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Is advanced practice nursing for you?

basic nursing care

Advice to steer you in the right direction
By Janet Selway, DNSc, ANP-BC, CPNP-PC, FAANP

Are you considering becoming an advanced practice registered nurse (APRN)? Healthcare provider shortages, our rapidly aging population, and in- creasing incidence of chronic diseases have put APRNs in the spot- light for their ability to deliver preventive, acute, and chronic disease care. Recent workforce surveys indicate licensed APRNs now account for 7% of the 4 million RNs in the United States.

If you’re thinking of joining their ranks, you’ll need to do thorough research to make an informed decision on which APRN role and education program are right for you. This article describes the four APRN roles, gives current data on each, and offers important points to consider when choosing an APRN education program.

Roles, population foci, and responsibilities

APRN ConsensusThe landmark document Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education delineates APRN roles and gives recommendations about APRN licensure, accreditation, certification, and education. According to the consensus model, to become an APRN, you must complete an accredited master’s or doctorate program that prepares you to function in one of four roles:

  • nurse practitioner (NP)
  • clinical nurse specialist (CNS)
  • certified registered nurse anesthetist (CRNA)
  • certified nurse-midwife (CNM).
    • (See A look at each APRN role.)

Once you’ve chosen a role, you must select a population focus applicable to that role. This ensures that you have a foundation of broad-based education before seek- ing additional expertise in a narrow- er specialty. Population foci include:

  • family
  • women’s health/gender-related • pediatric
  • neonatal
  • adult-gerontology
  • psychiatric-mental health.

These foci are most relevant to the NP role, which is divided into acute care and primary care.

APRNs need to have sufficient depth and breadth of clinical experience as RNs, and their APRN education must build on their RN competencies. They must be prepared to assume responsibility for health promotion and maintenance as well as assessment, diagnosis, and management of patient problems, including use and prescription of nonpharmacologic and pharmacologic interventions. APRN competencies are defined by patient-care needs, not practice setting.

APRNs must maintain national certification and practice with a significant focus on direct patient care. This focus differentiates APRNs from RNs with other types of graduate education (such as master’s degrees in nursing education or research or clinical doctorates). Many APRNs have clinical doctorates, but at this time a doctor-of-nursing practice (DNP) degree isn’t a requirement for APRN licensure or certification.

How to choose an APRN education program

Completing an APRN program takes a great deal of time and resources, so be sure about your decision before enrolling in a program. Even if you’re certain about which APRN role and population focus you want, you may find greater clarity if you spend some time shadowing an APRN who practices in your preferred role and population. (See Online information sources.)

Academic ability is crucial. APRN programs seek students who stand a good chance of handling the rigor of a tough graduate program. Program directors look at under-graduate nursing course grades, particularly in the sciences, such as anatomy, physiology, and pharmacology. Many won’t consider applicants with grade point averages (GPA) below 3.0. But GPA isn’t the whole story. If you had a less-than-stellar GPA in your BSN program, be prepared to explain why in your admission essay.

All APRN programs require students to complete the “3 P’s”: advanced pharmacology, advanced pathophysiology, and advanced physical/health assessment. These foundational courses for advanced clinical courses require new critical-thinking skills. If you didn’t do well in the undergraduate versions of these courses, think about why you didn’t and what you could do differently to succeed in the advanced versions. (Keep in mind that many programs have a pro-visional admission option.)

Online Information sources

Visit the links below for more information on advanced practice registered nurse (APRN) education programs and the four APRN roles.

Find out about prerequisites for the program you wish to apply to. For example, CRNA programs re- quire 1 year of acute-care nursing experience and a BSN or other appropriate bachelor’s degree. What’s considered an appropriate acute-care setting or an alternate bachelor’s degree may vary across CRNA programs. Be aware that some APRN programs may be open to direct-entry BSN-to-MSN degrees or some variation, whereas others require at least 1 or 2 years of RN experience.

Whichever program you choose, know that good computer skills are a must. You’ll be expected to navi- gate course web software, search library databases, watch online lectures, and use word processing, PowerPoint®, email, and statistical software. If your computer skills are marginal, consider taking a course to improve them.

Clinical preceptors

Find out if the APRN program you’re interested in can help you find a clinical preceptor. Some programs may expect you to find one on your own. Good clinical preceptors are in short supply and great demand; getting a commitment from a preceptor can take months.

Can you afford the program?

Does the program you’re interested in offer scholarships or other financial assistance options? Could you work full time while going to school? In many cases, managing a full-time job while attending school full time isn’t realistic and could be self-defeating. Many APRN students work part time and do well, but some programs discourage students from working while enrolled.

If you’d have to work a grueling schedule to pay the tuition at an expensive school, consider whether going to that school is worth it. Be realistic; sleep deprivation from a heavy work schedule can make the critical thinking required in APRN courses difficult. A less expensive school may be a better fit for you.

Interviews and admission forms

Many APRN programs require a written admission essay. To gauge your writing skills, some may require you to write an essay on the spot. Your admission essay should demonstrate excellent writing skills and convey not just your best qualities but also your passion for nursing and your desired APRN role. So be sure to convey your passion. If you seem lukewarm about your decision, it’s probably not the right decision for you.

Expect to interview in person or through electronic communication. For an in-person interview, be punctual, dress appropriately, and articulate exactly why you want to become an APRN. Explain why you think you’re capable of doing this and describe your goals. Program directors are looking for leadership qualities, excellent interpersonal skills, the ability to speak well, and an appropriate level of self-assurance.

A challenging and gratifying choice

APRNs are passionate about their roles and enjoy the added knowledge and responsibility that comes with the territory. They enjoy using new skills to help people while still maintaining a core nursing per- spective. Generally, their job satisfaction is high and compensation is good. Administering anesthesia, managing a patient’s diabetes, making a tough medical diagnosis, or delivering a healthy baby can be terrifying at times—yet profoundly gratifying.

Janet Selway is an assistant professor in the School of Nursing at The Catholic University of America in Washington, DC.

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