Advanced Practice Registered Nursing (APRN) Roles by Scope of Practice

APRNs are advanced practice registered nurses who have completed an accredited graduate-level program, passed a national certification exam, and earned a state license. 

Nurse practitioners (NP) are one of the four types of APRNs, along with clinical nurse specialists (CNS), certified registered nurse anesthetists (CRNA), and certified nurse-midwives (CNM). Overall, APRNs provide various primary, acute, and specialty healthcare services. 

APRNs are vital in delivering high-quality and accessible patient care with their advanced training. Some APRNs practice independently, and others under physician supervision, depending on the scope of practice determined by the state in which they are licensed and certified. APRNs can practice independently in states granting full practice authority or collaborate with physicians (MDs) in states with limited or restricted practice authority. 

With a master of science in nursing (MSN), post-master’s certificate, or doctorate of nursing practice (DNP), APRNs can specialize in specific areas, such as adult-gerontology or pediatrics, or serve as primary care providers for patients. Generally, APRNs’ scope of practice includes diagnosing and treating illnesses, prescribing medications, and managing overall patient care.

As demand for healthcare services increases, so too will job opportunities for APRNs who provide comprehensive care in underserved rural and populated urban areas. 

The US Bureau of Labor Statistics (BLS) shows nurse anesthetists, nurse midwives, and nurse practitioners positions will grow 40 percent in the coming decade, adding 118,600 new jobs between 2021 and 2031. This is eight times faster than the national average (5 percent), and  95 percent or 112,700 of those new positions will be nurse practitioners (BLS 2022). The states with the highest concentration of jobs are Tennessee, Mississippi, West  Virginia, Alaska, and Missouri (BLS May 2021). 

Read on to learn about the four APRN roles, education, certifications, career outlook, salary prospects, and general scope of practice.

Certified Nurse Practitioner (CNP)

NPs are expert clinicians who provide a wide range of primary, acute, and specialty health care services. They diagnose and treat health conditions, order and interpret diagnostic tests, prescribe medications, and provide preventive screenings and counseling on various health issues. NPs often serve as a patient’s primary health care provider and may provide general or specialized patient population care as family nurse practitioners or women’s-health nurse practitioners. 

Education

Becoming a certified nurse practitioner requires advanced education and training beyond that of a registered nurse (RN). To be eligible for NP programs, applicants must generally have a minimum of a bachelor of science in nursing (BSN) degree to apply for MSN, post-master’s certificate, or DNP program. 

That said, some programs accommodate RNs prepared with an associate degree in nursing (ADN), or an ADN plus a non-nursing bachelor’s degree and these programs are often called “RN to MSN” or “RN to MSN bridge” programs.

In addition to classroom study, nurse practitioner students complete clinical rotations in various specialties, such as pediatrics or women’s health. These experiences are critical for developing the skills necessary to provide comprehensive healthcare to patients. 

After obtaining the required degree and completing any necessary state requirements, individuals can become certified through an accredited organization, such as the American Association of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC). 

University of Arizona – DNP Nurse Practitioner with Specializations

The University of Arizona’s online BSN-to-DNP program offers multiple specializations for certified nurse practitioners, including adult-gerontology acute care (AGACNP), family (FNP), psychiatric-mental health (PMHNP), and pediatrics. Students in the program complete a minimum of 1,000 clinical hours, with at least 720 in their chosen specialty area. 

Dual specialization students have additional clinical requirements and attend two resident intensive summer experiences (RISE) and one clinical skills intensive (CSI). The program culminates with a final DNP project. With a range of specializations and comprehensive clinical training, graduates are well prepared to take a certification exam and move into an APRN role.  

• Location: Tucson, AZ 
• Duration: 2.5 to 3.5 years
• Accreditation: Commission on Collegiate Nursing Education (CCNE)
• Tuition: $975 per credit 

Certifications

Certifications for NPs include: 

• Family Nurse Practitioner (FNP) – American Academy of Nurse Practitioners
• Family Nurse Practitioner Certification (FNP-BC) – American Nurses Credentialing Center

Here are the organizations that offer national certification to NPs, depending on their population focus or specialization:

• American Academy of Nurse Practitioners (AANP)
• American Association of Critical-Care Nurses (AACN)
• American Nurses Credentialing Center (ANCC)
• Dermatology Nursing Certification Board (DNCB)
• National Certification Corporation (NCC)
• Nephrology Nursing Certification Commission (NNCC)
• Oncology Nursing Certification Corporation (ONCC) 
• Orthopaedic Nurses Certification Board (ONCB)
• Pediatric Nursing Certification Board (PNCB)

Career Outlook

According to the Bureau of Labor Statistics (2022), nurse practitioner positions will grow by 46 percent from 2021 to 2031, a rate which is much faster than the national average (5 percent) and more than five times the average for healthcare diagnosing and treating professions (9 percent). This equates to 112,700 new positions in the coming decade, partly due to the aging population and their resulting medical needs, as well as an increased emphasis on preventative care and access to healthcare. 

In addition, nurse practitioners often form long-term relationships with patients, leading to improved health outcomes and cost savings compared to traditional physician care in some cases. 

Salary 

Pursuing a certified nurse practitioner career promises fulfilling work with excellent job prospects and compensation. With a median salary of $120,680 (BLS May 2021), certified nurse practitioners are also financially rewarded for their essential work, earning more than double the national average of $58,260 (BLS May 2021).

Scope of Practice

A certified nurse practitioner’s scope of practice refers to the responsibilities and tasks they are legally allowed to perform in their role as a healthcare provider. These duties can vary by state and specialty but generally include performing physical exams, ordering and interpreting diagnostic tests, diagnosing illnesses and injuries, prescribing medication, treating patients, and managing chronic conditions. 

Nurse practitioners also play a critical role in educating patients about preventative care and self-management strategies. In some states, certified nurse practitioners have the authority to practice independently without physician oversight. However, laws regarding collaboration with physicians or referral to specialists may still apply in certain situations.

Certified Registered Nurse Anesthetist (CRNA)

A certified registered nurse anesthetist (CRNA) is crucial in providing anesthesia for surgical and non-surgical procedures. CRNAs work with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare providers to plan and administer anesthesia care. CRNAs may also participate in patient education and research. 

Education

To become a CRNA, nurses must obtain a bachelor of science in nursing (BSN) and have at least one year of critical care experience. In addition, they must complete an accredited nurse anesthesia program, pass the national certification exam, and obtain a state license. These programs typically require three to four years of full-time study and include classroom work, clinical rotations, and supervised clinical practice. 

CRNAs must also participate in ongoing education to maintain their certification and stay current with advancements in the field. With their comprehensive training and experience, CRNAs are well-prepared to provide safe and effective patient anesthesia care.

Loma Linda University – DNP in Certified Registered Nurse Anesthesia

The online DNP program at Loma Linda University offers a nurse anesthesia concentration for students looking to become certified registered nurse anesthetists. This 39-month, full-time graduate program is approved by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and the California State Board as a distance education program. 

The nurse anesthesia concentration has partnered with Kettering Health to provide primary clinical site experience in Dayton, Ohio for two students, with pediatric rotations completed at Loma Linda University Health. Graduates of this program have achieved a 100 percent pass rate on the certified registered nurse anesthetist exam, showcasing their exceptional preparation and skill. Individuals interested in becoming certified registered nurse anesthetists can find a strong foundation and support at Loma Linda University’s DNP program.

• Location: Loma Linda, CA
• Duration: Four years
• Accreditation: Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
• Tuition: $15,660 to $40,890 per year (depending on the year)

Certifications

• Certified Registered Nurse Anesthetist (CRNA) – National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)

Career Outlook

The career outlook for certified registered nurse anesthetists (CRNA) is promising. According to the Bureau of Labor Statistics (2022), employment for CRNAs is projected to grow 12 percent from 2021 to 2031, much faster than the average for all occupations (5 percent), creating 5,300 new positions in the same decade. 

This growth can be attributed to several factors, including an increase in surgeries and procedures due to a growing elderly population and advancements in medical technology. In addition, as more hospitals emphasize cost-effectiveness, they are turning towards CRNAs for their anesthesia services due to their track record of high-quality care at lower costs compared to physicians who specialize in anesthesia. 

Salary 

Due to the skilled vigilance needed to keep patients alive and unconscious for sustained periods, certified nurse anesthetists are the highest-paid APRNs. The BLS (May 2021) shows the average annual salary for CRNAs is $202,470 per year, with the lowest 10th percentile earning $131,840. The highest 10th percentile salary figure is not known precisely, but it is higher than $208,000 annually. 

Scope of Practice

Certified registered nurse anesthetists (CRNAs) are advanced practice nurses who specialize in administering anesthesia for surgical procedures, managing pain, and providing vital patient care before, during, and after surgery. In addition, as certified healthcare professionals, CRNAs can assess a patient’s medical history, perform physical exams, evaluate laboratory data and diagnostic imaging results, and provide anesthesia care throughout a surgery. 

In addition to their role in the operating room, CRNAs may also work in labor and delivery units or other healthcare settings where they administer anesthesia or manage pain relief. With specialized training and experience in anesthesia care, CRNAs play an integral role in ensuring safe and effective patient outcomes.

Bottom Line: APRN Roles

The scope of practice for advanced practice registered nurses is determined by the individual state in which they are licensed and certified. There are four APRN roles: 

• Certified Nurse Midwife (CNM)
• Certified Registered Nurse Anesthetist (CRNA)
• Clinical Nurse Specialist (CNS)
• Nurse Practitioner (NP)

Each APRN role has a different focus and scope of practice. Prospective students should research the requirements in the state they plan to live or work within to choose an educational program that aligns with state authorization and state licensure requirements set forth by state boards of nursing. Once completing an accredited graduate-level program and passing a certification exam, registered nurses (RNs) will be prepared to transition into APRN roles to provide a variety of primary, acute, and specialty healthcare services to their communities.