Thursday April 25th 2019

So you want to be an APRN? Know your options!

Andrea Brassard

This column is for RNs who are considering graduate education and clinical training to become an advanced practice registered nurse. Given that there are four APRN roles, your first decision is: What type of APRN do you want to be? (See table “Types of APRNs.”)

To help you decide, consider the patient populations that you would like to work with now and into the future. Network with APRN colleagues. Spend a day shadowing an APRN to picture yourself performing in that role. Following is a summary of APRN roles and settings, and suggestions regarding education and certification.

Lisa Summers

Certified nurse-midwives (CNMs) provide primary care for women from adolescence beyond menopause, care of the normal newborn during the first 28 days of life and care of male partners for sexually transmitted infections. CNMs provide prenatal care, labor and birth care, gynecological care, including prescribing contraceptive methods and other medications, as well as health education and counseling to women of all ages. Practice settings include hospitals, clinics, medical offices, free-standing birth centers and private midwifery practices. The American College of Nurse-Midwives (ACNM) FAQs for Prospective Midwifery Students is a good place to start learning more.

Graduate education is required. Most CNM programs require a bachelor’s degree for entry, but some will accept RNs without a bachelor’s degree, providing a bridge program to a BSN before the midwifery portion of the program. Some CNM programs require RN experience in labor and delivery.

The certification examination to become a CNM is administered by the American Midwifery Certification Board (AMCB). Accredited schools are listed on the Accreditation Commission for Midwifery Education (ACME) website.

Certified registered nurse anesthetists (CRNAs) provide anesthesia in collaboration with surgeons, anesthesiologists, obstetricians, dentists, podiatrists and other qualified health care professionals.  CRNAs provide anesthesia care in hospitals, ambulatory surgical centers, pain management centers and professional offices. In rural areas, CRNAs are the primary providers of anesthesia in critical access hospitals.

CRNA programs are transitioning to require a doctor of nursing practice (DNP). According to the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), students accepted into accredited CRNA programs after the year 2022, must graduate with a doctoral degree. RN experience in critical care is required for entry into a CRNA program. Accredited schools are listed on the COA website.

Certified nurse practitioners (CNPs) diagnose and treat patients in primary care or acute care. CNPs are recognized as APRNs and can prescribe medications in all 50 states and the District of Columbia.  Primary care NPs practice in diverse settings, including outpatient clinics, nurse-managed health centers, convenient care (retail health) clinics and physician offices. Acute care NPs provide comprehensive care in and across care settings for patients who have acute and chronic illness, and typically practice in hospitals. Some acute care NP programs require RN experience in acute care before entry. 

NP students usually enroll in either a primary care or an acute care NP program, and some graduate programs offer both. Your next decision is determining which population will be your focus:  family-individual across the life span (primary care only), adult-gerontology acute care or primary care, neonatal, pediatrics (acute care or primary care), women’s health or psychiatric-mental health. Your population focus will determine your future practice areas.

The Consensus Model for APRN Regulation, adopted in 2008, led to some changes in education and certification for NPs that you should be aware of. Think ahead to whether your interest is in acute or primary care and what population you are interested in. Learn about what certification examinations are available, and be sure that you chose an accredited program that will prepare you for the certification you desire. The American Nurses Credentialing Center (ANCC) offers several certification exams for NPs, with discounts for American Nurses Association members. The American Academy of Nurse Practitioners Certification Program is another resource.    The AACN Certification Corporation offers certification for Acute Care NPs.  Women’s Health NPs and Neonatal NPs can be certified through the National Certification Corporation (NCC); pediatric NPs through the Pediatric Nursing Certification Board, and ANCC.  Psychiatric-Mental Health NPs can be certified through ANCC.

Clinical Nurse Specialists (CNSs) are experts in leading change in direct patient care, nursing practice and health systems.

The implementation of the APRN Consensus Model has had a particularly great impact on CNS education and national certification exams.  Graduate education (masters or doctorate) in the CNS role and one of the six populations identified in the Consensus Model is required for the newly educated and licensed CNS. The clinical nurse specialist program educates the student across the health care continuum from wellness through acute care including diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities.

Although most people associate CNS delivery of services with the hospital setting, they also practice in the community, outpatient and long term care settings.

Both ANCC and AACNCC can provide information on available CNS certifications.

A note about accreditation

Programs that prepare APRNs must be accredited by a nationally recognized accrediting body.

For CNMs that is ACME; for CRNAs that is COA.  NP and CNS programs may be accredited by one of the two national bodies:  Accreditation Commission For Education in Nursing (ACEN), which accredits all types of nursing education programs, and the Commission on Collegiate Nursing Education (CCNE), which accredits baccalaureate and higher programs.

Choosing a program

Be prepared to ask the school questions such as:

  1. How does your program prepare me to meet the education eligibility criteria for my particular role, such as FNP, WHNP, PCNS?
  2. Which national nursing accreditation organization accredits your APRN program?
  3. What is your school’s pass rate for national certification?
  4. What information will be contained in my transcripts?

Beware of a school that guarantees eligibility for any national certification. Only the certification entity can make this determination based on information in your application. The school prepares you to meet the education requirements for certification and licensure according to national standards for the APRN role and population. If a school states you are being prepared for more than one APRN role and/or population, be sure to ask how the school will document the courses and clinical hours unique for each role and population.

The career horizon

The future of APRNs is broad and bright. APRNs in all four roles are licensed, independent practitioners who deliver high quality advanced nursing care in all health care settings. ANA advocates for all APRNs so that they may serve the interests of the nation’s nurses and their patients.

— Andrea Brassard is the director of Health Policy at ANA.
Lisa Summers is the senior policy fellow for APRN issues at ANA.

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