Advanced practice nurses are typically those nurses prepared at the master's or doctoral level, and they fall into four categories of clinicians: clinical nurse specialists, certified registered nurse anesthetists, nurse practitioners, and certified nurse-midwives.
Clinical nurse specialists
Nurses must have a baccalaureate degree or its equivalent to enroll in a CNS program. To use the title of CNS, the CNS must have a minimum of a master's degree from an education program that prepares CNSs. The training is graduate-level education. Some universities have a fast track program whereby they will accept individuals who do not have a baccalaureate and move them into a master's program. CNSs also take a certification exam in a specialty, offered by one of the nationally recognized certification entities.
CNS students go through advanced theory and practice training, revolving around the three areas of influence that impact on direct patient care, supervising direct patient care, and patient care systems.
The American Nurses Credentialing Center certifies CNSs as adult psychiatric, child psychology, community health, home health, gerontology, and medical-surgical CNSs. There also are other certifying bodies, including the Rehabilitation Nursing Certification Board, Oncology Nursing Certification Corporation, and American Association of Critical Care Nurses Certification.
The doctoral-level CNS typically focuses on research.
Certified registered nurse anesthetist
Nurse anesthetists are registered nurses who complete two to three years of higher education, beyond the bachelor's of nursing degree or other appropriate baccalaureate degree. They attend accredited nurse anesthesia educations programs, covering all areas of anesthesia. After completing an accredited program, nurse anesthetists must pass a national certification exam to obtain the CRNA designation.
The education for a nurse anesthetist involves about 24 to 36 months of graduate course work. It includes classroom and clinical experience.
In most cases, to be accepted into an accredited school, those who aspire to become nurse anesthetists must have an appropriate four-year degree, an RN license, and at least one year of acute care nursing experience, which varies by program.
Nurse practitioner
NPs receive their advanced educations through programs that award master's degrees. RNs who aspire to become NPs should have extensive clinical experience before applying to an NP program. NP programs include the components of an intensive preceptorship under the direct supervision of a physician or experienced NP and instruction in nursing theory. An increasing number of nurses are becoming prepared as both NPs and CNSs. Those prepared in both roles are more likely to function as nurse practitioners.
Certified nurse-midwife
CNMs are educated in the two disciplines of nursing and midwifery. They must possess evidence of certification according to the requirements of the American College of Nurse-Midwives. Being an RN is a requirement to become a certified nurse-midwife. In some cases, those with baccalaureate degrees in other fields are considered. Upon graduation, CNMs can receive MS (master's of science), MSN (master's of science in nursing), MPH (master's of public health) degrees or a doctoral degree. About 68% of CNMs have master's degrees, while 4% have doctoral degrees. There are also those who graduate with a certificate or from a nurse-midwifery education program. However, the number of states and employers who require master's-prepared CNMs is increasing. Once in the program, student CNMs receive labor and delivery experience in different types of settings. They must pass a national certification exam to call themselves CNMs.
Advanced education and training
All advanced practice nurses with master's degree can go on to get their doctorate degrees. Often, those with doctorate-level training go into research, administration, or teaching at the university level.
Future outlook
The outlook is good for all types of nurses, especially those at the RN level or higher. It is projected that if current trends continue, demand will exceed supply of RNs by about 2010. It is possible that as many as 114,000 jobs for full-time-equivalent RNs are going to go unfilled nationwide by 2015. This is due to a growing elderly population with mounting health care needs, an aging RN workforce, the expansion of primary care, and technological advances that require more highly trained nurses.
There is a growing demand for RNs with advanced clinical skills. Almost all who graduate have jobs waiting for them.
ORGANIZATIONS
American Association of Colleges of Nursing. One Dupont Circle, NW, Suite 530, Washington, DC 20036. (202) 463-6930. <http://www.aacn.nche.edu>.
American Association of Nurse Anesthetists. 222 South Prospect Avenue, Park Ridge, IL 60068-4001. (847) 692-7050. <http://www.aana.com>.
American College of Nurse-Midwives. 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006. (202) 738-9860. <http://www.acnm.org>.
American College of Nurse Practitioners. 503 Capitol Ct. NE, #300, Washington, DC 20002. (202) 546-4825. <http://www.nurse.org>.
American Nurses Association. 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (800) 274-4ANA. <http://www.ana.org>.
National Association of Clinical Nurse Specialists. 3969 Green Street, Harrisburg, PA 17110-1575. (717) 234-6799. <http://www.nacn.org>.
OTHER
The Registered Nurse Population National Sample Survey of Registered Nurses—March 2000. U.S. Department of Health and Human Services, Health Resources and Services administration. Bureau of Health Professions. Division of Nursing. <http://bhpr.hrsa.gov>.
