How to Become an Advanced Practice Registered Nurse

If you are interested in advancing your nursing career, you may wish to look at the role of an advanced practice registered nurse (APRN). This position allows for field specialization, greater job autonomy, high job demand and good earning potential. Read more on how you can become an advanced practice registered nurse.

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Advanced Practice Registered Nurse Job Duties and Responsibilities

If you are interested in a healthcare degree that may lead to an advanced practice registered nurse career, you are likely to have a few questions, such as what is an APRN? Is an APRN different than a registered nurse (RN)? What level of education do you need to become an APRN?

An APRN, or advanced practice registered nurse, is a general term for nursing professionals who hold at least a master’s degree in nursing and may perform many of the duties similar to a doctor. While registered nurses (RN) can practice with an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree, to practice as an APRN, you must hold a Master of Science in Nursing or Doctor of Nursing Practice degree.

What does an advanced practice registered nurse do? Depending on the APRN specialty, APRN duties will vary. However, in general, an APRN:

  • Diagnoses and treats illnesses
  • Manages acute and chronic diseases
  • Guides their patients on health issues
  • Performs physical exams and observes patients
  • Performs and orders diagnostic tests
  • Consults with doctors and other healthcare professionals, as needed

It is an APRN's responsibility to continue their education to stay current with developments in the field.

Types of APRNs

When deciding whether to advance your registered nursing career, it may be helpful to understand that there are four types of APRN specialties: a nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM) or clinical nurse specialist (CNS).

  • Certified Registered Nurse Anesthetists provide anesthetics and anesthesia-related care to patients. The state in which they practice determines what level of autonomy the CRNA has. Some states allow a high degree of independence while others require certified registered nurse anesthetists to work with a physician present.
  • Certified Nurse Midwives supply gynecologic care before, during and after stages of gestation: prenatal, pregnancy, birth and postpartum. In addition, CNMs provide primary care to women and their families throughout their reproductive lives.
  • Clinical Nurse Specialists define their area of expertise by population (pediatrics or geriatrics), disease or medical subspecialty (oncology, diabetes), setting (emergency room or critical care), type of health problem (pain or stress) or type of care (rehabilitation or psychiatric). CNSs also work in management and research or develop policies and procedures.
  • Nurse Practitioners treat the whole patient by providing a host of healthcare services (e.g., primary, acute and specialty care). NPs may work in various settings including hospitals, clinics and private practices. Responsibilities of this position include prescribing medications and treatments, managing the overall care of patients, ordering, conducting, and interpreting diagnostic tests like X-rays and lab work, and counseling.

Within the versatile role of nurse practitioner, there are a number of sub-specializations, each focused on a specific population:

  • Family Nurse Practitioner (FNP)
  • Women's Health Nurse Practitioner (WHNP)
  • Pediatric Nurse Practitioner (PNP)
  • Adult-Gerontology Acute Care Nurse Practitioner (ACNPC-AG)
  • Acute Care Pediatric Nurse Practitioner (CPNP-AC)
  • Neonatal Nurse Practitioner (NNP)
  • Psychiatric Mental Health Nurse Practitioner (PMHNP)
  • Women’s Health Nurse Practitioner (WHNP)

Additional certifications and work experience, or a combination of both, allow you to take on various other sub-specializations:

  • Cardiology Nurse Practitioner (CNP)
  • Aesthetic Nurse Practitioner (ANP)
  • Emergency Nurse Practitioner (ENP)
  • Dermatology Certified Nurse Practitioner (DCNP)
  • Oncology Nurse Practitioner (ONP)
  • Orthopedic Nurse Practitioner (ONP)

Six Common Steps to Becoming an APRN

Now that you understand what an APRN is and the types of responsibilities that come with the role, let’s examine how to become an advanced practice registered nurse. Although every journey is unique, there are six common steps to becoming a licensed APRN.

1: Get an Associate or Bachelor's Degree in Nursing

Becoming an RN requires at least an ADN and passing the NCLEX exam. If you’re an ADN-prepared RN, you’ll also have to earn a bachelor's degree in nursing before you can move on to the master’s degree that becoming an APRN requires.

2: Graduate with Your Advanced Nursing Degree

A Master of Nursing degree (MSN) program combines classroom study with clinical experience in your specified healthcare area and usually takes two years. A Doctor of Nursing Practice, or DNP, degree may take anywhere from 18 months up to four years to complete. You can find postgraduate degree programs in traditional and online formats. Online programs require you to complete in-person clinical hours, typically at a local site.

3: Obtain the Required Hours of Clinical Experience

In conjunction with BSN, MSN, and DPN practice coursework, you will need to gain the required clinical experience for an advanced practice registered nurse. Your area of specialization and your institution will determine your clinical experiences. For example, clinical hours for a certified nurse midwife range from 600 to 1,200; nurse practitioners can expect to need 500 hours of clinical experience while certified registered nurse anesthetists must complete more than 2,000 hours and administer about 850 anesthetics. Completion may take anywhere from two to five years.

4: Pass a National APRN Certification Exam

Although you must pass a national certification exam regardless of your APRN specialty, your specialty determines which exam you need to take. For example, NPs can either take the national family nurse practitioner (FNP) exam through the American Association of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC). The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the Certified Registered Nurse Anesthetist Exam. National certification exams are rigorous and require months of study, but each exam’s specific content and format may vary.

5: Apply for Licensure as an Advanced Practice Registered Nurse

After passing the appropriate APRN certification exam, you need to apply for an APRN license in the state you wish to practice as an APRN. Even though every state requires a certification for nurse practitioners before becoming a licensed APRN, additional licensure requirements vary among states. Once board certified, you may practice as an APRN. It is important to note the scope of practice could vary widely among states (PDF 598 KB), such as whether independent practice is permitted.

6: Begin the Search for Advanced Practice Registered Nurse Jobs

Now that you are certified and licensed, you are ready to enter the APRN workforce. Depending on your specialty, the settings in which you practice will vary, however, it is typical for APRNs to work in hospitals, clinics and private practices. Not sure where to start looking for advanced practice registered nurse jobs? Organizations like the American Association of Nurse Practitioners provide searchable job centers. If you have a facility already in mind, visit their website for job postings or call the human resources department.

What Are the Continuing Education Requirements for Advanced Practice Registered Nurses?

Regardless of your specialty, you will be required to take a recertification examination and/or continuing education on a specified cycle every five years. For example, certified registered nurse anesthetists must recertify with the National Board of Certification & Recertification for Nurse Anesthetists every four years, except for the first renewal, which only requires continuing education credits. Nurse practitioners must recertify every two years by either an American Academy of Nurse Practitioners recertification exam or by meeting a minimum number of continuing education credits and direct clinical practice hours.

As a licensed APRN, it may be helpful to keep up with the near-constant changes in nursing standards and advancements in technology. Continuing education enables you to do this.

A few factors go into determining what continuing education you will need. Every state requires continuing education for advanced practice registered nurses to renew their state license. However, your APRN specialty and your state licensing board's rules determine the hours of continuing education for APRNs and specific coursework is needed for license renewal. Contact your state board to determine relicensing requirements.

APRN Salary and Career Outlook

In addition to the unique skills and abilities you bring to your position as an APRN, many factors can affect your salary, including level of education, experience, employer, where you work, job title and performance.

According to the U.S. Bureau of Labor Statistics, in 2020, the median salary for nurse anesthetists, nurse practitioners, and nurse midwives was $117,670. Furthermore:

Overall job outlook for nurse practitioners, nurse anesthetists and nurse midwives has a positive projection. The BLS projects that employment of these roles will grow 45% from 2019 to 2029, which is a much faster rate than the average for all occupations. Anticipated job openings for each of these occupational titles during the ten-year projection includes an increase of 6,200 nurse anesthetists, 800 nurse midwives and 110,700 nurse practitioners. The high demand for APRNs is expected to continue, primarily due to an increased emphasis on preventive care and demand for healthcare services from an aging population.

Skills That Can Help You Become an APRN

Of course, solid clinical skills are needed to be an effective APRN as well as a positive attitude, the ability to organize and prioritize and the ability to successfully manage stress. Additional skills advanced practice registered nurses may use include:

1. Teamwork Skills

The ability to work well with the other people on a patient’s healthcare team (doctors, nurses and other staff) may improve the quality of care given to the patient. Having good teamwork skills may enhance patient safety, reduce medical errors, ease patient concerns and increase efficiency.

2. Communication Skills

The ability to communicate clearly, both orally and written, may also be a benefit to you and your patient. Active listening and awareness of nonverbal cues help you gather important patient information. The ability to communicate clearly with other members of the healthcare team may help produce better patient outcomes.

3. Empathy

Empathy allows you to understand, engage and connect with your patients and their families. Research has shown that a care provider’s empathy may help patients adhere better to medication recommendations, increase patient satisfaction and decrease the number of mistakes made.

The decision to advance your nursing career is not one to take lightly. There is little question that the required education, clinical hours, national exams, certification and licensure can be daunting. However, as many in the nursing profession may tell you, along with these challenges comes even greater rewards.

Last Updated April 2021