Introduction
In the US, nursing is a popular, highly paid, and in-demand profession. Generally, the National Council of State Boards of Nursing APRN Consensus Model defines four roles for nurses, including certified nurse-midwife (CNM), nurse practitioner (NP), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). The Advanced Practice Registered Nurse (APRN) role is usually seen as interchangeable with the nurse practitioner (NP), but the APRN concept is broader. This paper aims to determine the four types of APRNs and explain the scope of each practice, educational requirements, reimbursement, and relationship challenges in the workplace for each type.
The Four Types of APRNs
The four types of APRNs are widely accepted across the US, and there is a specific differentiation between these roles in terms of responsibilities, educational requirements, and salary. Nurse-midwives manage women’s health care, focusing on the issues of pregnancy, childbirth, newborn care, and postpartum care. Nurse-midwives also specialize in family planning and gynecology, and their consulting advice focuses on family-centered care, prevention, and patient education. Nurse practitioners have a wider spectrum of specialization that involves neonatal care, pediatrics, psychiatric-mental health, women’s health, adult/gerontology, and family care. They educate patients, perform diagnosing, collaborate with physicians and other specialists, and provide referrals. NPs are usually perceived as comprehensive professionals who can provide competent assistance in many healthcare issues and manage health concerns.
Clinical nurse specialists are experts in psychiatric-mental health care, critical care, oncology, and geriatric care. These practitioners’ distinctive feature is a more strategic approach to counseling, as they refine and develop new methods of nursing care and educate nurses. CNSs may also assess health problems and prescribe medications for patients. The active clinical position of CNSs is associated with reduced hospital costs, as well as reduced medical complications and emergency room visits. There are up to 45,000 Certified Registered Nurse Anesthetists (CRNAs) in the US, and to start practicing, these specialists need licensing and certification. They provide anesthesia services that are required in obstetrical, surgical, and trauma stabilization.
The Scope of Practice for Each Type
The scope of practice differs for each type and depends on the responsibilities associated with every role. Nurse-midwives focus on pregnancy management, childbirth, and aftercare, while NPs have broader mandates and provide services across pediatrics, mental health, women’s health, gerontology, and family counseling. Notably, all types of nurses provide counseling services, interact with other healthcare practitioners and provide referrals. CNSs’ role is specific in a way, that these specialists develop unique counseling methodologies and educate nurses. CNSs work in the sectors of mental health, critical care, and oncology. Finally, CRNAs provide anesthesia during surgical, obstetrical, and trauma operations.
Educational Requirements
The educational requirements for each type of APRN differ in some specific details but generally have more common features. All types of APRN roles require the initial RN license and continuing education through BSN, MSN, and doctorate programs. Equally important, all types of education, including continuing education or obtaining a new specialization, require certification. BSN is a four-year educational degree required for all 4 types of APRN roles.
BSN offers wider opportunities than the two-year associate degree in nursing (ADN), which is also acceptable for all four role types, but only for the entry positions, such as RNs. There is a National Council Licensure Examination (NCLEX) for RNs that nurses have to pass after finishing the BSN program (NCLEX and other exams, 2022). This exam includes four categories, eight subcategories, and 145 questions in total. Most nursing educational institutions have graduate programs that require a 1-2 year clinical experience, such as working as an RN. There are also specialized certification exams for nurse midwives, nurse practitioners, CNSs, and CRNAs.
Reimbursement for Every Type of APRN
Average salaries differ for various types of APRNs but are usually no less than $100,000 per year. Nurse-midwives average salary constituted $114,210 as of May 2021, with a projected 12% increase by 2019 (Nurse-midwives salary, 2022). For nurse practitioners, this amount is $115,598 as of May 27, 2022, with a range between $107,265 and $125,578 (NP salary, 2022). Noteworthy, the salary ranges can depend on many critical factors, such as education, additional skills, certifications, and years of practice. No less interesting, CNS specialists’ average salary is $112,267 as of May 27, 2022, with a range between $101,514 and $122,976 (Clinical Nurse Specialist salary, 2022). Finally, the CRNA salaries are the highest, with $174,790 as of May 25, 2022. Interestingly, the reimbursements differ depending on the state, with the highest numbers in Montana – $246,370, and the lowest in Idaho – $143,270 (CRNA salary, 2022). CRNAs also get attractive benefits like health insurance, paid vacation, paid sick time, incentives for healthy living, and career coaching.
The Relationship Challenges Faced by APRNs in the Workplace
Different types of APRNs may face various relationship challenges, including problems when communicating with patients or collaborating with colleagues. Problems with patients may feature the lack of understanding of diagnosis or during the educational counseling and the language barriers. Communication with colleagues can meet challenges when medical institutions have different digital systems, and the diagnosis and medication data cannot be properly aligned. There can also be problems in communication between the more and less experienced APRNs, especially in situations that entail explicit subordination.
Conclusion
Thus, the four types of APRNs were determined, and the scope of each practice, educational requirements, reimbursement, and relationship challenges at the workplace were explained. Scope of practice and reimbursement differ for APRNs’ roles, whereas educational requirements and relationship challenges remain generally similar. CRNAs have the highest average salary rates, while NPs have the highest trust levels among patients. At the same time, CNSs are different from other roles as they spend more time developing the nursing methodology.
References
Certified Registered Nurse Anesthetists salary in the United States. (2022). Web.
Clinical Nurse Specialist Salary in the United States. (2022). Web.
NCLEX and other exams. (2022). Web.
Nurse Practitioner salary. (2022). Web.
Nurse-midwives salary. (2022). Web.