Advanced practice nurses
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The Four Types of Advanced Practice Nurses Explained

Advanced practice nurses play an essential role on the front lines of healthcare, and demand for their clinical expertise continues to rise. Jobs for nurse practitioners, anesthetists and midwives are projected to grow 40% from 2021 to 2031, according to the U.S. Bureau of Labor Statistics.

If you’re a registered nurse (RN) interested in greater responsibilities, more autonomy and higher earning potential, consider a career as an APRN. Learn more about advanced practice registered nurses (APRN) as we break down the four types of advanced practice roles, including the education and certification requirements for each and their typical salary ranges.

What Is an Advanced Practice Nurse?

An advanced practice registered nurse is an RN who pursued a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) and earned their board certification in one of four areas:

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

APRNs undergo rigorous training to gain the knowledge to take on enhanced responsibilities, whether providing primary care or shaping healthcare policies. Their salaries reflect these additional qualifications. For example, an average RN salary was $37.24 per hour, while a nurse practitioner typically earned $53.77 per hour, according to Vivian’s salary data on November 22, 2022.

Professional Opportunities for APRNs

Once you earn your certification and are state-licensed, you can accept a permanent staff position at hospitals, clinics, private practices and other healthcare facilities. You also have the option of taking on temporary contracts as a travel healthcare professional due to demand for these roles throughout the country.

Facilities unable to fill staff positions often offer lucrative 13-week assignments to travelers to ease skill shortages. Travel nurse anesthetists, nurse midwives, nurse practitioners and clinical nurse specialists may also enjoy benefits such as housing stipends, health insurance and free CEUs from recruiters. Travel roles can be especially attractive if you enjoy exploring new places, want to set your own schedule and desire the added variety to what can sometimes be high-pressure jobs.

Certified Nurse Practitioners

Pediatric nurse practitioner

CNPs are highly trained healthcare professionals providing primary and specialty care to patients. In addition to diagnosing and treating common conditions, nurse practitioners focus on disease management and prevention, providing a comprehensive approach to overall health. CNPs must be board-certified and may specialize in a wide array of areas, such as:

  • Gerontology
  • Women’s Health
  • Pediatrics
  • Neonatal Health
  • Oncology
  • Orthopedics
  • Psychiatric Health
  • Acute Care

Nurse practitioner jobs are available in clinics, private practices, hospitals and nursing homes. 

Some of the highest-paid CNPs work in California, where the average wage was $67 to $91 per hour, according to our salary data for nurse practitioners from late November 2022. The typical weekly salary for travel NP jobs nationwide was $3,356 based on experience and location, while travel NP jobs in California paid an average of $3,955. 

Scope of Work

The Association of American Medical Colleges forecasts a shortage of up to 124,000 physicians by 2034. The job outlook for nurse practitioners is especially robust to help ease this burden.

While states have varying regulations regarding the type of work CNPs can do and whether they may practice independently, the general responsibilities of an NP include the following:

  • Assessing and evaluating patients
  • Ordering and interpreting tests such as blood work, ultrasounds and X-rays
  • Diagnosing conditions such as injuries, infections, high blood pressure, rheumatoid arthritis and diabetes
  • Recommending and managing treatment for acute and chronic conditions
  • Coordinating patient care
  • Prescribing medication
  • Performing physical exams
  • Providing health education to patients on lifestyle and disease prevention strategies
  • Managing overall health and well-being

How to Become a CNP

To become a CNP, you must:

  • Be a licensed RN 
  • Complete an MSN or a DNP from an accredited program
    • Some states require nurse practitioners to hold a DNP
  • Pass the CNP certification exam in your specialty through a recognized certification board
  • Apply for NP licensure in the state where you wish to work
  • Renew your certification regularly by completing continuing education and other requirements as set by your state and the certifying board
  • Maintain your state licensure as an NP

Clinical Nurse Specialist

Clinical nurse specialist

A clinical nurse specialist is an APRN with a high level of clinical expertise who may practice independently in several states. A CNS can provide direct patient care but also plays a leadership role in improving overall healthcare delivery. Clinical nurse specialists work in hospitals, clinics, nursing homes, private practices and corporations in the health field. They complete training in specialties such as geriatrics, pediatrics, women’s health, critical care, rehabilitation services, oncology and psychiatric care.

The average salary for staff clinical nurse specialists was $37.24 nationwide, but it varied based on location, per salary data on Vivian Health in late November 2022. For example, CNSs earned between $54 and $79 hourly in California, $50 to $63 in Hawaii and $46 and $64 in the District of Columbia. A travel CNS could expect to earn an average of $3,007 per week during that same period, depending on qualifications and the hiring facility.

Scope of Practice

The responsibilities of a clinical nurse specialist include:

  • Providing primary care to patients in specialized fields  
  • Performing examinations, ordering diagnostic tests, prescribing medication and developing treatment plans
  • Communicating with and educating patients and families
  • Developing training programs for nurses and staff
  • Assessing processes to recommend best practices and improve standards of care
  • Analyzing data, conducting research and developing policies with evidence-based research practices
  • Performing clinical research and trials

How to Become a CNS

To become a CNS, you must:

  • Be a licensed RN
  • Complete an MSN or DNP from an accredited program
  • Complete 500 hours of supervised clinical training hours 
  • Earn your CNS certification by passing the appropriate exam 
  • Receive a state license to practice
  • Renew your certification every 5 years

Certified Registered Nurse Anesthetist

CRNA

CRNAs provide anesthesia to ensure patients undergoing surgery stay asleep or don’t feel pain if they remain awake during procedures. According to the American Association of Nurse Anesthesiology, about 59,000 nurse anesthetists work in the United States in settings such as hospitals, ambulatory surgery centers, emergency rooms, outpatient care centers and the U.S. military. CRNA jobs are especially critical in rural communities, where nurse anesthetists represent 80% of anesthesia professionals.

Nurse anesthetists work alongside surgeons, obstetricians, podiatrists, dentists, ophthalmologists and plastic surgeons and can practice independently in many states. CRNAs top the list of best-paid APRNs, earning an average of $91 per hour in certain positions. Travel CRNAs earned an average of $5,980 per week, according to our job board data from late November 2022. However, travel pay varies depending on experience level and the location of the position. 

Scope of Work

The responsibilities of a CRNA typically include:

  • Evaluating patients before administration of anesthesia to predict how they might respond 
  • Selecting and administering initial anesthesia
  • Managing anesthesia during the procedure
  • Monitoring patient vital signs
  • Providing emergency care such as airway management or CPR if required
  • Overseeing patient recovery and delivery of additional fluids and blood if required
  • Discharging patients once they recover from anesthesia

How to Become a CRNA

It takes about 8 years to become a CRNA. The minimum requirements include:

  • Licensure as an RN or APRN
  • At least 1 year of experience as a registered nurse in a critical care setting
  • Completion of an accredited graduate program in nurse anesthesia
    • Some CRNAs completed an MSN, but these programs have transitioned into doctoral programs
    • By 2025, all graduates of these programs receive doctoral degrees
  • Passing the National Certification Examination to receive CRNA certification 
  • Obtaining a state license to practice as a CRNA
  • Completion of continuing education requirements to renew your certification every four years

Certified Nurse Midwife

Certified Nurse Midwife

A certified nurse midwife provides specialized care to women in sexual and reproductive health. They’re most often called upon during pregnancy and childbirth but also meet the health needs of women at different stages of life, such as puberty, adolescence, perimenopause and menopause.

More than 13,500 nurse midwives work in the United States, according to the American Midwifery Certification Board. CNMs may work in hospitals, birthing centers, private practices and community health. Some states permit CNMs to practice independently, while others require physician supervision.  

According to Vivian’s salary data for staff CNMs in late November 2022, these APRNs earned an average of $53.77 per hour nationwide but had a salary range between $56 and $91 in the highest-paying location. The typical travel CNM salary was $3,600 per week during this same period.

Scope of Practice

The responsibilities of a certified nurse midwife usually include:

  • Counseling patients on family planning and birth control
  • Performing gynecological health screenings
  • Writing prescriptions
  • Testing for STDs
  • Providing nutrition counseling
  • Monitoring the health of expectant mothers and their babies
  • Ordering and interpreting diagnostic tests
  • Assisting patients through labor and delivery
  • Helping new mothers with breastfeeding
  • Providing parenting education on newborn care 
  • Supporting women through perimenopause and menopause

How to Become a CNM

To become a certified nurse midwife, you must:

  • Be a licensed RN
  • Complete an MSN or a DNP in an accredited nurse-midwifery program
  • Earn your CNM certification by passing the American Midwifery Certification Board exam
  • Apply for state licensure as a nurse midwife
  • Renew your certification every 5 years

Transitioning from an RN to an APRN

Whether you’ve been working as an RN and want to expand your career opportunities or wanted to become an APRN from day one, it’s important to chart your journey carefully to ensure you meet all the requirements for board certification.

Most graduate programs require a Bachelor of Science in Nursing for admittance. If you have an associate degree, you may be able to enroll in a bridge program.

When choosing a graduate program, you may choose between an MSN or DNP, although a DNP is sometimes required. Confirm which degree is required by both the certifying board and the state where you want to practice. Even if an MSN is accepted, you may find that a DNP offers more career flexibility, as some employers prefer candidates with higher-level degrees. NPs, in particular, may find it easier to move between states as travel nurse practitioners with a DNP.

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