Alphabet Soup: The Ultimate Advanced Practice Nursing Guide

There are seemingly endless career options for nurses and advanced practice nursing is among the most popular avenues. Deciding to pursue an advanced nursing role can be confusing down to the 20+ acronyms for nurse practitioners that exist.

I’m Ashley Sayles, a Pediatric NP. I recently sat down with Trusted for a virtual, one-hour chat—”Alphabet Soup: The Ultimate Advanced Practice Nursing Guide”—where we broke down the various advanced practice roles. 

You can watch the full recording below!
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‍Below, we cover: 

• How to decide which avenues you can consider
• The required steps to apply for advanced practice nursing degree
• Your financial options for funding an advanced practice education
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First thing’s first…
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What’s Your Why?

When considering advanced practice nursing — consider your passions and career goals, what you’ve done, and the role you’d like to play in healthcare.

“If you really want to do something, you’ll find a way.  If you don’t, you’ll find an excuse.” - Jim Rohn

Advanced Practice Nursing Roles

Advanced Practice Registered Nurse = APRN

1. Clinical Nurse Specialist (CNS) – no prescriptive authority
2. Nurse Practitioner (NP)
3. Licensure: APRN, CRNP
4. Board Certification: FNP-BC, PMHNP-BC, CPNP-AC/PC, WHNP-BC, AGACNP-BC, AGPCNP-BC, etc.‍
5. Certified Nurse Midwife (CNM)‍
6. Certified Nurse Anesthetist (CRNA)
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Most states don’t allow Clinical Nurse Specialists to prescribe medications, but you can apply for prescriptive authority for some treatments like burn dressing supplies, etc.

CNSs usually work in very specialized areas and are used as expert resources for nurses and medical teams within that speciality.‍

Note: Licensure vs. Board Certification — it’s important to pay attention to this difference for nurse practitioners CBS, CNM & CRNA usually have the same licensure and certification credentials. 
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Advanced Practice Nursing Education

MSN, DNP, PhD & Certificates

• MSN (Master of Science in Nursing)

• CNS, NP, CNM, CRNA & some entry-level nursing programs

• DNP (Doctor of Nursing Practice)

• CNS, NP, CNM, CRNA & non-clinical roles

• PhD (Doctor of Philosophy in Nursing)

• Non-clinical roles such as education or research

• Certificate Programs

• Specialties: Infectious Disease, Pediatric Critical Care, Psychiatric Mental Health, Nursing Education
• Usually require Masters or Doctoral degrees for admission
  

Remember, degrees ≠ authority to practice! You must be enrolled in a program that will qualify you as eligible to sit for the exam you need to take.‍

Note: MSN entry-level nurses cannot sit for NP exams even though some NPs are MSN-prepared.
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Deciding on a Nursing Role

Here are three things to think about:

• What patient population do you want to work with?
• What do you want to offer that patient population?
• What existing role most closely aligns with my goal?
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Nursing has limitless career options, many requiring advanced education and training and many that do not. Nursing is ever changing, and this includes our scope of practice.  

Many nurses create positions for themselves based on care gaps they’ve identified, and having advanced education may help your argument to create the position you wish to hold.

That said, advanced practice nursing programs are hard, especially if you’re employed while enrolled. Because of this, lacking true passion will affect your will to continue on your worst days. It is important to be sure of your goals before investing so much of yourself into this endeavor!
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Advanced Practice Registered Nurse Roles

Below, we will detail the main concepts of most APRN roles. This will not be exhaustive, and I highly recommend continuing your research after making your way down this list!
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Clinical Nurse Specialist (CNS)

Unit Expert

• Highly specialized and highly knowledgeable
• Keeps abreast on the latest evidence-based research regarding their specialty
• May implement unit protocols and procedures, hold unit inservices, meet with facility leadership on behalf of nursing staff, etc.
• May provide insight on complex cases — but minimal diagnostic and prescriptive authority (if any)
  

CNSs are usually very experienced nurses that have committed their career to a very specific type of patient, diagnosis, or care area. Many CNSs provide education to both healthcare workers and patients as well as their families; i.e. a Clinical Nurse Educator.
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Certified Nurse Midwife (CNM)

All Things Labor and Delivery

• Nurse Midwives deliver newborn infants in hospitals, birthing centers & home-based settings to relatively low- risk expecting mothers
• Follows expecting families in  prenatal and postpartum periods and manages complications independently or with a medical team
• May also provide well woman exams & screenings, provide family planning options and prescriptions & diagnose common gynecological illnesses
• Usually works as a labor & delivery bedside nurse for a period of time prior to midwifery school 
  

CNMs often work with low-risk births with minimal prenatal complications or concerns. They typically work in hospitals or outpatient birthing centers.
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Nurse Practitioner (NP)

The Most Popular Advanced Practice Role

• Nurse practitioners evaluate, interpret, diagnose, and treat illnesses in patients within their speciality
• Nurse practitioners function in the role of a physician and can completely replace them in many states and in most care settings
• Numerous specialties for nurse practitioners: pediatric, neonatal, geriatric, psychiatric, women’s health, family, acute care, and primary care
• The extent of practice authority is state specific; nearly 25% of US states currently allow full practice authority for NPs
  

Many nurse practitioner subspecialties such as oncology, emergency, orthopedic, and dermatology require initial certification as pediatric, family, adult, etc. They either require you take a certification course (post-masters/post-doctoral) or provide proof of a predetermined number of clinical practice hours to be eligible to take certification exams.
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Certified Nurse Anesthetist (CRNA)

Anesthesia, Sedation, and Pain Control

• Work in place of anesthesiologists (MD or DO) in providing procedural anesthesia, ventilation, and hemodynamic management
• MUST work in ICU (not NICU) as a RN for a period of time prior to applying
• May also provide nerve blocks for procedures as well as epidurals for laboring mothers
• Focus on almost exclusively doctoral programs at this time 
  

The highest paid nurses in the United States are CRNAs. Schooling is intense and working during school is highly discouraged, if not contractually banned. Utilized mainly in OR or procedural settings, there are opportunities for specialties such as pediatric or L&D.  
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Other Nursing Specialties

Below are numerous roles for nurses that are not necessarily advanced practice but utilize nursing skills in different, specific ways. Typically, the term advanced practice refers to recognized nursing professions that are licensed to provide care in excess of those allowed by RN credentials. 

• Care Coordination
• Trauma Nursing
• Community Health Nursing
• Nurse Researcher
• Informatics Nurse
• Trauma Nursing
• Hospice Nursing
• Clinical Instructor
• Nurse Educator
• Forensic Nurse
• Case Manager
• Prior Authorization Specialist
• Nurse Management
• Flight Nursing
• Palliative Care
• School Nursing
• Dialysis Nursing
  

Most of these options do not require additional schooling or may require a short certification course.
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Applying to Become an Advanced Practice Nurse

The application process can be daunting, but it is doable with planning!
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Application Requirements

• Varies by school — pay attention to details on their websites
• Most require completed application, transcripts, resume/CV, personal statements/essays, references/rec letters; and, maybe an interview too
• Prerequisite courses — check how recently they need to have been completed
• The GRE is required for most graduate programs now, especially for DNP programs
• Strong personal statements are crucial in receiving acceptance letters!
  

Be sure to check admissions requirements frequently, as can change without notice from semester to semester. Also, it’s always a good idea to start tracking down transcripts and letters of recommendation early on in the application process!
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Some important things to note:

• Many schools require prerequisites to be completed within 5-10 years of application
• COVID-19 may have changed GRE rules similar to SAT/ACT rules for high school graduates
• Personal statements are an underrated portion of the application; they are how the admissions committee will learn about who you are, why you want to be there, and quite frankly, how you will put their school on the map
• What do you plan to do with your new credentials? How will you impact healthcare for the better? Be very specific about this — personal details help!
• The ultimate goal is to convince admissions/hiring professionals that you are serious about this, not just applying because you had a bad shift at the bedside!
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How to Choose a Nursing School

Reputation, Accreditation, and Cost

Firstly, ensure the school is accredited to offer the program you are interested in. Second, research the school’s offerings and reviews.
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Some answers to look for:

• Are their students supported in finding clinical rotations? 
• Do they offer career advising for new graduates?
• Are they online or traditional?
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Next, determine what you can afford to invest in returning to school, financially and time wise. Keep in mind that although online programs may be cheaper and more convenient, they often offer less assistance than traditional programs in day-to-day support, securing preceptors, etc.
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A Word About Online Nursing Programs

Research, research, research!

Here is a quick checklist to help you find the best online NP program for you:

• Options and flexibility needs

• Part-time, online options, evening classes, etc.

• Student support and available resources

• Career guidance, clinical/preceptor support, etc.

• Financial considerations

• Affordability, financing options, and debt

• Pros and cons of traditional vs. online nursing programs

• Think about what YOU need to learn and do well in school and choose the type that most aligns
  

Be honest with yourself and your needs. Your friend or coworker may have different needs than you... and that is ok! At the end of the day, you must do what is best for YOU!
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Financing Your Goals - How to Pay for Nursing School

Loans

Federal loans are eligible for government-sponsored loan repayment and forgiveness programs. Do your research here!
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Grants

Professional organizations and state or federal-sponsored programs are available.
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Cash/Credit

Are you going to be bankrolling your education yourself? How’s your credit score? Are you ready to take on debt and then pay it off efficiently?

Some students may opt to pay out of pocket to avoid loans — find out if a part-time schooling option is available, as this can sometimes be more affordable.
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Scholarships

There are many to look for, especially for healthcare professionals. Again, do your research! Even a couple thousand dollars a year can make a big difference in the long run.
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Employer Benefits

Some employers may offer to fund your education in exchange for future years of your service (just be sure to read the fine print)!

Now that you know your options. Get out there and research, plan, and apply!
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Looking to Save Up Before Returning to School?

Travel nursing can be a great way to save up some extra money quickly. Create a free Trusted profile to set your location preferences and find available travel nursing jobs for you!