Advanced practice nurses (APRNs) are registered nurses (RNs) who receive additional academic and clinical training, usually at the master’s level, in one of four different health care specialty areas which are: nurse practitioner (NP), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). Each of these areas may also contain a sub-specialty.  Some APNs prefer working with patients in a particular age group, such as children or older adults.  Others may opt to specialize with patients who have a specific condition such as neurological disease, heart problems, pregnancy, diabetes, or emotional problems to name a few.   Advanced practice nurses often serve as the primary health care provider.  They may work independently or with other members of health care to provide care to patients who are sick, injured, or hospitalized.


The nurse practitioner is usually defined as a registered nurse (RN) with education and experience enabling nursing performance in an expanded role, This nurse  works in many settings, including clinics, health centers, public health agencies, physicians’ offices, emergency departments, nursing homes, prisons, industry, and isolated rural areas.

The current educational requirements for nurse practitioners are a graduate degree of either a master’s or doctoral degree program. The nurse practitioners complete a four-year bachelor’s degree in nursing and then complete the 2-4 year graduate degree to gain the knowledge and skills to become an independent practicing nurse practitioner.

The nurse practitioner assesses the health status of patients by taking health histories, performing physical examinations, and ordering and interpreting diagnostic tests.  This nurse practices autonomously and consults with the physician and other members of the healthcare team to establish a health care plan including a treatment plan, preventive and maintenance measures to maintain patients’ health needs. The nurse recommends medication and other types of treatment such as physical therapy or psychotherapy.  This nurse may make referrals to specialists for treatment of conditions beyond the scope of the nurse practitioner and maintains records of patient’s condition, treatment, and prognosis.

Nurse practitioners have a teaching and counseling role in helping patients in maintaining health and preventing illness, assisting parents to develop better physical and emotional health for their children, and counseling the elderly in maintaining good health during the aging process.  These nurses may counsel the terminally ill and their families to help them through the death of a patient.  They may manage the care of women with normal pregnancies.

Nurse practitioners work with and under the guidance of a licensed physician.  However, there are some states in which the state law permits them to engage in independent practice.  Persons interested in this career should contact their state licensure board to determine what a nurse practitioner can do in their state.


Nurse-midwives are registered nurses (RNs) with a bachelor’s degree in nursing who receive extensive instruction in clinical midwifery, reproduction anatomy and physiology, and newborn care.

Nurse-midwives work in hospitals, birthing centers, health maintenance organizations, public health departments, physician’s offices and clinics.  Some have their own private practices.  Usually they deliver babies in hospitals or birthing centers, but some may deliver babies in the home if certain safety factors are met.

Nurse-midwives provide care for normal, healthy women before, during, and after childbirth. During the birthing process, they spend time with the mother to provide needed emotional and physical support. They assist in labor and delivery, help in newborn care, and counsel mothers on infant growth and future pregnancies. In many underserved, rural and inner-city areas where there are few physicians, nurse- midwives are a valuable member of the childbirth team because they offer safe, accessible birth care.


The role of the certified nurse specialist evolved in response to changes in health care technology that required nurses with highly specialized knowledge and skills.  These nursing professionals usually work in a hospital setting delivering direct patient care, teaching staff and patients, consulting with other professionals, and providing leadership and supervision in the workplace.

All clinical nurse specialists are registered nurses (RNs) who hold a master’s degree in nursing with a focus on a specific specialty.  The following are some of the areas in which a CNS may specialize: addiction disorders, critical care, adult health, child health, community health, emergency care, gerontological care, high-risk maternity care, maternal-child health, medical-surgical, neonatal, oncology, pediatric, perioperative, psychiatric/mental health, and women’s health.  Each specialty has its own method of credentialing, which is typically a combination of a specified number of hours of practice and a specialty board.


Certified registered nurse anesthetists are degreed RNs with critical care experience and graduate training in the delivery of anesthesia.  The CRNA is the oldest of the nursing specialties.  This specialty has grown to the extent that more than 70% of the anesthesia used today is administered by the nurse anesthetists.

CRNAs, under a doctor’s supervision, administer intravenous, spinal, and other anesthetics as needed for surgical operations, deliveries, and other medical and dental procedures.  They control the flow of gases or injected fluids to maintain the needed anesthetic state of the patient.  Anesthetists monitor blood pressure, pulse, and color to determine the status of the patient and carry out emergency measures when indicated to prevent the patient from going into shock. They keep the doctor advised of the patient’s condition and keep records of the pre/post operative state of the patient and all anesthesia and medication given. Because of the CRNA’s extensive training in respiratory and cardiopulmonary function, nurse anesthetists are often called upon to aid in the resuscitation of patients in intensive care, coronary care and other emergency situations.

Education and experience required to become a CRNA includes a Bachelor of Science degree in nursing  or another appropriate baccalaureate degree; at least one year’s experience in an acute care nursing setting; two years of graduate education in an accredited school of nurse anesthesia including a clinical practicum in a university-based or large community hospital; passing of a national certification exam; and the successful completion of a continuing education and re-certification program every two years.

Nurse anesthetists are accorded much respect, responsibility and autonomy.  There is a great demand for CRNAs across the nation, and particularly in rural areas throughout the country.


Nurse Practitioner (NP)
American Academy of Nurse Practitioners
P.O. Box 12846, Capitol Station
Austin, TX 78711

(512) 442-4262

Certified Nurse-Midwife (CMN)
American College of Nurse-Midwives
8403 Colesville Rd, Suite 1550
Silver Spring, MD 20910

Clinical Nurse Specialist (CNS)
American Nurses Association
8515 Georgia Ave., Suite 400
Sivler Spring, MD 20910

Certified Registered Nurse Anesthetist (CRNA):
American Society of Nurse Anesthetist
222 South Prospect Avenue
Park Ridge, IL 60068
(847) 692-7050