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Posted: September 13th, 2022

Four APN Roles

Four APN Roles: Describe the role, educational preparation, and work environment for the four APN roles (CNP, CNS, CRNA & CNM). Provide support from at least one scholarly source.
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The Advanced Practice Nurse (APN) role encompasses four different specialties: Clinical Nurse Specialist (CNS), Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). Each of these roles has a specific educational preparation and work environment.

The Clinical Nurse Specialist (CNS) is an expert in a specific patient population or clinical area, such as pediatrics or oncology. They typically have a master’s or doctorate degree in nursing and a certification in their specialty area. They work in a variety of settings, such as hospitals, clinics, and community health agencies, and they may also serve as educators or consultants. The role of the CNS includes direct patient care, education, consultation, research, and leadership (American Nurses Association, 2015).

The Certified Nurse Practitioner (CNP) is a licensed APRN who has a master’s or doctorate degree in nursing and a certification in their area of practice. CNPs can provide primary and specialty care in a variety of settings, such as clinics, hospitals, and private practices. They have the ability to diagnose, treat and manage patients independently, and in collaboration with physicians. They are trained to take patient history, perform physical examination, order and interpret diagnostic studies, and develop a plan of care (National Council of State Boards of Nursing, 2020)

The Certified Registered Nurse Anesthetist (CRNA) is an APRN who has a master’s or doctorate degree in nursing and a certification in nurse anesthesia. CRNAs administer anesthesia in a variety of settings, such as hospitals, clinics, and ambulatory surgery centers, and they may also provide pain management services. They work closely with surgeons, anesthesiologists, and other healthcare professionals to ensure patient safety and comfort during surgical and other procedures (American Association of Nurse Anesthetists, 2021).

The Certified Nurse Midwife (CNM) is an APRN who has a master’s or doctorate degree in nursing and a certification in nurse midwifery. CNMs provide primary care for women, including prenatal care, labor and delivery care, and postpartum care. They work in a variety of settings, such as hospitals, birthing centers, and private practices, and they may also provide primary care for women throughout their lifespan (American College of Nurse Midwives, 2020).

The four APN roles have different responsibilities and characteristics, but they all share the goal of providing high-quality care to patients. They require specific educational preparation and certifications, and they work in a variety of settings, such as hospitals, clinics, and private practices.

References
American Association of Nurse Anesthetists. (2021). What is a CRNA? Retrieved from https://www.aana.com/patients/about-anaesthesia-care/what-is-a-crna
American College of Nurse Midwives. (2020). What is a CNM?. Retrieved from https://www.midwife.org/what-is-a-cnm
American Nurses Association. (2015). Clinical nurse specialist practice and education. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/cnspractice/
National Council of State Boards of Nursing. (2020). APRN Consensus Model. Retrieved from https://www.ncsbn.org/aprn.htm
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Advanced Practice nurses are registered nurses who have earned a graduate-level degree, Masters of Science in Nursing (MSN), or a Doctorate of Nursing Practice (DNP).
There are four areas of specialty from which an APN can choose to major in; CNP, CNS, CRNA, and CNM.
CNP
Certified Nursing practitioners (CNPs) are directly involved with the patients serving as primary care providers and helping them in day-to-day activities. Duties of a certified nursing practitioner include performing physical examinations, ordering and interpreting diagnostic tests, providing guidance and counseling services, and writing prescriptions.
To become a CNP, one must first become a registered nurse by acquiring a bachelor’s degree and obtaining licensure from the state of practice. After practicing as an RN for some time, one should pursue a master’s or a doctorate program and achieve certification by passing a state-administered nursing exam to become a CNP. Areas of specialization for CNPs include pediatrics, gerontology, family practice, women’s health, and psychiatric. CNPs can work in various health care settings, including hospitals, schools, community clinics, nursing homes, doctor’s offices, or private practice.
CNS
A clinical nurse specialist (CNS) is an advanced practice nurse expert who works in evidence-based practice nursing within one or multiple specializations areas. Unlike CNPs, CNS are indirectly involved in caring for the patients. They take care of other nurses to ensure they extend quality and effective care based on available evidence. It is their responsibility to ensure that the nurses have the necessary knowledge, skills, processes, policies, supplies, and equipment required for safe and effective care. CNSs are also involved in the hiring, firing, and disciplinary committees wherever there is a clinical issue in care.
The educational path of becoming a CNS is similar to that of a CNP. One must first become a registered nurse by completing a four-year degree nursing program, acquiring licensure and certification in the state of practice. One then proceeds to complete a master’s or doctorate program in the interest area of specialization and acquiring certification to become a CNS. A CNS can practice in hospitals, clinics, and healthcare facilities in areas like gerontology, oncology, cardiology, and mental health.
CRNA
Certified Registered Nurse Anesthetists (CRNAs) are APRNS certified to administer anesthesia to patients during surgical, diagnostic, obstetric, pain management, and therapeutic procedures. Basically, a CRNA is primarily involved in overseeing anesthesia administration during different medical procedures and monitoring the patients during their recovery.
A person looking to became a CRNA must first complete a four-year degree nursing program and acquire licensure. After several years of practice, they can sit for the exams to become RNs and then proceed to pursue a master’s or doctorate degree in the field of interest. The final step is passing the CRNA exams to become a certified CRNA. CRNAs can work in various medical settings, including hospitals, surgical centers, military facilities, outpatient care centers, public health centers, universities, and colleges.
CNM
A Certified Nurse Midwife (CNM) is an APRN involved in giving a full range of primary care health services to women from adolescence to beyond menopause. The roles of a CNM include providing primary care for women in all stages of pregnancy, including before, during, and after birth. A CNM is also involved in administering treatment for male partners with reproductive health issues like sexually transmitted diseases.
The educational journey of becoming a CNM begins with becoming a registered nurse by completing a diploma associate’s or bachelor’s degree in nursing and then passing the NCLEX-RN to become a certified registered nurse. The next step is to complete a master’s program in any nurse-midwifery program and then go ahead to acquire certification by sitting for the American Midwifery Certification Board AMCB Exams to become a CNM. Most CNMs specialize in areas like prenatal care, antepartum care, postpartum care, midwifery management, and health assessment. A CNM can work in public and private hospitals, military hospitals, birthing centers, public health clinics, and home care.

Finn, Timothy P. Vigilance of Certified Registered Nurse Anesthetists. Diss. Loyola University Chicago, 2020.
Fraze, Taressa K., et al. “Role of nurse practitioners in caring for patients with complex health needs.” Medical care, Advanced Nurse Practitioners 58.10 (2020): 853.
Mattison, Cristina A., et al. “A critical interpretive synthesis of the roles of midwives in health systems.” Health Research Policy and Systems 18.1 (2020): 1-16.
Moore, Amy, Kamie Parks, and Inola Mello. “Transitioning from RN to APRN.” Nursing made Incredibly Easy 18.2 (2020): 51-54.

Footnotes:
Advanced Nurse Practitioners (ANPs) are a well-known subset of nurses who have acquired expert knowledge and advanced clinical skills. Since the International Council of Nurses and other formal regulatory bodies and organizations formally accepted and recognized advanced nurse practitioners, the role has been adopted by most departments and clinical specialties, particularly in high-income countries (81 countries classified as high-income [World Bank, 2019]) such as the United States, United Kingdom, Australia, New Zealand, and the Netherlands (Scanlon et al., 2020). Advanced nurse practitioners are thought to improve patient care and experiences. Simultaneously reducing medical staff workload, optimizing the cost-effectiveness and efficiency of health care services, and improving overall patient satisfaction. Emerging evidence suggests that advanced nurse practitioners can provide comparable levels of care and achieve comparable outcomes to physicians (both junior and senior clinicians / medical doctors) and, in some cases, achieve superior outcomes in terms of patient satisfaction, waiting times, chronic disease control, and cost-effectiveness. Although the International Council of Nurses has supported this position, Carney (2014) emphasizes that defining the distinctive nature of advanced nursing practice, recognizing the key competencies and capabilities of advanced nurse practitioners, and exploring facilitative strategies in maintaining, implementing, and supporting the role of advanced nurse practitioners worldwide are still incrementally developing, and ongoing studies are required to map and monitor the role of advanced nurse practitioners worldwide.

Implications for current methods of practice
As a result of the fact that the majority of studies have found support for advanced nurse practitioners as being providers of non-inferior care and outcomes in comparison to care led by physicians or doctors and to usual care, these studies pose a number of implications for practice. These include the following: the incorporation of advanced nurse practitioners into various clinical settings is both feasible and required to help alleviate the burden placed upon physicians and reduce waiting times for patients; the study findings also extend to implications related to the cost of healthcare and service provision, as it appears that advanced nurse practitioners may help reduce costs and improve efficiency in the health care system; a wider benefit for patient flow, with the potential to reduce wait times and improve the overall flow of patients through the system; and a wider benefit for patient flow, with the potential to

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