Advanced practice nurse

Assistant Editor-In-Chief: Michelle Lew

Overview
Advanced Practice Nurses (APNs) are Registered Nurses with advanced didactic and clinical education, knowledge, skills, and scope of practice. The term "Advanced Practice Nurse" is a blanket term used to describe four separate, graduate-level professions within the nursing profession as a whole. "Advanced Practice Nurse" is used to describe
 * Nurse practitioners
 * Certified Registered Nurse anesthetists
 * Clinical nurse specialists
 * Certified Nurse midwife

Training requirements in the United States
In the majority of instances, APNs 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).

To become an Advanced Practice Nurse, an education at doctorate level is not yet required in the United States. For many other professions, such as the examples in the following table, a doctorate level education is required.

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). 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 APNs. 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 APNs, who have been in the profession for many years and therefore have been "grandfathered" into the APN 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. Every state has different laws, rules, regulations, licensing and certification requirements for Advanced Practice Nurses, thus some states may require APNs 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 Nurse or a person with a profession listed in the table above can further obtain a "terminal degree." A terminal degree, generally a doctorate, is the highest degree awarded in a field of study.

Examples of terminal degrees are
 * Doctor of Philosophy (Ph.D.)
 * Doctor of Nursing Science (D.N.Sc.)
 * Doctor of Education (Ed.D.)
 * Doctor of Science (D.Sc.)

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:


 * C.R.N.P. - Certified Registered Nurse Practitioner
 * A.R.N.P. - Advanced Registered Nurse Practitioner
 * C.R.N.A. - Certified Registered Nurse Anesthetist
 * 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