Advanced practice nurse
Encyclopedia
An advanced practice registered nurse (APRN) is a nurse with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing
.
APRN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at the post-graduate
level and may work in either a specialist
or generalist
capacity. However, the basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidenced based
decision making.
education is designed to teach an APN to use multiple approaches to decision-making, manage the care of individuals and groups, engage in collaborative practices with the patient or client to achieve best outcomes; provide a supportive environment for colleagues; manage the utilization of staff and physical resources; engage in ethically justifiable nursing practice; protect the rights of individuals and groups; engage in activities to improve nursing practice; develop therapeutic and caring relationships; fulfill the conduct requirements of the profession; act to enhance the professional development of self; and function in accordance with legislation and common law affecting nursing practice.
APRN education forms the basis of four recognized general areas of specialization:
Each nurse specialty, especially NPs, can have sub-specialties or concentrations in a specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being an APRN.
While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, these roles are regulated by legislation and specific professional regulation. This allows for prescribing and referral, insurance reimbursement, and admitting privileges to health care facilities. In the US, the licensing boards are governed by State regulations and statutes and are the final arbiters of who is recognized to practice within a given State. While APRNs are educated differently depending on their specific specialty, all APRNs are now trained at the graduate level and are required to attain at least a master's degree, generally a Master of Science in Nursing
in their field of concentration.
In 2004, The American Association of Colleges of Nursing
(AACN) in conjunction with the National Council of State Boards of Nursing (NCSBN) recommended that advanced practice registered nurses move the entry level degree to the doctorate level by 2015. Accordingly, all APRN training programs are required to convert their master's degree to a Doctor of Nursing Practice degree by the year 2015. Although The American Association of Nurse Anesthetists approved this recommendation, it is not requiring program compliance until the year 2025.
The majority of programs will grant a Doctor of Nursing Practice (DNP). Because 45% of the nurse anesthesia programs are located in Schools of Allied Health, these programs will award a Doctor of Nurse Anesthesia Practice (DNAP). The Doctor of Nursing Practice will be the direct-entry, minimum academic requirement for advanced practice registered nurses; it is a clinical/practice-based doctorate but because it is not the entry degree for the profession of nursing
(which includes advanced practice registered nursing), it is a terminal degree
.
Every state has different laws, rules, regulations, licensing and certification requirements for Advanced Practice Registered Nurses, thus some states may not have a grandfather clause
in their State Board of Nursing laws, in particular as it may relate to transferring a license from one State to another. The US National Counsel of State Boards of Nursing (NCSBN) continues to work on a collaborative muti-state compact licensure agreement for advanced practice nurses to be able to work in multiple US States with a singular active home State license. there are on-going discussions on expanding that type of licensure nationally similar to the existing Nurse Compact for recognition of RN and LPN licenses.
concluded that APRN care is safe, cost-effective, and results in similar clinical outcomes and patient satisfaction as compared to care by physicians.
Examples of terminal degrees in research are:
Examples of terminal professional degrees in nursing are:
A list of post-nominal initials include, but are not limited to:
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
.
APRN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at the post-graduate
Postgraduate education
Postgraduate education involves learning and studying for degrees or other qualifications for which a first or Bachelor's degree generally is required, and is normally considered to be part of higher education...
level and may work in either a specialist
Specialty (medicine)
A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.-History of medical specialization:To...
or generalist
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
capacity. However, the basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidenced based
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
decision making.
Education, accreditation, and certification
APRNs demonstrate effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgments and interventions. Intensive post-graduatePostgraduate education
Postgraduate education involves learning and studying for degrees or other qualifications for which a first or Bachelor's degree generally is required, and is normally considered to be part of higher education...
education is designed to teach an APN to use multiple approaches to decision-making, manage the care of individuals and groups, engage in collaborative practices with the patient or client to achieve best outcomes; provide a supportive environment for colleagues; manage the utilization of staff and physical resources; engage in ethically justifiable nursing practice; protect the rights of individuals and groups; engage in activities to improve nursing practice; develop therapeutic and caring relationships; fulfill the conduct requirements of the profession; act to enhance the professional development of self; and function in accordance with legislation and common law affecting nursing practice.
APRN education forms the basis of four recognized general areas of specialization:
- Nurse anesthetistNurse anesthetistA nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
s (in the United States, Certified Registered Nurse AnesthetistsNurse anesthetistA nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
or CRNAs) - Nurse midwivesNurse midwifeIn the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
(in the United States, Certified Nurse MidwivesNurse midwifeIn the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
or CNMs) - Clinical nurse specialistClinical nurse specialistA clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
s (CNSs) - Nurse practitionerNurse practitionerA Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
s (NPs)
Each nurse specialty, especially NPs, can have sub-specialties or concentrations in a specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being an APRN.
While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, these roles are regulated by legislation and specific professional regulation. This allows for prescribing and referral, insurance reimbursement, and admitting privileges to health care facilities. In the US, the licensing boards are governed by State regulations and statutes and are the final arbiters of who is recognized to practice within a given State. While APRNs are educated differently depending on their specific specialty, all APRNs are now trained at the graduate level and are required to attain at least a master's degree, generally a Master of Science in Nursing
Master of Science in Nursing
A Master of Science in Nursing is an advanced-level postgraduate degree for registered nurses and is considered an entry-level degree for nurse educators and managers. The degree also may prepare a nurse to seek a career as a nurse administrator, health policy expert, or clinical nurse leader...
in their field of concentration.
In 2004, The American Association of Colleges of Nursing
American Association of Colleges of Nursing
The American Association of Colleges of Nursing is the only remaining national organization of nurses in the United States that is dedicated exclusively to advancing nursing education at the baccalaureate and graduate levels. Established in 1969, it now represents nursing schools at 547...
(AACN) in conjunction with the National Council of State Boards of Nursing (NCSBN) recommended that advanced practice registered nurses move the entry level degree to the doctorate level by 2015. Accordingly, all APRN training programs are required to convert their master's degree to a Doctor of Nursing Practice degree by the year 2015. Although The American Association of Nurse Anesthetists approved this recommendation, it is not requiring program compliance until the year 2025.
The majority of programs will grant a Doctor of Nursing Practice (DNP). Because 45% of the nurse anesthesia programs are located in Schools of Allied Health, these programs will award a Doctor of Nurse Anesthesia Practice (DNAP). The Doctor of Nursing Practice will be the direct-entry, minimum academic requirement for advanced practice registered nurses; it is a clinical/practice-based doctorate but because it is not the entry degree for the profession of nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
(which includes advanced practice registered nursing), it is a terminal degree
Terminal degree
A terminal degree is, in some countries, the highest academic degree in a given field of study. This phrase is in common use in the United States, but is not universal in an international context: the concept is not in general use in the United Kingdom, for example, and the exact definition varies...
.
Grandfather exception
The future Doctor of Nursing Practice requirement will apply only to those who are not yet licensed and practicing as APRNs. Those currently licensed as APRNs will be permitted to maintain their current level of education and certification. Some APRNs who have been in the profession for many years have been grandfathered into continuing APRN practice and licensure even without a master's degree. For example, the first Nurse Practitioner program was created by a nurse educator, Loretta Ford, Ed.D, RN, PNP and a physician, Henry Silver, MD, in 1965 at the University of Colorado as a non-degree certificate program, and all the early NP programs were initially established as these type of certificate programs before transitioning them to master's degrees in the 1980s.Every state has different laws, rules, regulations, licensing and certification requirements for Advanced Practice Registered Nurses, thus some states may not have a grandfather clause
Grandfather clause
Grandfather clause is a legal term used to describe a situation in which an old rule continues to apply to some existing situations, while a new rule will apply to all future situations. It is often used as a verb: to grandfather means to grant such an exemption...
in their State Board of Nursing laws, in particular as it may relate to transferring a license from one State to another. The US National Counsel of State Boards of Nursing (NCSBN) continues to work on a collaborative muti-state compact licensure agreement for advanced practice nurses to be able to work in multiple US States with a singular active home State license. there are on-going discussions on expanding that type of licensure nationally similar to the existing Nurse Compact for recognition of RN and LPN licenses.
APRNs and patient outcomes
Numerous studies have been conducted comparing the patient outcomes of care provided by APRNs and physicians. The conclusions reached indicate that care by APRNs is comparable, and in some instances better, than care by a physician. A recent systematic reviewSystematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
concluded that APRN care is safe, cost-effective, and results in similar clinical outcomes and patient satisfaction as compared to care by physicians.
Terminal degrees
An APRN may earn a terminal degree in several ways. A terminal degree is generally a doctorate. In some fields, especially those linked to a profession (e.g. medicine, nursing, dentistry, law, optometry, architecture, pharmacy, social work, religious ministry, engineering, accounting, education, etc.), a distinction is to be drawn between a first professional degree, an advanced professional degree, and a terminal academic degree. A first professional degree is generally required by law or custom to practice the profession without limitation. An advanced professional degree provides further training in a specialized area of the profession. A first professional degree is an academic degree designed to prepare the holder for a particular career or profession, fields where scholarly research and academic activity are not the work, but rather the practice of a profession. In many cases, the first professional degree is also the terminal degree because usually no further advanced degree is required for practice in that field even though more advanced professional degrees may exist.Examples of terminal degrees in research are:
- Doctor of PhilosophyDoctor of PhilosophyDoctor of Philosophy, abbreviated as Ph.D., PhD, D.Phil., or DPhil , in English-speaking countries, is a postgraduate academic degree awarded by universities...
(Ph.D.) - Doctor of EducationDoctor of EducationThe Doctor of Education or Doctor in Education degree , in Latin, Doctor Educationis, is a research-oriented professional doctorate that prepares the student for academic, administrative, clinical, or research positions in educational, civil, and private organizations.-Differences between an Ed.D...
(Ed.D.) - Doctor of ScienceDoctor of ScienceDoctor of Science , usually abbreviated Sc.D., D.Sc., S.D. or Dr.Sc., is an academic research degree awarded in a number of countries throughout the world. In some countries Doctor of Science is the name used for the standard doctorate in the sciences, elsewhere the Sc.D...
(D.Sc.) - Doctor of Nursing ScienceDoctor of Nursing ScienceThe Doctor of Nursing Practice is a terminal professional degree that focuses on the clinical aspects of nursing rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research. The DNP is intended primarily...
(D.N.Sc., DNS)
Examples of terminal professional degrees in nursing are:
- Doctor of Nursing Practice (DNP)
- Doctor of Nurse Anesthesia Practice (DNAP)
Post-Nominal Initials
The specific titles, credentials, post-nominal initials, and so on, Advanced Practice Nurses utilize will vary greatly by country, state, license-type, academic degrees, and board certifications.A list of post-nominal initials include, but are not limited to:
- ACNP - Acute Care Nurse Practitioner
- ANP - Adult Nurse Practitioner
- APRN - Advanced Practice Registered Nurse (Same as Advanced Practice Nurse)
- APN - Advanced Practice Nurse (Refers to the four recognized general areas of advanced professional specialization: CRNA, NP, CNM, and CNS)
- ARNP - Advanced Registered Nurse Practitioner (Refers to Nurse Practitioners in some US States)
- C or BC following a title - Certified or Board Certified (i.e., APRN-BC, WHNP-BC, PNP-BC, FNP-C, GNP-C, ANP-BC)
- CNM - Certified Nurse Midwife
- CNS - Clinical Nurse Specialist
- CRNP - Certified Registered Nurse Practitioner
- CS - Clinical Specialist
- CRNA - Certified Registered Nurse Anesthetist
- DNP - Doctor of Nursing Practice (the terminal professional degree for APNs)
- FNP - Family Nurse Practitioner
- GNP - Gerontological Nurse Practitioner
- NNP - Neonatal Nurse Practitioner
- NP - Nurse Practitioner
- ONP - Oncology Nurse Practitioner
- PMHCNS - Psychiatric & Mental Health Clinical Nurse Specialist
- PMHNP - Psychiatric & Mental Health Nurse Practitioner
- PNP - Pediatric Nurse Practitioner
- PsyNP - Psychiatric Nurse PractitionerPsychiatric and mental health Nurse PractitionerAn Advanced Practice Psychiatric/Mental-Health Nurse Practitioner, PMHNP, provides a wide range of services to adults, children, adolescents, and their families in a primary care facility, outpatient mental health clinic, psychiatric emergency services, private practice, or in a hospital or...
- WHNP - Women's Health Nurse Practitioner
See also
- NursingNursingNursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
- Clinical nurse specialistClinical nurse specialistA clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
- Nurse PractitionerNurse practitionerA Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
- Nurse MidwifeNurse midwifeIn the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
- Nurse anesthetistNurse anesthetistA nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...