Nurses faced the brunt of the COVID-19 pandemic, including dealing with the emotional toll of patients dying alone. The American Nurses Association surveyed over 22,000 nurses between January 19 and February 16, 2021, and found that 43% felt exhausted, and 28% indicated a desire to quit the nursing profession or leave their current role.

At the same time, the Association of American Medical Colleges reports an upcoming shortage of about 122,000 physicians by 2032. This trend indicates faster demand than supply to meet the growing need for experienced professionals to provide primary care for the nation’s patients. What does the future hold for the nursing profession?

Nurse leaders, such as advanced practice registered nurses (APRNs) including nurse practitioners (NPs), can help address the challenges. Nurses pursuing leadership opportunities can benefit from understanding the differences between an APRN vs. NP.

An initial comparison of an APRN vs. NP reveals that an NP is one of the several APRN specialties that nurses can pursue. Additional APRN specialty roles include certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS).

What is an APRN, and what are the responsibilities of the role? APRNs are nurses with an advanced education, such as a master’s or doctoral degree. They use their knowledge of clinical practices and leadership skills to assess, diagnose, and treat acute and chronic illnesses.

To maintain their certification, APRNs participate in continuing education to meet clinical practice requirements and stay ahead of technological and methodological developments.

APRN responsibilities include the following:

• Helping patients build wellness strategies. In addition to prescribing medications and therapies, APRNs manage treatments for patients with chronic conditions. They also proactively promote long-term health practices to help prevent illness and foster overall patient wellness. Patients often turn to APRNs for help developing healthier lifestyles and making informed health decisions.
• Delivering care in specialized situations. APRNs work in various settings and can provide different types of primary and preventive care services. The range of services is dependent upon their specialization. For example, APRNs who specialize in reproductive care work solely with women, while specialists in anesthesia delivery can work with patients undergoing surgeries and medical procedures in hospitals and clinics. APRNs may also specialize in delivering acute care to patients in emergency settings.
• Advising the public on various health issues or concerns. APRNs are vital contributors to public health, providing leadership and consulting during public health issues. For example, they guide nurses to make informed decisions during crises. APRNs also advocate for health access and education and policies that improve health care at the highest levels of their organization and government.

APRNs can choose specialties in various areas of health care. What follows are four common APRN roles.

An NP delivers initial and ongoing care; promotes healthy lifestyles and health education; provides disease prevention services; and counsels patients in clinics, hospitals, hospice facilities, long-term care centers, and other medical office settings. NPs can serve various populations, including families, children, women, and older adults. NPs can also work as primary care NPs or acute care NPs, depending on their certifications.

A CNS can diagnose, treat, and provide ongoing disease management in settings such as critical care units and hospital emergency rooms. CNSes promote best practices and guide nurses who give bedside care. They advise RNs in offering evidence-based care to optimize health outcomes. CNS specialties can be based on population (pediatrics, women, etc.), medical subspecialty, and more.

A CRNA’s primary responsibility is to administer anesthesia to patients undergoing surgery or other medical procedures. Common work settings for CRNAs include critical and intensive care units, hospital operating rooms, and outpatient centers. The U.S. has more than 55,000 CRNAs, according to the National Board of Certification and Recertification for Nurse Anesthetists.

A CNM can work in hospitals, clinics, and patients’ homes to provide pregnant women with care and counseling. CNMs support women during labor and in the postpartum period. They also help provide care for newborns. CNM health services include taking preventive measures, detecting complications, accessing medical care, and taking emergency measures as needed.

The path for an RN to become an APRN begins with an advanced education, including board certification. What is an APRN certification, though, and why does obtaining certification matter?

An APRN certification confirms that an RN has the knowledge and skills to practice a specialty as well as the ability to meet a specific population’s needs (for example, women or infants). An APRN certification offers evidence that an RN has expertise in a specific patient care area.

To take an APRN certification exam, candidates must have a minimum of a master’s degree.

However, the highest level of nurse education, the Doctor of Nursing Practice (DNP), is recommended. The position of the American Association of Colleges of Nursing (AACN) is “for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level.”

The DNP is a terminal degree that indicates expertise in evidence-based practice. A Master of Science in Nursing (MSN) to DNP program can help nurses who hold a master’s degree prepare to earn a doctorate-level degree. The MSN to DNP program delivers in-depth foundational knowledge and skills to prepare at the highest level for APRN certification.

The two certifying bodies are:

• American Nurses Credentialing Center (ANCC)
• American Academy of Nurse Practitioners (AANP)

Test fees typically range from $200 to $400. Members in the respective organizations pay lower exam fees. Candidates pay additional fees for retakes and recertification of the exams.

The exam formats differ. For example, the AANP Family Nurse Practitioner (FNP) exam has 175 questions, while the ANCC FNP exam has 150 questions. The exams are proctored and timed — lasting about 3 to 3.5 hours.

The question types vary as well. For example, the AANP and ANCC exams include multiple-choice questions. The ANCC asks test-takers to write responses to questions.

Each certifying body tests different content domains. For example, clinical-related content in the AANP exam includes questions about:

• Patient assessments
• Diagnosis
• Planning
• Evaluation

ANCC exam content includes questions about:

• Patient assessments
• Diagnosis
• Clinical management
• Professional roles

Both certifying bodies offer test-prep materials on their websites, including study guides and practice exams.

After passing the certification exam, the candidate can practice as an APRN. Importantly, every state has laws and regulations that can impact an APRN’s practice level. APRNs should learn about licensure requirements to determine what level of practice they can expect in their state.

Although each state’s nursing board has specific rules regarding licensure, APRN requirements are becoming standardized across states. Through its APRN Consensus Model, the National Council of State Boards of Nursing (NCSBN) provides states with guidance on adopting “uniformity in the regulation of APRN roles, licensure, accreditation, certification, and education.”

Even after APRNs pass their exam and obtain certification, education remains a component of their career. Additionally, APRNs have to fulfill a minimum number of clinical hours to keep their credentials active.

According to April 2021 data from PayScale, the median annual salary for APRNs is around $96,400. However, each type of APRN has a different median salary. For example, the median salary for a CNS is lower ($91,600) than that for a CRNA ($158,700). Other factors that determine the APRN salary include the following:

• Education and Experience. Level of education and experience can influence the median salary for an APRN. For example, PayScale reports that an entry-level APRN with about a year of experience can expect a median salary of around $90,600. In contrast, the median salary of a 20-year veteran APRN is around $104,300.
• Location. Where the role is situated matters. The median salary for APRNs in New Haven and Hartford, Connecticut, is between 8% and 10% higher than the national average. The lowest median salaries can be found in major cities in Florida, including Tampa, Orlando, and Miami.
• Competencies and skills. Skills can be a crucial determinant in how much an APRN earns. APRNs with essential skills can earn more. For example, APRNs with emergency room skills earn nearly 25% higher than the median salary, according to PayScale. An APRN with internal medicine and orthopedics skills earns 4% more than the median salary.

The nursing field expects APRN roles to grow fast in the years to come. According to the U.S. Bureau of Labor Statistics (BLS), APRN roles such as nurse practitioner, nurse anesthetist and nurse-midwife are projected to grow by 45% from 2019 to 2029. This rate is much faster than the projected average growth rate for other professions. The rapid growth rate can be attributed to a growing emphasis on preventive care and the increasing health care needs of an aging population.

Nurse practitioners are a special type of APRN. They use their advanced clinical decision-making skills to deliver safe, quality patient care. Their advanced education prepares them with the knowledge and skills to assess, diagnose, and treat illnesses.

What is an NP, and what are the responsibilities of the role? Below are examples of an NP’s duties:

• Providing specialized patient-centered care, including developing individualized patient care plans, coordinating health care services, prescribing medications according to state laws on NP prescriptive authority
• Evaluating patient health, including performing physical examinations; ordering laboratory tests, such as blood work; and diagnosing health and medical conditions
• Promoting patient health through preventive therapies, teaching, and counseling
• Collaborating with patients and their families, as well as other health care providers

Specific NP duties may vary based on demographics. For example, in rural and urban areas where access to health care may be challenging, many people choose NPs as their primary health care provider. In this capacity, the NP’s role closely resembles the responsibilities of a physician. According to AANP, 290,000 licensed NPs worked in the U.S. as of December 2019. AANP also reports that over 1 billion patients visited NPs in 2018.

Based on certification requirements of different states, NPs can pursue full practice, reduced practice, or restricted practice authority.

Full Practice

A total of 24 states, as well as Washington, D.C., Guam, and the Northern Mariana Islands, allow licensed APRNs to perform all duties, according to AANP. This includes diagnosing, ordering, and interpreting diagnostic tests, prescribing medicine, and managing treatments.

Reduced Practice

Licensure laws in 16 states and Puerto Rico, the U.S. Virgin Islands, and American Samoa enable educated and licensed APRNs to perform major nursing practice activities in providing care for patients, with some limitations. Under a collaborative, regulated agreement, reduced practice APRNs deliver care to patients working with another health care provider.

Restricted Practice

Restricted practice limits an NP’s ability to conduct certain activities that nurses in states with full and reduced practice can perform. Their permitted activities fall within a regulated agreement with another health care provider. This is the NP practice environment for 11 states.

NPs can choose specialties in various areas of health care. Six common types of NP careers follow.

Pediatric nurse practitioners (PNPs) enjoy working with children. They specialize in caring for newborns, infants, toddlers, and adolescents. PNPs also provide health care services to young adults. They balance the physical and emotional needs of their young patients with those of their parents and caregivers. PNPs work in pediatric centers; in children’s hospitals; or in pediatric units in hospitals, clinics, schools, and urgent care clinics.

FNPs work with patients across generations. They provide care throughout a patient’s lifetime, including providing preventive care, monitoring patient health, and collaborating with family practice physicians. FNPs are increasingly serving as primary care practitioners in underserved communities. Work settings for FNPs include clinics, community centers, doctors’ offices, hospitals, outpatient centers, and digital platforms, such as telehealth.

COVID-19 has impacted the mental health of millions of Americans. However, even before the pandemic, mental health was a growing concern. Mental Health America reports that 19% of adults experienced a mental illness from 2017 to 2018.

Psychiatric mental health nurse practitioners (PMHNPs) play a key role in addressing the mental health epidemic by assessing, diagnosing, and treating a patient’s mental health needs. They identify and treat psychiatric conditions, conduct physical and psychosocial assessments, provide emergency psychiatric care, and assess the effectiveness of treatments. PMHNPs typically work in primary care settings and specialty providers in inpatient centers.

Women’s health nurse practitioners (WHNPs) work with women’s health issues. Their activities can include screening for breast cancer, evaluating and treating issues with menstruation and fertility, diagnosing and treating chronic diseases, and encouraging patients to practice healthy habits. Throughout a patient’s life, women’s health services can also include wellness exams, adolescent health care, Pap smears, wellness counseling, contraceptive care, evaluation of common infections, and health management during pregnancy.

APRNs with adult-gerontology nurse practitioner (AGNP) credentials help at-risk adults of all ages to manage their chronic health conditions, including prescribing medicines and treatments for hypertension, diabetes, and respiratory illnesses. AGNPs perform health assessments, diagnosis, and planning in various settings, from long-term and hospital-based clinics to private practices. Activities may include recording and obtaining medical histories, performing physical examinations, and interpreting diagnostic tests.

Nurse educators have competencies that include analytical, communication, leadership, and training skills to prepare new nurses for success in various health care settings. They teach clinical best practices and provide guidance on procedures. A key aim of a nurse educator is to motivate RNs to excel and build collaborative and effective nurse teams. Nurse educators are typically active listeners and have a natural ability to build relationships.

Passing a certification exam demonstrates that an individual possesses the clinical knowledge to deliver specialty care to specific patient populations. Here are some recommended steps for preparing for the different types of NP certifications:

1. Meet the qualification requirements. The individual must have at least a master’s degree. Another condition involves having a current and valid RN license.
2. Register for the exam. Once eligibility is confirmed, the individual should become familiar with the exam fees, and then register for the exam.
3. Prepare for the exam. One way to prepare is to understand the content domain covered in the exam and become familiar with the format.
4. Schedule the exam. Once ready, the individual can schedule a time to take the exam. Before heading to the test center, the individual should be aware that the exam can last from two to four hours, so scheduling other pressing activities on the exam day would not be wise.

Various certifications focus on specific areas. Among the most popular certifications is the Family Nurse Practitioner certification.

Passing the FNP certification exam demonstrates clinical knowledge to manage care across patients’ lifespans. Examples of knowledge areas tested include health promotion, disease prevention, physiology, therapeutic communication, signs and symptoms, physical examinations, diagnostic and therapeutic tests, and clinical decision-making. Other subjects covered center on clinical management and legal and ethical considerations for health.

As previously discussed, two organizations — AANP and ANCC — offer certification exams. Below are the fees associated with each exam:

• AANP: $240 for members and $315 for nonmembers
• ANCC: $295 for members and $350 for nonmembers

To qualify to sit for certification exams, students need to demonstrate knowledge in the specialty area. Completing an online Doctor of Nursing Practice degree can help prepare individuals to confidently sit for the certification exams offered by the following exam boards and credentialing organizations:

The American Nurses Credentialing Center
American Association of Nurse Practitioners
Pediatric Nursing Certification Board
National League of Nursing (NLN)
National Certification Corporation
Certified Nurse Educator (CNE)

According to the BLS, the median annual NP salary is $117,670 as of May 2020. However, NP salaries vary by role. For example, a family nurse practitioner can earn a median salary of $96,478. The median salary for a pediatric nurse practitioner is $91,271.

Salaries can also vary based on education, experience, and work environment.

• Education and experience. The level of education and experience can also influence the median salary for NPs. For example, PayScale reports that an entry-level NP with about a year of experience can expect a median salary about 7% less than the national median salary. In contrast, the median salary of a 20-year veteran NP can be 12% above the national median salary.
• Work setting. The workplace location matters, too. The BLS reports that the median salary for NPs working in state, local, and private hospitals is $124,660. Those working in educational services earn a median salary of $111,400.

NP roles are expected to grow by 52% from 2019 to 2029, according to the BLS. The increasing need for preventive care and caring for an aging population are the primary drivers for this growth rate. The projected growth rate for NPs is much faster than the projected average growth rate for other professions.

According to the World Health Organization (WHO), about half of the 43.5 million health workers worldwide are nurses and midwives. The world has witnessed the heroism of these front-line health workers amid the COVID-19 pandemic.

Nurses have been held in high esteem long before the pandemic. According to Gallup, the nursing profession has been ranked highest in honesty and ethics for 18 consecutive years. As the most trusted profession in health care, nurses and nurse leaders are well positioned to drive change in health care.

An advanced degree can help nurses elevate their careers and take on leadership roles in various health care settings. For example, the MSN to DNP online program at Regis College can help prepare you to pursue nursing leadership positions, including APRN and NP roles.

The program offers a unique, focused curriculum in the following six specialty areas of primary care:

• Pediatrics (PNP)
• Family (FNP)
• Psychiatric Mental Health (PMHNP)
• Women’s Health (WHNP)
• Adult-Gerontology (AGNP)
• Nurse Education

Even more, the program’s curriculum, including courses such as Cultural Perspectives in Health Care; Concepts in Nurse Leadership; and Health Policy, Politics, and Perspectives, can equip you with essential skills and knowledge to advance your understanding of nursing leadership.

Discover how the MSN to DNP online program at Regis College can help you pursue your professional goals and advance your nursing career.