Week 2:  Advanced Practice Nursing (Texas)

Week 2:  Advanced Practice Nursing (Texas)

Dr Storms & Class,

In this week’s discussion, we explored the four (4) main APN categories of advanced nursing practice for the State of Texas, Pro’s and Con’s related to each area of practice, my rationale for choosing the CNP advanced practice role over the other three APN designations, what my clinical plans following graduation, and whether my ideas of NP has changed after researching my state of future FNP practice.

Work Environments

The CNS (Clinical Nurse Specialist) works in multiple environments within the hospital system, as a mentor, change agent for support of system and evidence-based practices, diversity within the workplace and as a patient advocate when clinical and ethical decision making is needed.

The CNP (Certified Nurse Practitioner) may work within a Family Practice, Pediatrics care clinic, Internal Medicine, Geriatrics, Women’s healthcare center, or Urgent Care Settings.

The CNM (Certified Nurse Midwife) work environment of the CNM can include a patient’s home, birthing center, the hospital, ambulatory care settings, private offices, community or public health clinics.

The CRNA (Certified Registered Nurse Anesthetist) works in multiple settings to include ambulatory surgery centers, hospital operating rooms,  trauma/ stabilization units, as well as, military, pain management, dental, ophthalmology, podiatry and plastic surgery clinics.

Scope of Practice, Level of Accountability & Population

All of the practice(s) of the APN Scope of Practice is regulated by the Nurse Practice Act of Texas and limited practice under the State of Texas.  The APN does not practice independently of Physicians and should practice according to individual advanced practice skills and competencies.

The CNS is accountable for diagnosis and treatment of health or illness related disease management and health promotion or prevention.  They address risk behaviors that extends out to beyond individual patients to families and groups. Unlike the CNS, the CRNP (Certified Registered Nurse Practitioner) and CNM (Certified Nurse Midwife) under the agreement with a Physician and under a supervising Physician during practice, are responsible for initial, ongoing, comprehensive exams (ie.  Physical Exams and Health Assessments), interpretation of labs, Screenings or orders for health related screenings and/or labs & imaging studies. Responsibilities expand across the lifespan for patients for the CNP that may be well or , present with acute, multiple illness, symptoms, or chronic disease diagnoses. The primary focus of responsibilities of the CNM are women throughout their lifespan, gynecologic care, family planning, preconception care, prenatal and postpartum care, or childbirth and the care of the newborn.  The CNM’s expertise extends to the male partner of the patient to address STD’s and reproductive health. The CRNA is accountable to practice in a variety of settings to include assessment and interventions of the APN to apply critical skills that may be invasive or non-invasive in nature. The CRNA is responsible for pre/ post anesthesia assessment or recovery of patients across the lifespan, critical or acute care of the patient being stabilized or undergoing anesthesia; including nerve blocks.

Salary

According to the Bureau of Labor Statistics for Texas (2016) of each advanced nurse professional researched within the State of Texas, the CRNA was the highest paid advanced practice nurse with an annual mean wage of $158,510.  Mean hourly wages were $76.21 dollars per hour. Next on the list from highest paid to least, the CRNP averaged an Annual Mean Wage of $158,510; with mean hourly wages of $52.24 dollars per hour.  Followed by the CRNP, the CNM’s Annual Wage Means were $85,900; with Mean hourly wages of $41.30 per hour.  Last, but certainly not the least of professions, was the CNS which was not found on the list; however, through further inspection of the site and inquiry, surprisingly, was grouped with the Registered Nurses.  Clinical Nurse Specialists (CNS) were depicted to have an Annual Mean Wage of under $72,890 dollars; or $35.04 mean hourly wages.

Pros and Cons

Personally, I respect each are of advanced nursing practice and understand the work , commitment, and drive that one has to have to complete and continue within the necessary requirements for licensure and/or endorsement as a lifelong learner and professional.  I will start with at least one Pros for each role as it pertains to future goals.