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The Résumé Rx

A Complete Guide to Advanced Practice Registered Nursing

Amanda Guarniere

An Advanced Practice Registered Nurse (APRN) is a clinician with a registered nurse license and a master’s or doctoral degree who performs advanced healthcare roles.

APRN is an umbrella term that encompasses clinical nurse specialists (CNS), nurse practitioners (NPs), certified nurse midwives (CNMs), and nurse anesthetists (CRNAs).

They commonly work in hospitals, residential care facilities, birth centers, private physicians’ offices, and surgical centers. This article provides information on the career path, responsibilities, and how to become an APRN.

In this post, we’ll give you an overview of the career of an APRN – including their career path, day-to-day responsibilities, and how to become one.

Contents

What does an Advanced Practice Registered Nurse do?

The general responsibility of an APRN typically falls between that of an RN and a physician. Because of their expertise, they have considerable autonomy since they can diagnose and treat conditions and prescribe medications.

APRNs’ roles vary depending on specialty. Because of the broadness of their duties, they are often tasked with coordinating patient care, providing primary or specialty healthcare.

Some primary roles and responsibilities of APRNs include the following:

  • Recording a patient’s medical history.
  • Ordering diagnostic tests.
  • Writing prescriptions.
  • Evaluating and identifying patients’ need for care.
  • Referring patients for further care.
  • Performing physical exams.
  • Managing patient records.
  • Dispensing medications.
  • Administering vaccinations.
  • Formulating treatment plans.
  • Educating patients on their condition and care.

Advanced Practice Registered Nurse Salary info (How much do they make?)

According to Payscale, the average annual salary for APRNs is $101,118 as of June 2023. However, this number varies depending on the sub-specialty, years of experience, and employer’s pay factors. For example, nurse practitioners earn a median salary of $121,548 as of June 26, 2023, while certified nurse midwives earn a median salary of $120,032 as of the same date.

Advanced Practice Registered Nurse Subspecialties: Roles, Requirements, and Salaries

There are four types of APRNs. Let’s explore each of them in more detail:

Nurse Practitioner (NP)

What does a nurse practitioner do?

Nurse practitioners are a type of APRN who provide advanced and thorough care to patients. They work alongside physicians to assist and treat patients and have the authority to prescribe medication, examine patients, and diagnose certain illnesses. Nurse practitioners may specialize in different areas, including acute care, adult gerontology, emergency, or family. As a result of their advanced skills, they are often responsible for coordinating patient care and providing primary or specialty healthcare.

What’s required to become a nurse practitioner?

To become a nurse practitioner, you need to have a Bachelor of Science in Nursing degree (BSN), a working RN license, a nursing graduate program, and relevant experience in the field.

How much does a nurse practitioner make?

According to salary.com, the average annual salary for Nurse Practitioners (NPs) is $121,548 as of June 2023. However, this number may vary depending on factors such as education, certifications, additional skills, and experience.

Certified Nurse Midwife (CNM)

What does a certified nurse midwife do?

Certified nurse-midwives are APRNs who specialize in childbirth and women’s reproductive health. They provide essential services for women’s and babies’ health, such as conducting preventative screenings, counseling on unexpected pregnancies, monitoring fetal development and labor progress, delivering newborns, and providing guidance on newborn care. After childbirth, they also explain psychological changes and assess the mother’s health.

What’s required to become a certified nurse midwife?

To become a Certified Nurse Midwife (CNM), you must complete an accredited nursing program and earn a Bachelor of Science in Nursing (BSN) degree. After obtaining your license by passing the NCLEX-RN exam, you can then apply to a nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME). Once enrolled, you can take the certified nurse-midwife certification, which needs to be renewed every five years, and then apply for state licensure.

How much does a certified nurse midwife make?

A Certified Nurse Midwife earns a median salary of $120,032 as of June 2023, which might vary depending on residential state, employer, and degree earned.

Clinical Nurse Specialist (CNS)

What does a clinical nurse specialist do?

A Clinical Nurse Specialist (CNS) is an APRN who provides leadership and high-level clinical expertise in a specialty area of medicine. The expertise of CNSs allows them to work almost universally, including:

  • Settings like critical care, home health, emergency room, health centers, and medical/surgical units.
  • Diverse populations such as women’s health, geriatrics, adult health, neonatal, and pediatrics.
  • Specific care areas like rehabilitation, psychiatry, and public health.
  • Managing non-major health problems such as wounds, stress/anxiety, pain, and disease.
  • Assisting in subspecialties like oncology, orthopedics, neurology, infectious disease, and diabetes.

What’s required to become a clinical nurse specialist?

To become a Clinical Nurse Specialist (CNS), you will need a working RN license, an MSN, Postgraduate, or Doctoral degree, and a Clinical Nurse Certification accredited by the America Nurses Credentialing Center (ANCC).

The graduate program must include the following courses

  • Advanced pathophysiology
  • Advanced pharmacology
  • Advanced physical/health assessment courses.

You will also need a minimum of 500 supervised clinical hours in the CNS role and population of choice.

How much does a clinical nurse specialist make?

Payscale reports the salary range for CNS as $66,000- $135,000, with an average salary of $97,817 as of 2023. Like most nursing specialties, salaries vary considerably by region, education, experience, and employer, so it’s best to research salaries in your practice area.

Certified Registered Nurse Anesthetist (CRNA)

What does a certified registered nurse anesthetist do?

Certified Registered Nurse Anesthetists (CRNAs) are APRNs who administer anesthesia to patients during surgery or other medical procedures while ensuring patient safety. CRNAs perform a wide range of duties, including patient assessments, administering anesthetics, inserting lines and epidurals, and monitoring patients during procedures. They also educate patients and families about the effects and possible reactions of anesthesia, as well as facilitate recovery from anesthesia.

CRNAs can work in a variety of settings, including hospitals, dental offices, public health centers, pain management centers, plastic surgery centers, and outpatient surgery centers.

What’s required to become a certified registered nurse anesthetist?

To become a Certified Registered Nurse Anesthetist (CRNA), you must have a Bachelor of Science in Nursing degree or a related field from an accredited program, an unrestricted license as a registered nurse, at least one year of experience in a critical care setting, and complete a master’s degree from an accredited nurse anesthesia educational program.

How much do certified registered nurse anesthetists make?

To put into perspective how valued CRNAs are – they are the highest-paid nursing specialists with an average annual salary of $195,610 as of May 2021 according to the BLS occupational handbook.

Career Path to Becoming an APRN

The journey for each sub-specialty is unique, but there are five common steps to becoming a licensed APRN.

Step 1: Become a Registered Nurse (RN)

If you want to become an Advanced Practice Registered Nurse (APRN), the first step is to enroll in an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing Degree (BSN) program and pass the NCLEX-RN exam to become a registered nurse (RN).

Step 2: Enroll in a Graduate Program (MSN or DNP)

Once you have your bachelor’s degree, you can enroll in a graduate program, typically a Master’s degree in Nursing (MSN) or Doctor of Nursing Practice (DNP).

If you hold an RN license but without a bachelor’s degree, you can enroll in an RN-to-MSN bridge program.

Step 3: Obtain the Required Hours of Clinical Experience

All study programs incorporate practice coursework, but you must also gain the required hours of clinical experience to become an APRN.

Your area of specialization and institution will determine your requirements for clinical hours. Some examples of clinical hourly requirements include:

  • Certified nurse midwives (CNM): 600-1,200 hours
  • Nurse practitioners (NP): 500 hours
  • Certified registered nurse anesthetists (CRNA): at least 2,000 hours

Step 4: Pass the National APRN Certification Exam

Passing a national certification exam is rigorous and takes months of preparation. Although you must pass the national certification exam regardless of your specialty, which exam you take depends on your specialty. For example, NPs can either take the Family Nurse Practitioner (FNP) exam administered by the American Association of Nurse Practitioners (ANCC) or the American Nurses Credentialing Center (ANCC). The CRNA exam is offered by the National Board of Certification and Recertification or Nurse Anesthetists (NBCRNA).

Step 5: Apply for Licensure as an APRN

After passing the APRN certification exam, an individual must apply for the APRN license in the state where they want to practice. The requirements for licensure and the scope of practice may vary widely among different states so remember to research the specific requirements of the state where you plan to practice to ensure compliance with their regulations.

Continuing Education Requirements for an Advanced Practice Registered Nurse

APRNs are required to take recertification exams or continuing education every five years. There are two options for certification renewal:

  • Recertification by clinical practice hours and continuing education where you’ll need to hold a current RN license, a minimum of 1,000 practice hours as an NP, and a minimum of 100 hours of advanced continuing education (CE).
  • Recertification by Examination – Here, you’ll need to hold an active RN license and then take the A-GNP or FNP National Certification Examination.

Take note that a few factors go into determining what CE units you’ll need and that every state licensing board determines licensing and CE requirements and hours of continuing education for APRNs.

Core Skills Required to Become an Advanced Practice Registered Nurse

To truly excel as an Advanced Practice Registered Nurse (APRN), you’ll need a blend of both clinical and soft skills. These skills will help you balance the numerous responsibilities of your role and provide excellent patient care: 

  • Patient Assessment: As an APRN, one of your primary roles will be performing patient assessments. This involves a comprehensive evaluation of a patient’s health status. You’ll need to develop sharp clinical judgment to interpret patient symptoms, medical history, and diagnostic tests.
  • Active Listening: Active listening is paramount to providing patient-centered care. It’s about understanding the patient’s concerns, asking insightful follow-up questions, and empathetically responding to their descriptions of pain and discomfort.
  • Effective Communication: Efficiently conveying information is crucial in healthcare. It’s not just about explaining diagnoses and treatment plans to patients, but also communicating effectively with other healthcare professionals to ensure seamless patient care.
  • Compassion: As an APRN, you’ll often interact with patients in distress. Being compassionate can help you provide emotional support and foster trusting relationships with patients.
  • Critical Thinking: APRNs must possess the ability to think critically, particularly during complex or emergency health situations. This involves analyzing data, considering potential outcomes, and making informed decisions to provide optimal patient care.
  • Teamwork: Teamwork is key in the healthcare realm. As an APRN, you’ll work with various healthcare professionals such as physicians, pharmacists, and other nurses. Collaborating effectively with your team can improve patient outcomes and create a more efficient work environment.
  • Stress Management: The healthcare field can be stressful. Learning how to manage stress can help maintain your mental well-being and prevent burnout.
  • Self-development: The field of healthcare is constantly evolving. To stay current, APRNs must commit to lifelong learning. This could involve participating in continuing education programs or professional development workshops.

Where Can APRNs Work?

Advanced Practice Registered Nurses (APRNs) are an integral part of many different healthcare contexts, serving as primary care providers, supervisors, and specialists. Their high level of training and expertise allows them to work within a variety of sectors.

Below are some of the most common settings where APRNs can find employment, each with its own unique roles and responsibilities: 

  • Private Physicians’ Offices – In this setting, APRNs often serve as primary healthcare providers. They are responsible for diagnosing and treating a wide range of health conditions. Additionally, they often play a supervisory role in managing Registered Nurses (RNs).
  • Outpatient Care Facilities – Here, APRNs provide a spectrum of primary care services to patients who come in for various treatments and procedures. This requires a solid understanding of a broad range of medical conditions and treatments.
  • Hospitals – Within the hospital setting, the role of an APRN can vary greatly depending on the specific department or unit. They may administer medications, lead nursing departments, and diagnose and treat a variety of health conditions.
  • Birthing Centers – Certified Nurse Midwives (CNMs), a specific type of APRN, often work in birthing centers. They provide prenatal care, assist during labor and delivery (intrapartum care), and offer postpartum care.
  • Residential Care Centers – In these facilities, APRNs may provide primary care to residents, as well as diagnose and treat a variety of illnesses. This role requires a high level of adaptability and excellent patient management skills.
  • Surgical Centers – Some APRNs, such as Certified Registered Nurse Anesthetists (CRNAs), often work in surgical centers. They administer anesthetics, monitor patients during surgery, and assist in surgical procedures.

FAQs

How long does it take to become an APRN?

Becoming a licensed APRN takes 6-8 years, depending on whether you pursue a part-time or full-time course. Adding a DNP to your MSN will take another 2-3 years to complete.

What is the career outlook for APRNs?

The US Bureau of Labor Statistics projects a 40% growth in APRN employment from 2021 through 2031. This translates to about 30,200 job openings annually over the decade.

What is the difference between an RN and APRN?

A Registered Nurse (RN) works directly with patients, caregivers, and other healthcare professionals to provide and coordinate patient care. They implement hands-on care and are responsible for executing a patient’s healthcare plan. This plan can involve administering medication, performing minor medical operations, and monitoring patient recovery and progress. 

On the other hand, Advanced Practice Registered Nurses (APRNs) operate at a higher level. They have additional training and education that allows them to perform tasks that RNs cannot. This includes formulating patient care plans and making critical decisions about patient care. They have the authority to diagnose illnesses, manage patient care, and provide treatment. 

Key Differences Between RNs and APRNs 

Registered Nurse (RN)Advanced Practice Registered Nurse (APRN)
RoleDirect patient careFormulating patient care plans
ResponsibilitiesImplementing patient care planSupervising RNs and other medical professionals
EducationBachelor's or associate degree in nursingMaster's or doctoral degree in nursing

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