Advanced Practice Registered Nurses

Kim Maryniak, PhD, RNC-NIC, NEA-BC


An advanced practice registered nurse (APRN) is an experienced RN with additional training in a nursing specialty that provides knowledge and skills to operate in an expanded role. APRNs practice in a variety of specialty areas, including family practice, acute care, adult medicine, women’s health, obstetrics and gynecology, pediatrics, school health, neonatology, geriatrics, emergency medicine, and psychiatry.

APRNs use critical thinking by conducting comprehensive health assessments, determining differential diagnoses, and managing acute and chronic illnesses. APRNs may perform independently or in collaboration with other healthcare professionals. The focus of care is on promotion and maintenance of wellness as well as diagnosis and management of acute and stable chronic illnesses (Robert Wood Johnson Foundation [RWJF], 2017).

APRNs consist of certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), nurse practitioners (NPs), and clinical nurse specialists (CNSs).
  •   A CRNA specializes in anesthesia through an approved and accredited graduate nurse-anesthetist program
  •   A CNM specializes in the management of women, including family planning, pregnancy, childbirth, postpartum care, care of the newborn, and gynecology
  •   An NP is an expert in a specific area, can diagnose, order, supervise, interpret tests, manage, and prescribe treatments
  •   A CNS is an expert in a specific population, provides diagnosis, treatment, and ongoing management of patients. They also provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout the organization, and ensure the use of best practices and evidence-based care to achieve the best possible patient outcomes
(Blair & Jansen, 2015, NACNS, 2018)

Each state has a nurse practice act which describes the scope of APRN practice. When defining the scope of practice, many states rely on national standards developed by the various specialties. Some states regulate APRNs through the state nursing board, some through the state medical board, and other states use a combination of both nursing and medical boards. No consistent sources of law govern APRNs. It is essential to the practicing APRN that he/she knows the scope of practice for his/her licensure in the state they want to practice in.

Although there have been changes in many states’ nurse practice acts, barriers to APRN practice remain. These barriers occur on federal, state, and organizational levels (Poghosyan, 2018). RWJF reports that these barriers exist despite the increasing volume on research indicates that APRNs who have full practice authority provide comparable care to those APRN’s who practice in states that require physician oversight (2017). Currently, only 22 states grant full practice authority to APRNs. Nursing and specialty organizations, in collaboration with legislative groups are advocating for removing barriers to the full potential of APRNs in practice (Robert Wood Johnson Foundation, 2017).

Blair, K., & Jansen, M. (2015). Advanced practice nursing: Core concepts for professional role development (5th ed.). New York: Springer.

National Association of Clinical Nurse Specialists. (2018). What is a CNS? Retrieved from: https://nacns.org/about-us/what-is-a-cns/

Poghosyan, L. (2018). Federal, State and Organizational Barriers Affecting Nurse Practitioner Workforce and Practice. Nursing Economics. Retrieved from https://www.nursingeconomics.net/necfiles/2018/JF18/43.pdf

Robert Wood Johnson Foundation. (2017). Charting nursing’s future: The case for removing barriers to APRN practice. Retrieved from https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf435543

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