government to $119,900 per year for those working at hospitals. It has been estimated that those working in outpatient care centers earn around $146,430 annually.

While the Bureau of Labor and Statistics does not report statistics specifically for clinical nurse specialists, a popular job search website said that in mid-July 2022, the average salary earned by a CNS was $112,221 per year, which includes an average of $97,336 per year for a pediatric CNS and $115,254 for an oncology CNS.

The advanced practice registered nurses that regularly earn the highest salaries are certified registered nurse anesthetists. The U.S. Bureau of Labor and Statistics reports that in May 2021, nurse anesthetists earned an average annual salary of $202,470. These average salaries varied according to where they worked (e.g., $194,240 per year for those employed in physicians’ offices, $212,340 per year for those who work for hospitals, and $254,180 per year for those employed in outpatient care centers).

Advanced practice registered nurses play a vital role in healthcare delivery by providing direct care using skills and knowledge obtained through additional education and certification. There are four advanced registered nurses (e.g., certified nurse practitioner, clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist). The scope of practice of each type is based on the nurse’s certification and the state in which they practice. APRNs are employed in clinical practice across many settings, including hospitals, private practices, home healthcare services, and outpatient care centers. Their average salary varies on the type of certification and location of employment.