Advanced Practice Registered Nurse Career Overview

January 4, 2022 · 6 Min Read

Reviewed by Shrilekha Deshaies

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What is an advanced practice registered nurse or APRN? An APRN is a clinician with a registered nurse (RN) license who has also earned a master's in nursing in one of the following specialities: certified registered nurse anesthetist (CRNA), certified nurse midwife, clinical nurse specialist, or nurse practitioner.

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Advanced Practice Registered Nurse Career Overview
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What Does an APRN Do?

MSN required
certification optional


The role of an advanced practice nurse falls between a registered nurse (RN) and a physician in such areas as training, independence, responsibilities, and compensation.

Advanced practice registered nurses (APRNs) have considerable autonomy since they can diagnose and treat conditions. They can also prescribe medications. In some states, they must work under the supervision of or in collaboration with a physician. They often supervise RNs.

APRNs typically hold the following key skills and responsibilities.

Primary Responsibilities

  • Primary care provider; provides patient education
  • Disease and condition management; makes diagnoses and orders treatment
  • Oversight of staff, including RNs

Key Skills

  • Empathy
  • Continual learner
  • Good decision-making under pressure
  • Scientific aptitude
  • Communication skills

Credit: Ariel Skelley / Photodisc / Getty Images

Where Do APRNs Work?

Depending on their speciality, advanced practice nurses may work in hospitals, private physicians' offices, birth centers, surgical centers, clinics, or residential care settings.

APRNs might find work in these common settings.

Private Practices

APRNs can act as a primary care provider, diagnose and treat health conditions, and supervise RNs.

Hospitals

Advanced practice nurses might administer medication, lead nursing departments, and diagnose and treat health conditions.

Outpatient Care Facilities

APRNs, such as nurse practitioners, are valuable members of healthcare teams at outpatient care facilities and clinics where they may provide primary care services to patients.

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How to Become an APRN

Advanced practice nurses must have an RN license, a graduate degree in nursing, and, in the majority of states, national or state certification. Most graduate schools require RN experience before admission. Specific requirements vary by state and the certifying board.

Graduate with a bachelor of science in nursing (BSN).
Some graduate schools offer bridge programs that combine BSN and master of science in nursing (MSN) studies for students with an ADN.
Pass the NCLEX-RN exam to receive RN licensure.
The National Council Licensure Examination for RNs (NCLEX-RN) takes up to six hours and covers clinical and other healthcare situations nurses are likely to encounter.
Explore different nursing specialty areas while gaining clinical experience.
Most specialty nursing entry-level positions include on the job training for that area. Clinical experience introduces nurses to work in specialties with different populations. Many graduate school programs require or prefer at least one year of clinical nursing experience.
Apply to an MSN-APRN or doctoral nursing program.
APRN programs typically take two years for a master’s degree or 3-4 years for a doctor of nursing practice (DNP). Some specialties, such as the CRNA, require a board-certified program, while others require only an accredited program. Admission requirements usually include a GPA of at least 3.0, an essay or personal statement, and recommendations.
Graduate with an MSN or a DNP.
As far as degree level, only the MSN is required to become an advanced practice nurse and qualify for licensing and certification exams, but academic medical centers and teaching jobs often require or prefer a DNP.
Earn certification from an approved nursing specialty board.
Each board has its own requirements beyond passing the certification exam. These typically include an unencumbered RN license, application, and a submission of academic records. Often, earning certification is required before applying for the advanced practice nursing license.
Apply for state licensure.
State advanced practice nurse requirements may include background checks and verification of education and required clinical hours.

The Four Types of APRN Roles

msn or dnp Required
High Demand

Certified Nurse Practitioner

Most certified nurse practitioners work in family practice, but others specialize in fields such as gerontology, pediatrics, or mental/psychiatric health.
Salary $109,820
Job Outlook 52% increase from 2019-2029
Learn More About Certified Nurse Practitioners
msn Required

Clinical Nurse Specialist

Clinical nurse specialists are advanced practice nurses who work in a specialty area such as oncology, cardiology, or emergency care.
Salary $91,300
Job Outlook Positive job outlook in coming years
Learn More About Clinical Nurse Specialists
msn Required
High Demand

Certified Nurse Midwife

Certified nurse midwives are advanced practice nurses who specialize in the care of pregnant women, labor, and birth. Like physicians, they are authorized to oversee births.
Salary $105,030
Job Outlook 12% increase from 2019-2029
Learn More About Certified Nurse Midwives
msn or dnp Required
High Demand

Certified Registered Nurse Anesthetist

CRNAs administer anesthesia and often treat patients for postoperative pain. They generally earn the highest advanced practice nurse salaries.
Salary $174,790
Job Outlook 45% increase from 2019-2029
Learn More About Certified Registered Nurse Anesthetists

What Is the Average APRN Salary?

According to the U.S. Bureau of Labor Statistics (BLS), advanced practice nurse salaries are considerably above the national average annual salary of $56,310. The highest paid APRN specialization is nurse anesthetist with an average annual salary of $189,190. Nurse practitioners can earn an average annual salary of $114,510. The median salary for all APRNs is $117,670.

Demand for advanced practice nurses is growing. The BLS projects a 45% growth between 2020 and 2030.



Find State-Specific Salary Data


What Is the Difference Between an APRN and RN?


APRN

High levels of autonomy; can practice independently in most states with limited physician supervision in others Can make diagnoses and order treatments Can prescribe medications, including controlled substances Minimum six years of college with master's degree in nursing Requires education and certification beyond RN

RN

Limited autonomy and independence; must practice under direct supervision of a physician or an APRN Cannot diagnose conditions or prescribe medications; carries out physician or APRN treatment plans Minimum two years of college with an associate degree in nursing (ADN) Requires RN license Can be an entry-level position

Advanced Practice Nurse versus Nurse Practitioner

A nurse practitioner (NP) is a type of APRN. An APRN is a nurse who holds at least a master of science in nursing (MSN) in an APRN specialty. APRN specializations include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists.

APRNs, including NPs, may work across various healthcare settings, including hospitals, ambulatory clinics, or long-term care facilities.

Nurse practitioners are APRNs who are independent, organized, and want to work closely with patients, often seeing the same families over the span of many years. Nurse practitioners may also specialize further in a specific population such as women, infants, or adults throughout their lifespans.

The following table includes important differences between the two.

NURSE PRACTITIONER ADVANCED PRACTICE NURSE

Education

Currently an MSN is required at minimum. A doctor of nursing practice (DNP) may be required in the future.

APRNs must have at least a master's degree to sit for one of the APRN specialization exams.

Typical duties

  • Take health histories
  • Assess, diagnose, and treat acute and chronic illnesses, often acting as primary care medical provider
  • Offer referrals for specialized care

Typical APRN duties vary depending on the nurse's specialization. Nurse midwives, for example, focus on women’s healthcare, while nurse anesthetists work primarily in surgical settings.

Can prescribe medications?

Yes, but the types of medicines and level of supervision is determined by state laws.

Some, but not all, APRNs have prescriptive authority depending on their specialization and the state where they work.

Common practice settings

  • Private practice
  • Ambulatory clinics
  • Long-term care facilities
  • Community clinics

Any healthcare setting including hospitals, private practice clinics, and long-term care facilities.

APRNs may also work in educational or healthcare policy settings.

Licensing and certification

Certification for nurse practitioners in various specialties is available through both the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP). Nurses must also register with their state board of nursing in the state where they choose to work.

Certification for nurse practitioners and clinical nurse specialists is available through the American Nurses Credentialing Center.

Certification for nurse anesthetists is available from the National Board of Certification & Recertification for Nurse Anesthetists.

Certification for nurse midwives is available through the American Midwifery Certification Board.

Continuing education requirements

NPs must recertify with AANP every five years. Recertification requires at least 1,000 hours of clinical practice over the past five years and 75 contact hours of continuing education for nurses, relevant to the NP's role and focus. This means an NP who works in pediatrics must focus their continuing education on that population.

ANCC recertification is also required every five years. As of 2018, the ANCC requires 150 continuing education hours, including at least 51% directly related to the NP's focus and at least 25 hours in pharmacotherapeutics.

The continuing education requirements for APRNs depends on the nurse's specialization. To recertify in any specialty there will be both clinical and classroom work in that nurse's specialty.

Specialization or population focus

  • Adult-gerontology acute care
  • Adult-gerontology primary care
  • Psychiatric mental health
  • Family health
  • Neonatal
  • Pediatric acute care
  • Pediatric primary care
  • Women's health and gender-related

The four main APRN roles are certified registered nurse anesthetist (CRNA), certified nurse midwife, clinical nurse specialist, and nurse practitioner.

Every NP is an APRN but the opposite is not true.

The clinical nurse specialist may specialize like an NP and shares some of the same specializations (pediatric and adult gerontology being the most common).

Successful personalities

Like all nurses, NPs are dedicated to patient care. In many states, NPs are free to work without the direct supervision of a physician, meaning the most successful NPs are independent and organized.

Patient communication is also integral to an NP's job. These skills, along with empathy and the ability to interact with a diverse population, are also important.

An APRN must be committed to providing excellent patient care. Some APRNs work in patient-facing positions, and others work in policy or educational settings.

In all roles, patient communication skills are essential. This means the ability to consult with a patient and families on sensitive and emotional subjects.

APRNs are most successful when they are organized and can handle stress without becoming overwhelmed.

Common clinical collaborators

Some NPs must have collaborative agreements with physicians (e.g., medical doctor or doctor of osteopathic medicine) to practice in some states.

Whether or not this supervision is required depends on the state in which they practice.

In the hospital setting, APRNs will collaborate with other nurses and physicians as well as hospital administrators. APRNs have more professional autonomy in full-practice authority states.

Frequently Asked Questions About APRNs


How long does it take to become an APRN?

It takes at least six years of education to become an advanced practice nurse and seven for the DNP option. Some graduate schools and certification boards require or prefer at least 1-2 years of clinical experience as an RN.

A DNP typically requires three years, whereas an MSN takes two.

Do APRNs need to earn their doctorate?

A doctorate is not a degree requirement for most advanced practice nurse roles. To become a CRNA, the minimum degree requirement is a DNP or doctor of nurse anesthesia practice.

Some practitioners and organizations support making the DNP the minimum academic degree for all advanced practice nurses. Some fear this will further limit the number of APRNs, specifically nurse practitioners, and raise the cost of becoming an advanced practice nurse.

What is the highest paying APRN role?

Nurse anesthetists earn the highest advanced practice nurse salary at a median $183,580 annually. Other than the speciality, factors that affect advanced practice nurse salaries include geography, experience, and type of employer.

Is an APRN considered a medical doctor?

No, APRNs hold either an MSN or a DNP which are nonmedical degrees. An advanced practice nurse with a DNP is a doctor of nursing practice but not a medical doctor or physician. In many healthcare settings, only physicians are referred to as doctors.

Resources for APRNs

The ANA offers professional education; issues credentials; publishes books, journals, and newsletters; engages in advocacy for nurses and healthcare reform; and offers networking opportunities. Full membership is open to RNs, and students and others can join as subscribers. At 118,000 members, the AANP is the largest professional association for NPs in the United States. It offers professional education, including an annual conference, engages in advocacy, and issues scholarly journals, newsletters, and other publications. Membership is open to NPs, students, retirees, and affiliate members. The ACNM provides professional education, including a conference, publishes newsletters and a journal, promotes the profession of midwifery, and conducts advocacy. Certified midwives and nurse midwives can be full members; students and others can join as nonvoting members. The AANA serves around 54,000 nurse anesthetists with newsletters and scholarly publications, networking opportunities, professional education in several formats, recognition programs, and malpractice insurance. Membership is open to nurse anesthetists and students. The NACNS offers publications, toolkits, and clinical resources; provides scholarship and awards programs; conducts research on the profession and clinical nursing standards; and engages in advocacy. Membership is open to individuals and institutions.

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Page Last Reviewed November 23, 2021

NurseJournal.org is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

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