Advanced practice nurse

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An advanced practice nurse (APN) is a nurse with post-graduate education and training in nursing. Nurses practicing at this level may work in either a specialist or generalist capacity. APNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing. [1]

Contents

In the United States, the National Council of State Boards of Nursing along with other nursing authorities and organizations recommend the use of the term and acronym advanced practice registered nurse (APRN) as described in the Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education.

Education, accreditation, and certification

APNs or APRNs are intended to demonstrate effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgments and interventions, while remaining under physician supervision. Post-graduate education is designed to teach an APRN 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. [2]

APRN education forms the basis of four recognized general areas of specialization:

Each specialty can have concentrations in a specific field or patient population.

As of 2023, an APRN in the United States may hold a Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or Doctor of Nurse Anesthesia Practice (DNAP) degree.

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. [3] Accordingly, all APN training programs are recommended (but not required as of yet) to convert their master's degree to a Doctor of Nursing Practice (DNP) degree by 2015. Although the American Association of Nurse Anesthetists approved this recommendation, it is not requiring program compliance until 2025. [4]

The majority of programs will grant a DNP degree. [3] 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 DNP 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.

Regulation

Advance Practice Nursing in the United States

The preferred regulator term for advanced practice nursing in the United States is Advanced Practice Registered Nurse.Nursing in the United States is regulated at the state level. The National Council of State Boards of Nursing (NCSBN) drafts consensus models of proposed legislation for the individual states to implement. In 2008, the NCSBN's APRN consensus model identified four roles:

Patient outcomes

In 2020 Pain Medicine found that CNPs prescribe opioids at a rate 28 times higher than physician counterparts in states where they practice autonomously. [6]

Post-nominal initials

The specific titles, credentials and post-nominal initials used by advanced practice nurses will vary greatly by country, state and educational level.

A list of post-nominal initials include, but are not limited to:

See also

Related Research Articles

<span class="mw-page-title-main">Registered nurse</span> Nurse who has graduated from a nursing program

A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.

<span class="mw-page-title-main">Nurse anesthetist</span> Nurse trained to provide anaesthesia care

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy.

<span class="mw-page-title-main">Certified registered nurse anesthetist</span> Professional title for nurse anesthetists in the United States

A Certified Registered Nurse Anesthetist (CRNA) is a type of advanced practice nurse who administers anesthesia in the United States. CRNAs account for approximately half of the anesthesia providers in the United States and are the main providers (80%) of anesthesia in rural America. Historically, nurse anesthetists have been providing anesthesia care to patients for over 150 years since the American Civil War and the CRNA credential came into existence in 1956. CRNA schools issue a doctorate of nursing anesthesia degree to nurses who have completed a program in anesthesia, which is roughly 3 years in length.

The School of Nursing is the graduate school of nursing at Columbia University in the Washington Heights neighborhood of Manhattan, New York City. Founded in 1892, it stands as one of the oldest nursing schools in the United States.

<span class="mw-page-title-main">Nurse practitioner</span> Mid-level medical provider

A nurse practitioner (NP) is an advanced practice registered nurse (APRN) and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. One study found that although reasons for referrals to specialists are similar for both physicians and NPs, the quality of documentation in the referrals may be lower for NPs.

A Master of Science in Nursing (MSN) 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. The MSN may be used as a prerequisite for doctorate-level nursing education, and used to be required to become an advanced practice registered nurse such as a nurse practitioner, clinical nurse specialist, nurse anesthetist, or nurse midwife.

<span class="mw-page-title-main">Certified nurse-midwife</span> Advanced practice nurse who provides mid-level nursing and midwifery care

In the United States, a Certified Nurse-Midwife (CNM) is a nurse midwife who exceeds the International Confederation of Midwives' essential competencies for a midwife and is also an advanced practice registered nurse, having completed registered nursing and midwifery education leading to practice as a nurse midwife and credentialing as a Certified Nurse-Midwife. CNMs provide care of women across their lifespan, including pregnancy and the postpartum period, and well woman care and birth control. Certified Nurse-Midwives are recognized by the International Confederation of Midwives as a type of midwife in the U.S.

The Doctor of Nursing Practice (DNP) is a professional degree in nursing popular in the United States.

Nursing credentials and certifications are the various credentials and certifications that a person must have to practice nursing legally. Nurses' postnominal letters reflect their credentials—that is, their achievements in nursing education, licensure, certification, and fellowship. The letters usually appear in the following order:

A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Clinical Nurse Specialists are registered nurses who have had graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in the advanced practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings.

In the United States, anesthesia can be administered by physician anesthesiologists, an anesthesiologist assistant, or nurse anesthetist.

<span class="mw-page-title-main">University of South Florida College of Nursing</span>

The University of South Florida College of Nursing is one of 14 colleges at the University of South Florida. The college has three campuses: Tampa, St. Petersburg, and Sarasota-Manatee.

<span class="mw-page-title-main">Alice Magaw</span> American nurse (1860–1928)

Alice Magaw was an American nurse known for her work on anesthesia. Her innovations helped lead to major advances in modern surgery and earned her the title of the 'mother of anesthesia.'

The Consensus Model for APRN Regulation is a model and document created by the National Council of State Boards of Nursing to create consensus on licensure, accreditation, certification, and education for advanced practice registered nurses (APRNs).

<span class="mw-page-title-main">Neonatal nurse practitioner</span> Type of certified nurse practitioner

A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a bedside registered nurse in a Level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master's or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).

Advanced practice registered nurses (APRNs) are registered nurses with graduate degrees in nursing. APRN roles include: certified nurse midwife, clinical nurse specialist, certified registered nurse anesthetist, and nurse practitioner. APRNs assess, diagnose, manage patient medical problems, order diagnostic tests, and prescribe medications. Rules, regulations, and credentialing for APRNs vary by state. This page outlines the regulatory processes for nurse practitioners in Wisconsin, including education, certification, licensing, and credentialing. Regulatory and credentialing processes are continuously changing, and the information contained on this page is current as of November 2015.

Nursing is the largest healthcare profession in the United States, with more than 3.1 million registered nurses. Between 2012 and 2022, employment for nurses is projected to grow by 19 percent, which is more than any other profession. Nurses make up the largest component of staff in hospitals but are also able to provide care in clinic settings, patient's homes, schools, nursing homes, public health agencies, and mental health centers. In addition, nurses can be found in the military, in industry, nursing education, and do health care research. Nurses in these various roles and settings can provide direct patient care and case management, but also develop and establish nursing practice and quality standards within complex healthcare systems. As each degree can provide a different level of care for patients and function in vastly different roles, it is important to differentiate between them. The levels of nursing degrees have different educational requirements, licensure, and credentialing that can vary state to state.

An acute care nurse practitioner (ACNP) is a registered nurse who has completed an accredited graduate-level educational program that prepares them as a nurse practitioner. This program includes supervised clinical practice to acquire advanced knowledge, skills, and abilities. This education and training qualifies them to independently: (1) perform comprehensive health assessments; (2) order and interpret the full spectrum of diagnostic tests and procedures; (3) use a differential diagnosis to reach a medical diagnosis; and (4) order, provide, and evaluate the outcomes of interventions. The purpose of the ACNP is to provide advanced nursing care across the continuum of health care services to meet the specialized physiologic and psychological needs of patients with acute, critical, and/or complex chronic health conditions. This care is continuous and comprehensive and may be provided in any setting where the patient may be found. The ACNP is a licensed independent practitioner and may autonomously provide care. Whenever appropriate, the ACNP considers formal consultation and/or collaboration involving patients, caregivers, nurses, physicians, and other members of the interprofessional team.

Advanced Practice Registered Nurse (APRN) refers to a nurse with advanced education, typically at least a master's degree, and certification by a national certifying program. The APRN provides specialized and multifaceted care and are able to do 60 to 80 percent of preventative and primary care done by physicians. Minnesota Statutes section 148.171, subd. 3 states that in Minnesota, APRN "means an individual licensed as a registered nurse by the board, and certified by a national nurse certification organization acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist, nurse midwife, or nurse practitionerr".

The End-of-Life Nursing Education Consortium (ELNEC) project is a national education initiative whose mission is to improve palliative care. The project provides an undergraduate and graduate nursing faculty, CE providers, staff development educators, specialty nurses in pediatrics, oncology, critical care, and geriatrics, and other nurses with training in palliative care so they can teach this information to nursing students and practicing nurses. ELNEC is a partnership between the American Association of Colleges of Nursing (AACN), Washington, DC and the City of Hope, Duarte, CA. The project provides undergraduate and graduate nursing faculty, CE providers, staff development educators, specialty nurses in pediatrics, oncology, critical care, and geriatrics, and other nurses with palliative care training. Once trained, these healthcare professionals go on to teach this essential information to nursing students and practicing nurses. The project, which began in February 2000, was initially funded by a major grant from The Robert Wood Johnson Foundation (RWJF). The National Cancer Institute (NCI), American Association of Colleges of Nursing (AACN), US Cancer Pain Relief Committee, the Aetna, Archstone, Oncology Nursing, California HealthCare, Milbank, Stupski, Open Society, and Cambia Health Foundations, and the Department of Veterans Affairs (VA) have provided additional funding.

References

  1. "American Nurses Association". Archived from the original on 1997-04-06.
  2. "AACN - Publications - Position Statements". www.aacn.nche.edu. Archived from the original on July 20, 2011.
  3. 1 2 "Aacn - Dnp - Faqs". Archived from the original on 2011-10-01. Retrieved 2008-12-24.
  4. AANA - Home
  5. "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education" (PDF). www.NCSBN.org.
  6. Ellenbogen, Michael I.; Segal, Jodi B. (2020). "Differences in Opioid Prescribing Among Generalist Physicians, Nurse Practitioners, and Physician Assistants". Pain Medicine. pp. 76–83. doi:10.1093/pm/pnz005. PMC   6953344 . PMID   30821817.