Advanced Practice Nursing: A New Age in Health Care

Innovative advances in health care make frequent headlines, but there is an equally innovative, if somewhat misunderstood, treatment for the cost and accessibility woes plaguing the United States health care system. More than 240,000 advanced practice registered nurses (APRN) -and their numbers are growing-are carving out a new role in delivering timely, cost-effective, quality health care, especially to chronically underserved populations such as the elderly, the poor, and those in rural areas.

Some 60% to 80% of primary and preventive care traditionally done by doctors can be done by a nurse for less money. This is not to say nurses work cheaper, but their costeffectiveness reflects a variety of factors related to the employment setting, liability insurance, and the cost of education.

With an emphasis on health promotion and disease prevention and a proven record of providing excellent primary care in diverse settings, advanced practice nurses form a critical link in the solution to America's health care crisis. Removing the barriers to advanced practice nursing would pay a healthy dividend now and in the future.

Who are these nurses?

The advanced practice registered nurse is an umbrella term given to a registered nurse (RN) who has met advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all RNs. Advanced practice registered nurses include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. Nurse Practice Acts vary widely among states, and they define just what advanced practice registered nurses can do.

Nurse Practitioners (NP)

* Number: 141,209 (51 % of all APRNs)

* Education: Nurse Practitioners (NPs) include RNs prepared beyond initial nursing education in an NP program of at least 3 months. Approximately 65 percent of NPs have completed a master's degree program and an additional 10 percent have a postmasters certificate as their NP preparation.

* What they do: Nurse Practitioners may practice independently, or they may work in hospitals, long-term care facilities, and for various health care agencies. Most NPs function primarily as clinicians. NPs may diagnose and treat a wide range of acute and chronic illnesses and injuries, interpret lab results, counsel patients, develop treatment plans, and they may prescribe medication.

Clinical Nurse Specialists (CNS)

* Number: 72.521 (24% of all APRNs)

* Education: Clinical nurse specialists (CNS) are RNs who have formal clinical preparation resulting in a master's degree. The vast majority of CNSs, 93 percent, received their CNS education through a master's program, with an additional 3 percent of CNSs prepared through a post-master's certificate.

* What they do: Clinical Nurse Specialists, like Nurse Practitioners, practice independently, or work in hospitals, long-term care facilities, and for various health care agencies. CNSs may also function as administrators, researchers, policymakers, educators, or consultants.

Certified Registered Nurse Anesthetist (CRNA)

* Number: 32,523 ( 13% of all APRNs)

* Education: While 37 percent of the nurse anesthetists received their nurse anesthetist educational preparation through a master's program, 58 percent received their educational preparation through a post-RN certificate.

* What they do: CRNAs provide anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified health care professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. Military, Public Health Services and Department of Veterans Affairs health care facilities.

Certified Nurse Midwives (CNM)

* Number: 32,523 (4% of all APRNs)

* Education: While 56 percent of these RNs received their educational preparation in this specialty through a master's program and an additional 5 percent through a post-master's certificate, 36 percent were estimated to have received their nurse midwife preparation through a certificate program.

* What they do: CNMs provide primary health care to women. This includes evaluation, assessment, treatment, and referral to a specialist, if required. CNMs provide preconception counseling, care during pregnancy and childbirth, normal gynecological services, and care of the peri- and post-menopausal woman.

Sources:

The Registered Nurse Population. Findings from the National Sample Survey of Registered Nurses, March 2004, U.S. Department of Health & Human Services, Public Health Service, Division of Nursing, Health Resources Services Administration. http://bhpr.hrsa.gov/healthworkforce/repQrts/rnpopulation/prcliminaryfindings.htm