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Advanced Practice Registered Nurses (APRNs) are Registered Nurses with advanced didactic and clinical education, knowledge, skills, and scope of practice.^[1]

APRN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at post-graduate level and may work in a specialist or generalist capacity. However, the basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidenced based decision-making.

APRN forms the basis for the role of nurse practitioner. The nurse practitioner role is an expanded form of advanced practice nursing which is specifically regulated by legislation and by professional regulation. Legislation may allow prescribing and referral, in addition to admitting privileges to health care facilities.

APRNs demonstrate more effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgements and interventions.

Uses multiple approaches to decision making; Manages the care of individuals and groups; Engages in collaborative practices to achieve client outcomes; Provides a supportive environment for colleagues; Manages the utilization of staff and physical resources; Engages in ethically justifiable nursing practice; Protects the rights of individuals/groups; Engages in activities to improve nursing practice; Develops therapeutic and caring relationships; Full fills the conduct requirements of the profession; Acts to enhance the professional development of self; Functions in accordance with legislation and common law affecting nursing practice14.

APRN is general term that actually encompasses four areas of specialty practice: certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists and certified nurse practitioners. Each specialty, especially NPs, can have sub-specialties or concentrations in specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being APRNs. While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state.

Training requirements in the United States

In the majority of instances, APRNs are educated at the graduate level, that is, they have a Masters degree, most commonly a Master of Science in Nursing. Many other Advanced Practice Nurses are educated at the doctorate level. These APNs have the degree of Doctor of Nursing Practice (DNP/DrNP).

The institutions which are member of the American Association of Colleges of Nursing (AACN) decided that for advanced nursing practice within these colleges, by 2015, Advanced Practice Nurses will also be required a clinical/practice doctorate, the Doctor of Nursing Practice (DNP/DrNP).^[2] The Doctor of Nursing Practice will be the direct-entry, minimum academic requirement for Advanced Practice Nurses; it is a clinical/practice-based doctorate and therefore is a professional doctorate or first professional degree.

The DNP/DrNP doctoral degree requirement will apply only to those who are not yet licensed and practicing as APRNs. Those currently licensed as Advanced Practice Nurses who hold a Masters degree will be permitted to maintain their current level of formal education and certification.

Grandfather exception

Some APRNs, who have been in the profession for many years and therefore have been "grandfathered" into the APRN professions. That means that they do not need to meet the current requirement of a graduate degree. For example, the first Nurse Practitioner program was created by a nurse educator, Loretta C. Ford, Ed.D., R.N., P.N.P. and a physician, Henry K. Silver, M.D., in 1965 at the University of Colorado as a non-degree, certificate program training Registered Nurses for advanced roles as Pediatric Nurse Practitioners due to a shortage of primary care physicians.^[3] Every state has different laws, rules, regulations, licensing and certification requirements for Advanced Practice Registered Nurses, thus some states may require APRNs to possess a minimum of a Masters degree for licensure and practice and do not have a "grandfather" clause in their State Board of Nursing laws.

Terminal degrees

An Advanced Practice Registered Nurse 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:

Doctor of Philosophy (Ph.D.)
Doctor of Education (Ed.D.)
Doctor of Science (D.Sc.)
Doctor of Nursing Science (D.N.Sc., DNS)

Examples of terminal professional degrees are:

Doctor of Nursing Practice (DNP/DrNP)
Doctor of Nurse Anesthesia Practice (DNAP)

Post-Nominal Initials

The specific titles, credentials, post-nominal initials, and so on, Advanced Practice Nurses utilize will vary greatly by country, state, license-type, academic degrees, and board certifications. A list of post-nominal initials include, but are not limited to:

APRN - Advanced Practice Registered Nurse (Refers to the four recognized general areas of specialization: CRNA, NP, CNM, and CNS)
C.R.N.P - Certified Registered Nurse Practitioner
A.R.N.P. - Advanced Registered Nurse Practitioner
CRNA - Certified Registered Nurse Anesthetist (there are no periods after each letter)
C.N.M. - Certified Nurse Midwife
C.N.S. - Clinical Nurse Specialist
A.P.R.N. - Advanced Practice Registered Nurse
F.N.P. - Family Nurse Practitioner
P.N.P. - Pediatric Nurse Practitioner
W.H.N.P. - Women's Health Nurse Practitioner
N.N.P. - Neonatal Nurse Practitioner
P.M.H.N.P. - Psychiatric & Mental Health Nurse Practitioner
Psy.N.P. - Psychiatric Nurse Practitioner
G.N.P. - Gerontological Nurse Practitioner
A.C.N.P. - Acute Care Nurse Practitioner
A.N.P. - Adult Nurse Practitioner
O.N.P. - Oncology Nurse Practitioner
C. or B.C. - Certified or Board Certified (i.e., APRN-BC, FNP-BC, FNP-C, GNP-C, ANP-BC)
N.P.-C. - Nurse Practitioner - Certified
C.S. - Clinical Specialist

References

Deutsches Netzwerk für Advance Nursing Practice www.dnapn.de

External links

[1] "American Nurses Association".

[2] ttp://www.aacn.nche.edu/DNP/DNPFAQ.htm

[3] ttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml

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