Advanced practice nurse

An advanced practice nurse (APN) is a nurse with post-graduate education in nursing. APNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing.[1]

Nurses practicing at this level may work in either a specialist or generalist capacity.

Education, accreditation, and certification

APNs are intended to demonstrate effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgments and interventions, while remaining under physician supervision. Post-graduate education is designed to teach an APN to use multiple approaches to decision-making, manage the care of individuals and groups, engage in collaborative practices with the patient or client to achieve best outcomes; provide a supportive environment for colleagues; manage the utilization of staff and physical resources; engage in ethically justifiable nursing practice; protect the rights of individuals and groups; engage in activities to improve nursing practice; develop therapeutic and caring relationships; fulfill the conduct requirements of the profession; act to enhance the professional development of self; and function in accordance with legislation and common law affecting nursing practice.[2]

APN education forms the basis of four recognized general areas of specialization:

Each nurse specialty can have concentrations in a specific field or patient population.

In 2004, The American Association of Colleges of Nursing (AACN) in conjunction with the National Council of State Boards of Nursing (NCSBN) recommended that advanced practice registered nurses move the entry level degree to the doctorate level by 2015.[3] Accordingly, all APN training programs are recommended (but not required as of yet) to convert their master's degree to a Doctor of Nursing Practice degree by the year 2015. Although the American Association of Nurse Anesthetists approved this recommendation, it is not requiring program compliance until the year 2025.[4]

The majority of programs will grant a DNP.[3] Because 45% of the nurse anesthesia programs are located in schools of allied health, these programs will award a Doctor of Nurse Anesthesia Practice (DNAP). The DNP will be the direct-entry, minimum academic requirement for advanced practice registered nurses; it is a clinical/practice-based doctorate but because it is not the entry degree for the profession of nursing (which includes advanced practice registered nursing), it is a terminal degree.

Patient outcomes

Continuing studies comparing the patient outcomes of care provided by APRNs and physicians indicate that outcomes of care by APRNs supervised by physicians is comparable to care by a physician alone. Recently it has been shown that NP's prescribe opioids at a rate 28 times higher than physician counterparts in states they practice autonomously.[5]

Terminal degrees

An APN may earn a terminal degree in several ways. A terminal degree is generally a doctorate. In some fields, especially those linked to a profession (e.g., medicine, nursing, dentistry, law, optometry, architecture, pharmacy, social work, religious ministry, engineering, accounting, education, etc.), a distinction is to be drawn between a first professional degree, an advanced professional degree, and a terminal academic degree. A first professional degree is generally required by law or custom to practice the profession without limitation. An advanced professional degree provides further training in a specialized area of the profession. A first professional degree is an academic degree designed to prepare the holder for a particular career or profession, fields where scholarly research and academic activity are not the work, but rather the practice of a profession. In many cases, the first professional degree is also the terminal degree because usually no further advanced degree is required for practice in that field even though more advanced professional degrees may exist.

Examples of terminal degrees in research are:

Examples of terminal professional degrees in nursing are:

  • Doctor of Nursing Practice (DNP)
  • Doctor of Nurse Anesthesia Practice (DNAP)

Post-nominal initials

The specific titles, credentials and post-nominal initials used by advanced practice nurses will vary greatly by country, state and educational level.

A list of post-nominal initials include, but are not limited to:

  • ACNP: Acute Care Nurse Practitioner
  • AGACNP: Adult-Gerontology Acute Care Nurse Practitioner
  • ANP: Adult Nurse Practitioner
  • APHN: Advanced Public Health Nurse
  • APRN: Advanced Practice Registered Nurse (Same as Advanced Practice Nurse)
  • APN: Advanced Practice Nurse (Refers to the four recognized general areas of advanced professional specialization: CRNA, NP, CNM, and CNS)
  • ARNP: Advanced Registered Nurse Practitioner (Refers to Nurse Practitioners in some US States)
  • C or BC following a title: Certified or Board Certified (i.e., APRN-BC, WHNP-BC, PNP-BC, FNP-C, GNP-C, ANP-BC)
  • CMCN: Certified Managed Care Nurse
  • CNM: Certified Nurse Midwife
  • CNS: Clinical Nurse Specialist
  • CRNP: Certified Registered Nurse Practitioner
  • CS: Clinical Specialist
  • CRNA: Certified Registered Nurse Anesthetist
  • DNP: Doctor of Nursing Practice (the terminal professional degree for APNs)
  • FNP: Family Nurse Practitioner
  • GNP: Gerontological Nurse Practitioner
  • NNP: Neonatal Nurse Practitioner
  • NP: Nurse Practitioner
  • ONP: Oncology Nurse Practitioner
  • PMHCNS: Psychiatric & Mental Health Clinical Nurse Specialist
  • PMHNP: Psychiatric & Mental Health Nurse Practitioner
  • PNP: Pediatric Nurse Practitioner
  • PNP-AC: Pediatric Nurse Practitioner- Acute Care
  • PsyNP: Psychiatric Nurse Practitioner
  • WHNP: Women's Health Nurse Practitioner

References
  1. "American Nurses Association". Archived from the original on 1997-04-06.
  2. http://www.aacn.nche.edu/publications/positions/cerreg.htm Archived July 20, 2011, at the Wayback Machine
  3. Aacn - Dnp - Faqs
  4. AANA - Home
  5. https://academic.oup.com/painmedicine/article/21/1/76/5368063
  6. Newhouse, Robin; Julie Stanik-Hutt; Kathleen M. White; Meg Johantgen; Eric B. Bass; George Zangaro; Renee F. Wilson; Lily Fountain; Donald M. Steinwachs; Lou Heindel; Jonathan P. Weiner (September–October 2011). "Advanced Practice Nurse Outcomes: 1990-2008: A Systematic Review" (PDF). Nursing Economic$. 29 (5): 230–50, quiz 251. PMID 22372080. Archived from the original (PDF) on 11 October 2013. Retrieved 16 August 2011.
  7. Nursing Licensure Debate - Nursing
  8. APRN Compact
  9. A Closing Word: National Licensure for Nurses
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