The nursing profession offers different levels and types of patient care based on the nurse’s education and training. An APRN (advanced practice registered nurse) is a registered nurse with postgraduate education, training and certification. Advanced practice nursing refers to nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists. These registered nurses function in areas that were solely the physicians’ area of responsibility.

Nurse Practitioners (NPs)

An APRN may choose to practice as a Nurse practitioner (NP). Nurse practitioners see patients of all ages and can serve as a patient’s primary health care provider. They have been trained to diagnose and manage acute and chronic medical conditions. They provide many health services from screenings such as PAP smears and physical exams to ordering diagnostic tests and treatments. Nurse practitioners also make referrals and prescribe medications and rehabilitation treatments.   NPs may also choose to specialize in other areas of medicine like OB/GYN, cardiology, dermatology, orthopedics, etc. They must function within the scope of their practice, which is set by State Boards of Nursing.   Nurse practitioners work in different locales including community clinics, nursing homes, school clinics and physician offices. In many states, they can practice independent of physician supervision and can operate their own offices, clinics, etc., also directly billing for their services.  Besides health care services, NPs may also conduct research and teach. More information about NPs may be found at Health Communities.


Clinical Nurse Specialist (CNS)

Another option for advanced practice nursing is as a clinical nurse specialist. This APRN has clinical expertise in a specific setting such as critical care, emergency room, hospice and long-term care facilities; or a specific population such as pediatrics or geriatrics; or a particular type of health problem like pain, wounds or psychiatric. The primary focus of the CNS is continuous improvement of patient outcomes and nursing care. Clinical Nurse Specialists (CNSs) not only serve as consultants they give direct patient care and are responsible and accountable for diagnosis, treatment, health promotion and prevention of illness.

Certified Nurse –Midwives (CNMs)

Midwifery is another advanced practice nursing specialty. Not all midwives are nurses or have the same training. A direct entry midwife is not required to be a nurse and may or may not have a college degree or be certified. A nurse-midwife is an RN who has completed an accredited midwifery program and received certification.
In addition to assisting with births, CNMs write prescriptions and give a variety of care: they perform gynecological exams, newborn care, prenatal care and health maintenance counseling. CNMs work with other medical professionals and make referrals when more medical advice or care is needed. CNMs work in a variety of settings including hospitals, private practices, birth centers and patient homes.

Certified Registered Nurse Anesthetist (CRNA)

CRNAs have been trained to administer every kind of anesthesia such as general, local, epidural or spinal; for all types of surgeries or procedures, in all settings-physician offices, hospitals, pain clinics, outpatient surgery centers, etc., to patients of any age. They may work with other CRNAs, or in independent practice.
Many areas of knowledge and expertise that were exclusive to physicians have crossed over to nurses. This cross-over evolved into advanced practice nursing. As the evolution continues, many universities already have or are planning programs for the Doctor of Nursing Practice.