Advancing Your Nursing Degree Part 2: The Advanced Practice Registered Nurse

Female nurse practitioner consulting with a female patient

The highest level of licensure for nurses is the Advanced Practice Registered Nurse (APRN). There are four different APRN specialties: Certified Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife. Certification information can be found at the National Council of State Boards of Nursing website. There are three avenues one can pursue to become academically prepared to sit for licensure as a nurse practitioner: masters, graduate certificate, and doctorate. For this blog, I will focus on preparation at the master’s level.

Nurse Practitioner Options

If I had to guess, I would say about 60% of the employees I speak with say they plan on pursuing the Family Nurse Practitioner program. After our coaching session, about half remain interested in that degree plan as they often are not aware of the available specialties. What I hope you will gain from this blog is a better understanding of some of the options available, general requirements, and a program option for each. I’ll provide different schools for each area of specialization. Keep in mind, each school offers several specialties, so if you do not see a school you are interested in, try clicking on a different specialty. Nurse Practitioner programs tend to be about 45 semester credits with 600-700 clinical hours. For the purposes of this blog, I have focused on online programs in the suggestions offered below.

You will need to be both certified and licensed as a nurse practitioner to practice, so you must ensure the school meets your state’s licensing requirements. I also encourage you to check your local state university as they may be the most affordable option and many have fully online or hybrid offerings. Once you complete the academic program, credentialing is done by the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Board (AANPCB). 

The generalists are the Family Nurse Practitioners. According to the American Association of Nurse Practitioners, FNP’s comprise 69.7% of the workforce. They specialize in family practice, internal medicine, women’s health, pediatrics, mental health, and gerontology. Nurse practitioners are authorized to diagnose, treat, and prescribe medications. Dependent on state regulations they may work independently or under a physician. If you live in a rural area this may be a great choice as primary care physicians are in short supply, so the FNP is in high demand. This is especially true in those states where they can practice independently. The University of Missouri offers the FNP and four different specialties online at an affordable price for in-state or out-of-state residents.  

Are you interested in continuing your hospital career working with the adult population? If so, the Adult Gerontology Acute Care Nurse Practitioner may be a great fit for you. Typical admissions requirements for AGACNP programs are 2 years of Emergency, ICU, or Med-Surg experience. Graduates who complete the Adult-Gerontology ACNP program can obtain national certification through the American Association of Critical-Care Nurses (AACN) or ANCC. One of the more affordable, fully online programs is Northern Kentucky University

Adult Gerontology Primary Care Nurse Practitioners provide primary care services to adults who experience acute and chronic illnesses with emphasis on health promotion/disease prevention and rehabilitation needs. The Primary Care Nurse Practitioner typically is employed in ambulatory care settings such as clinics, physician offices, home health, rehabilitation settings, palliative care, and long-term care facilities. Credentialing is through the ANCC or AANPCB. One of the most affordable options in the EdAssist Solutions Education Network is Post University American Sentinel College of Nursing.

If you love working with children, there are a few different options. There is a Pediatric Acute Care option if you would like to focus on hospital-based care, or a Pediatric Primary Care Nurse Practitioner option for primary care settings. If you can’t decide, there are a few schools that offer dual programs so you can be certified in both disciplines. If you have experience working with premature infants, what about the Neonatal Nurse Practitioner program? Most schools will require a minimum of 2 years of NICU experience. Credentialing is through the Pediatric Nursing Certification Board (PNCB). The University of South Alabama offers all of these specialties. Drexel University, an EdAssist Solutions Network School, offers a dual degree option.  

Women’s Health is also an area of need. These practitioners provide care for women from puberty through adulthood with primary, gynecologic, and obstetric services. Ideal candidates for this program will have some experience in labor and delivery, post-partum care, GYN or OB/GYN clinics. Typically, one year of bedside nursing is required. The National Certification Corporation certifies WHNP’s. Georgetown University offers both the WHNP stand-alone program or a joint WHNP/Midwifery program. Georgetown offers a scholarship to Bright Horizons clients. 

Psychiatric Mental Health Nurse Practitioners are in short supply and trained to provide psychiatric services for patients across the lifespan from children to geriatric patients. They can practice in a variety of settings from private practice to community health to providing inpatient care. ANCC is the credentialing agency. Eastern Kentucky offers a completely online program with no campus visits. 

Finally, if you are already a Nurse Practitioner many of the schools above offer post-graduate certificate programs to add to or change your area of specialization. They typically average about 25 credits with 500 clinical hours.  

Other APRN Specialties

The Clinical Nurse Specialist provides leadership in their discipline of choice focusing on not only the patient but also nursing practice and the needs of the healthcare organization. It is a blend of teaching, care, and management. CNS’s assess patients, evaluate care plans, and provide leadership to achieve quality and cost-effective care to patients. These positions are designed to identify gaps in healthcare delivery and then implement interventions to improve care. They provide support to nurses caring for the patient and are a catalyst for change in the healthcare organization. 

A CNS is an expert with advanced education and training in a specialized area. They can focus on age groups such as gerontology or pediatrics and type of practice such as home health, critical care, or rehabilitation. They may also choose to focus on a type of disease or problem across the age groups such as diabetes or pain management. One of the large differences between a CNS and an NP is the CNS does not have prescribing authority and typically is not providing direct patient care.

A Certified Nurse Anesthetist provide anesthetics to patients during surgical, diagnostic, or obstetric procedures. They determine the amount and type of anesthesia needed and the method for administration. According to the American Association of Nurse Anesthetists, “They are the sole anesthesia providers in nearly all rural hospitals, and the main provider of anesthesia to the men and women serving in the U.S. Armed Forces.” Most States allow CRNA’s to work independently, but some require supervision by a medical doctor (MD/DO). The CRNA is the highest paid of the APRN specialties, has the longest program of study, and the most admissions requirements. A candidate for a CRNA program must have ICU experience and be willing to commit to a full-time, 3-year either on-campus or hybrid program. Many schools have transitioned to a doctorate in this specialty. By 2025 all new CRNA’s will require a doctorate. If you are interested in this specialty, I would suggest you research your local universities with nursing schools. The AANA also has a list of programs and a fact sheet on becoming a CRNA that may be of assistance.  

Certified Registered Nurse Midwife is another option to consider if you are interested in women’s health. They focus on labor and birth, gynecologic care, and newborn care. The University of Cincinnati offers a 57-credit online program that requires 784 clinical hours with 2 onsite visits. The ideal candidate will have experience in any of the above focus areas. Graduates will be eligible to sit for the American Midwifery Certification Board (AMCB) to become a certified nurse-midwife.

I hope this provides you some options for advancing your clinical nursing career.

Written by: Melissa Kessler

May 13, 2021

About the Author

Melissa Kessler headshot

Melissa brings 25 years of experience in higher education to Bright Horizons, including 15 years as the Assistant Director of the Office of Financial Aid and Scholarships at Rochester Institute of Technology and 7 years advising within a Nursing program. Melissa holds a Master’s in Career Development.