Advanced Practice Nurse (APN) Roles and Career Paths

Advanced practice nurses (APNs), also known as advanced practice registered nurses (APRNs), are nurses who have obtained advanced training and certification, with either a master’s degree or a doctorate in nursing.

There are four types of APNs: nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), and certified nurse anesthetists (CNAs).

APNs are among a group of healthcare providers described as advanced practice providers (APPs). Although they are not physicians, they perform many medical activities typically performed by a physician. In doing so they expand and enhance the delivery of healthcare in the United States,

This article explains what different advanced practice nurses do, including their roles, responsibilities, qualifications, and certifications.

Responsibilities of an APN

APNs are a higher level of nursing professionals. They can perform many of the tasks that were once the sole domain of medical doctors (physicians). Among other things, they can treat and diagnose illnesses, advise the public on health issues, and manage other nurses or healthcare professionals.

APNs hold at least a master’s degree in nursing after completing the education and licensing required for all registered nurses (RNs). They work in many healthcare settings, including hospitals, clinics, private practices, and long-term care facilities. Some also work in educational or healthcare policy settings.

While their responsibilities can vary by state regulations and their chosen specialty, APNs are generally authorized to perform the following medical activities:

• Perform physical examinations
• Make diagnoses
• Order and interpret lab tests and imaging studies
• Treat acute and chronic diseases
• Prescribe medications
• Refer patients to specialists
  

Nurse Practitioner

A nurse practitioner (NP) is a registered nurse who has advanced education and clinical training in a healthcare specialty. According to the American Association of Nurse Practitioners, there are approximately 385,000 NPs in the United States.

NPs operate with greater autonomy than RNs. Currently, NPs can practice independently in 27 states and the District of Columbia and with limited physician supervision in the other 23 states.

Their responsibilities include:

• Evaluating patients
• Diagnosing, ordering, and interpreting diagnostic tests
• Initiating and managing treatments
• Prescribing medications, including controlled substances (allowed in all 50 states and D.C.)

Over 70% of NPs function as the primary care provider (PCP), while others opt to deliver specialty healthcare in the following fields of practice:

• Geriatrics
• Psychiatry
• Pediatrics
• Acute care
• Women's health
• Neonatal care

NPs must first obtain a Master of Science in Nursing (MSN) degree or a Doctor of Nursing Practice (DNP) degree before sitting for a certification exam. Certification is available through the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP).

Licensing requirements vary from state to state.

Certified Nurse-Midwives

Certified nurse-midwives (CNMs) provide primary, gynecological, and reproductive healthcare to female patients.

CNMs work with obstetrician-gynecologists (OB-GYNs) and are trained to provide a broad range of services for women and newborns, including:

• Taking a medical history
• Doing a physical exam
• Ordering lab tests and procedures
• Managing treatment
• Conducting activities that promote women's health and reduce health risks

CNMs are granted the authority to write prescriptions in all 50 states and D.C., albeit with limitations on prescribing controlled substances in some states.

Currently, 27 states and the District of Columbia authorize CNMs to practice independently within the scope of their certification. Three states require physician supervision, while the remaining 20 require a signed agreement with a supervising physician to deliver specific midwifery services (such as intrapartum care).

CNMs must obtain at least an MSN degree with a nurse-midwifery program accredited by the American College of Nurse-Midwives (ACNM). Certification is available through the American Midwifery Certification Board.

Licensing occurs at the state level and falls under specific state laws.

Nurse Anesthetists

Certified registered nurse anesthetists (CRNAs) provide anesthesia and pain management services. CRNAs practice in hospitals, surgical centers, and office-based settings, delivering all types of anesthesia-related care for surgical, diagnostic, and therapeutic procedures.

CRNAs provide anesthesia for all specialties, including general surgery, obstetrics, cardiology trauma, orthopedics, dentistry, gastroenterology, and plastic surgery.

CRNAs are generally authorized to:

• Perform a physical examination and medical history
• Develop a plan for anesthesia, pain management, and postoperative recovery
• Prescribe and administer medications, including certain controlled substances
• Deliver anesthesia or sedation for surgery or medical procedures (like colonoscopy)
• Monitor vital signs like heart rate and respiration during anesthesia
• Oversee recovery from anesthesia
• Provide advanced pain management for people with acute or chronic pain disorders
  

CRNAs typically work alongside anesthesiologists but can sometimes be the sole anesthesia professionals delivering care to the military, rural, and medically underserved communities,

CNMs must obtain at least an MSN degree with a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Certification is available from the National Board of Certification & Recertification for Nurse Anesthetists.

Licensure requirements vary by state.

Clinical Nurse Specialists

Clinical nurse specialists (CNSs) have advanced clinical expertise in a specialized area of nursing, ensuring optimal practices and organizational oversight for hospitals and other healthcare setting. They are involved in three spheres of practice:

• Direct patient care, with an emphasis on the diagnosis and treatment of specific illnesses in specific at-risk groups (such as pediatric oncology or adult neurology)
• Nursing practices, providing expertise and support to nurses caring for patients
• Organizational oversight, creating systems and effecting organizational changes within a healthcare setting to ensure best practices

A CNS must obtain at least an MSN degree with a clinical nursing program accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).

In most states, a CNS must obtain certification based on a specific population group, either adult/geriatric, pediatric, or neonatal (newborns). Certification is available through the American Nurses Credentialing Center (ANCC) or the American Association of Critical-Care Nurses (AACN).

Differences Between APNs and Other Healthcare Professionals

APNs are essential healthcare providers with specific roles and responsibilities. While some of their functions overlap with other providers like physicians and physician assistants (PA), they operate within a specific framework to support, rather than replace, these providers.

APNs vs. Physicians

APNs perform many of the key functions of a physician, but they are not physicians. An APN holds either an MSN or DNP degree, both of which are non-medical degrees.

While APNs undergo six to seven years of education, physicians must complete 11 to 12 years, including four years of medical school to earn an MD (doctor of medicine) or DO (doctor of osteopathic medicine) degree.

Because of the education and training, physicians have unimpeded authorization and autonomy to prescribe medications or perform procedures that APNs cannot.

APNs vs. Physician Assistants

Physician assistants are medical professionals with master's degrees and national certifications. They also complete graduate-level medical studies, often side-by-side with MDs in training. However, their postgraduate training is compressed into three years.

PAs perform many of the same functions as an APN, including:

• Conducting physical exams
• Diagnosing and treating illness
• Ordering and interpreting tests
• Developing treatment plans
• Performing procedures
• Assisting in surgery
• Making rounds in hospitals and nursing homes

However, one of the big differences between APNs and PAs is that APNs focus on a specialty, while PAs practice more generally. Additionally, PAs must be supervised by a physician, whereas APNs have a certain level of autonomy and can function independently in some states.

APNs vs. Registered Nurses

Registered nurses (RNs) must obtain a Bachelor of Science in Nursing (BSN) degree to practice. In contrast, APNs have master's or doctorate degrees after obtaining the BSN.

APNs tend to oversee patient care less directly than RNs and are more often tasked with developing treatment plans that are carried out by RNs. While RNs follow instructions from a physician, APNs can make a great many decisions on their own.

APNs can also coordinate and supervise an entire medical team.

Summary

Advanced practice nurses (APNs) are highly qualified nursing professionals who can practice independently or with limited physician supervision, depending on state law. They operate on a higher level than registered nurses (RNs) after having obtained a master's or doctorate degree.

APNs are qualified to diagnose diseases, design and dispense treatments, order and interpret tests, and direct patient care. There are four types of APNs: nurse practitioners (NPs), certified nurse-midwives (CNAs), certified nurse anesthetists (CNAs), and certified nurse specialists (CNSs).

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. American Nurses Association. Advanced practice registered nurse (APRN).
2. American Association of Nurse Practitioners. NP fact sheet.
3. American Association of Nurse Practitioners. State practice environment.
4. American College of Nurse-Midwives. Full practice authority.
5. American Medical Association. State law chart: certified professional midwife scope of practice.
6. MedlinePlus. Certified nurse-midwife.
7. American Association of Nurse Anesthesiologists. Scope of nurse anesthesia practice.
8. National Institutes of Health. Nursing at the NIH Clinical Center: certified nursing specialists.
9. National Association of Clinical Nurse Specialists. What is a CNS?
10. American Medical Association. What's the difference between physicians and nurse practitioners?
11. American Academy of Physician Associates. What is a PA?
12. Bureau of Labor Statistics. Licensed practical and licensed vocational nurses.

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