The Advance-Practice Registered Nurse (APRN)

The Advance-Practice Registered Nurse (APRN)

The Advance-Practice Registered Nurse (APRN) role can by filled as a Certified Nurse Practitioner (CNP), Certified Nurse Midwife (CNM), Clinical Nurse Specialist (CNS), or Certified Registered Nurse Anesthetist (CRNA). One article helps to describe the roles that can be filled and states, “Advanced Practice Registered Nurse specialty education and practice build upon and are in addition to the education and practice of the APRN role and population focus, e.g, a Certified Registered Nurse Anesthetist (CRNA) could specialize in pain management; a Certified Nurse-Midwife (CNM) could specialize in the care of postmenopausal women, a Clinical Nurse Specialist (CNS) could specialize in palliative care, or, the Nurse Practitioner (NP) could specialize in Hematology-Oncology” (Hoebelheinrich, 2018). In the state of Connecticut the APRN roles are as follows:

Certified Nurse Practitioner (CNP)

Scope of Practice: “This APRN performs acts of diagnosis, and treatment of alterations in health status and must collaborate with a Connecticut-licensed physician. In all settings, the APRN may, in collaboration with a licensed physician, prescribe, dispense, and administer medical therapeutics and corrective measures and may request, sign for, receive, and dispense drug samples” (Kasprak, 2009).

Work Environment/Patient Population: “Nurse practitioners (NPs) are health care providers who practice in a variety of settings such as acute care, outpatient care and specialty clinics. Sometimes they serve in leadership, management, research or teaching roles within healthcare organizations or universities. NPs have undergone advanced academic and clinical training to provide medical care for a wide variety of patients. Their daily practice closely resembles that of a doctor; many NPs serve as primary care providers to adults, children and families. Others specialize in a particular area of medicine, such as psychiatry or dermatology” (Painter, 2018).

Level of Accountability: “Any NP who elects to practice without a collaborative agreement shall maintain documentation of having engaged in the performance of advanced practice level nursing activities in collaboration with a Connecticut licensed physician for a period of not less than three (3) years and not less than two thousand (2,000) hours” (DPH, 2019). Therefore, in CT, an NP must work under a Physician for no less than three years. They have a collaborative agreement that specifically outlines what the NP will be held accountable for. “The collaboration shall address a reasonable and appropriate level of consultation and referral, coverage for the patient in the absence of such APRN, a method to review patient outcomes and a method of disclosure of the relationship to the patient” (DPH, 2019).

Salary: “The average Nurse Practitioner salary in Connecticut is $116,693 as of October 30, 2019, but the range typically falls between $108,281 and $126,765. Salary ranges can vary widely depending on the city and many other important factors, including education, certifications, additional skills, the number of years you have spent in your profession” (“Nurse Practitioner”, 2019).

Pros: Autonomy after three years, Ability to open up own practice, Recognized as Primary Care Provider (PCP)

Cons: Autonomy limited in hospital settings

Certified Registered Nurse Anesthetist (CRNA)

Scope of Practice: “A licensed CRNA in CT maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administering medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the setting where the surgery is taking place” (Kasprak, 2009).

Work Environment/Patient Population: “CRNAS work in just about every medical or healthcare facility where anesthesia is administered, including surgical units, hospitals, obstetrical delivery rooms, physicians’ clinics, dental offices, pain management clinics, veterans’ hospitals, cosmetic surgery centers, military hospitals, etc.” (“CRNA”, 2019).

Level of Accountability: “Nurse anesthetists provide anesthetics to patients in collaboration with surgeons, anesthesiologists, dentists, podiatrists and other qualified health care professionals. As advanced practice registered nurses, they are given a high degree of autonomy” (“Nurse Anesthetist”, 2019). In CT however, a CRNA is not allowed to practice independently without physician supervision. Must complete 2 years in the ICU before applying to CRNA Pro