Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

Summary

What Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners Do About this section

APRNs give patients medicines and treatments.

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and may provide primary and specialty healthcare. The scope of practice varies from state to state.

Duties

Advanced practice registered nurses typically do the following:

• Take and record patients' medical histories and symptoms
• Perform physical exams and observe patients
• Create patient care plans or contribute to existing plans
• Perform and order diagnostic tests
• Operate and monitor medical equipment
• Diagnose various health problems
• Analyze test results or changes in a patient’s condition, and alter treatment plans, as needed
• Give patients medicines and treatments
• Evaluate a patient’s response to medicines and treatments
• Consult with doctors and other healthcare professionals, as needed
• Counsel and teach patients and their families how to stay healthy or manage their illnesses or injuries
• Conduct research

APRNs work independently or in collaboration with physicians. In most states, they can prescribe medications, order medical tests, and diagnose health problems. APRNs may provide primary and preventive care and may specialize in care for certain groups of people, such as children, pregnant women, or patients with mental health disorders.

Some APRN duties are the same as those for registered nurses, including gathering information about a patient’s condition and taking action to treat or manage the patient’s health. However, APRNs are trained to perform many additional functions, including ordering and evaluating test results, referring patients to specialists, and diagnosing and treating ailments. APRNs focus on patient-centered care, which means understanding a patient’s concerns and lifestyle before choosing a course of action.

APRNs also may conduct research or teach staff about new policies or procedures. Others may provide consultation services based on a specific field of knowledge, such as oncology, which is the study of cancer.

The following are types of APRNs:

Nurse anesthetists (CRNAs) provide anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and some emergency services. Before a procedure begins, nurse anesthetists discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have, so that anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or administer a regional or local anesthesia to numb an area of the body. They remain with the patient throughout a procedure to monitor vital signs and adjust the anesthesia as necessary.

Nurse midwives (CNMs) provide care to women, including gynecological exams, family planning services, and prenatal care. They deliver babies; manage emergency situations during labor, such as hemorrhaging; repair lacerations; and may provide surgical assistance to physicians during cesarean births. Nurse midwives may act as primary care providers for women and newborns. They also provide wellness care, educating their patients on how to lead healthy lives by discussing topics such as nutrition and disease prevention. Nurse midwives also provide care to their patients’ partners for sexual or reproductive health issues.

Nurse practitioners (NPs) serve as primary and specialty care providers, delivering advanced nursing services to patients and their families. They assess patients, determine the best way to improve or manage a patient’s health, and discuss ways to integrate health promotion strategies into a patient’s life. Nurse practitioners typically care for a certain population of people. For instance, NPs may work in adult and geriatric health, pediatric health, or psychiatric and mental health.

Although the scope of their duties varies some by state, many nurse practitioners work independently, prescribe medications, and order laboratory tests. All nurse practitioners consult with physicians and other health professionals when needed.

See the profile on registered nurses for more information on clinical nurse specialists (CNSs), also considered to be a type of APRN.

Work Environment About this section

APRNs work in a variety of healthcare settings, including hospitals.

Some advanced practice registered nurses (APRNs) may treat patients in their patients’ homes. Some nurse midwives work in birthing centers, which are a type of outpatient care center.

APRNs may travel long distances to help care for patients in places where there are not enough healthcare workers.

Injuries and Illnesses

APRN work can be both physically and emotionally demanding. Some APRNs spend much of their day on their feet. They are vulnerable to back injuries because they must lift and move patients. APRN work can also be stressful because they make critical decisions that affect a patient’s health.

Because of the environments in which they work, APRNs may come in close contact with infectious diseases. Therefore, they must follow strict, standardized guidelines to guard against diseases and other dangers, such as accidental needle sticks or patient outbursts.

Work Schedules

Most APRNs work full time. APRNs working in physicians’ offices typically work during normal business hours. Those working in hospitals and various other healthcare facilities may work in shifts to provide round-the-clock patient care. They may work nights, weekends, and holidays. Some APRNs, especially those who work in critical care or those who deliver babies, also may be required to be on call.

How to Become a Nurse Anesthetist, Nurse Midwife, or Nurse Practitioner About this section

APRNs must earn a master’s degree which typically includes clinical experience.

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), must earn at least a master’s degree in one of the specialty roles. APRNs must also be licensed registered nurses in their state and pass a national certification exam.

Education

Nurse anesthetists, nurse midwives, and nurse practitioners must earn a master’s degree from an accredited program. These programs include both classroom education and clinical experience. Courses in anatomy, physiology, and pharmacology are common as well as coursework specific to the chosen APRN role.

An APRN must have a registered nursing (RN) license before pursuing education in one of the advanced practice roles, and a strong background in science is helpful.

Most APRN programs prefer candidates who have a bachelor’s degree in nursing. However, some schools offer bridge programs for registered nurses with an associate’s degree or diploma in nursing. Graduate-level programs are also available for individuals who did not obtain a bachelor’s degree in nursing but in a related health science field. These programs prepare the student for the RN licensure exam in addition to the APRN curriculum.

Although a master’s degree is the most common form of entry-level education, APRNs may choose to earn a Doctor of Nursing Practice (DNP) or a Ph.D. The specific educational requirements and qualifications for each of the roles are available on professional organizations’ websites.

Prospective nurse anesthetists must have 1 year of clinical experience as a prerequisite for admission to an accredited nurse anesthetist program. Candidates typically have experience working as a registered nurse in an acute care or critical care setting.

Licenses, Certifications, and Registrations

Most states recognize all of the APRN roles. In states that recognize some or all of the roles, APRNs must have a registered nursing license, complete an accredited graduate-level program, and pass a national certification exam. Each state’s board of nursing can provide details.

The Consensus Model for APRN Regulation, a document developed by a wide variety of professional nursing organizations, including the National Council of State Boards of Nursing, aims to standardize APRN requirements. The model recommends all APRNs to complete a graduate degree from an accredited program, be a licensed registered nurse, pass a national certification exam, and earn a second license specific to one of the APRN roles and to a certain group of patients.

Certification is required in the vast majority of states to use an APRN title. Certification is used to show proficiency in an APRN role and is often a requirement for state licensure.

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the National Certification Examination (NCE). Certified registered nurse anesthetists (CRNAs) must recertify via the Continued Professional Certification (CPC) Program every 4 years.

The American Midwifery Certification Board offers the Certified Nurse-Midwife (CNM). Individuals with this designation must recertify via the Certificate Maintenance Program every 5 years.

There are a number of certification exams for nurse practitioners because of the large number of populations NPs may work with and the number of specialty areas in which they may practice. Certifications are available from a number of professional organizations, including the American Nurses Credentialing Center and the Pediatric Nursing Certification Board.

In addition, APRN positions may require certification in cardiopulmonary resuscitation (CPR), basic life support (BLS) certification, and/or advanced cardiac life support (ACLS). 

Important Qualities

Communication skills. Advanced practice registered nurses must be able to communicate with patients and other healthcare professionals to ensure that the appropriate course of action is understood.

Critical-thinking skills. APRNs must be able to assess changes in a patient’s health, quickly determine the most appropriate course of action, and decide if a consultation with another healthcare professional is needed.

Compassion. APRNs should be caring and sympathetic when treating patients who are in pain or who are experiencing emotional distress.

Detail oriented. APRNs must be responsible and detail oriented because they provide various treatments and medications that affect the health of their patients. During an evaluation, they must pick up on even the smallest changes in a patient’s condition.

Interpersonal skills. APRNs must work with patients and families as well as with other healthcare providers and staff within the organizations where they provide care. They should work as part of a team to determine and execute the best possible healthcare options for the patients they treat.

Leadership skills. APRNs often work in positions of seniority. They must effectively lead and sometimes manage other nurses on staff when providing patient care.

Resourcefulness. APRNs must know where to find the answers that they need in a timely fashion.

Advancement

Some APRNs may take on managerial or administrative roles, while others go into academia. APRNs who earn a doctoral degree may conduct independent research or work in an interprofessional research team.

Pay About this section

Most advanced practice registered nurses (APRNs) work full time. APRNs working in physicians’ offices typically work during normal business hours. Those working in hospitals and various other healthcare facilities may work in shifts to provide round-the-clock patient care. They may work nights, weekends, and holidays. Some APRNs, especially those who work in critical care or those who deliver babies, also may be required to be on call.

Job Outlook About this section

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About $tools.number.format('#,###',$op) openings for nurse anesthetists, nurse midwives, and nurse practitioners are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.

Employment

Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 26 percent from 2018 to 2028, much faster than the average for all occupations. Employment growth will vary by occupation. However, because nurse midwives is a small occupation, the fast growth will result in only about 1,000 new jobs over the 10-year period.

Growth will occur because of an increase in the demand for healthcare services. Several factors will contribute to this demand, including an increased emphasis on preventive care and demand for healthcare services from the aging population.

Advanced practice registered nurses (APRNs) can perform many of the same services as physicians. APRNs will be increasingly utilized in team-based models of care, particularly in hospitals, offices of physicians, clinics, and other ambulatory care settings, where they will be needed to provide preventive and primary care.

APRNs will also be needed to care for the large, aging baby-boom population. As baby boomers age, they will experience ailments and complex conditions that require medical care. APRNs will be needed to keep these patients healthy and to treat the growing number of patients with chronic and acute conditions.

As states change their laws governing APRN practice authority, APRNs are being allowed to perform more services. They are also becoming more widely recognized by the public as a source for primary healthcare.

Job Prospects

Overall, job opportunities for advanced practice registered nurses are likely to be excellent. APRNs will be in high demand, particularly in medically underserved areas such as inner cities and rural areas.

State & Area Data About this section

Occupational Employment and Wage Statistics (OEWS)

The Occupational Employment and Wage Statistics (OEWS) program produces employment and wage estimates annually for over 800 occupations. These estimates are available for the nation as a whole, for individual states, and for metropolitan and nonmetropolitan areas.

Projections Central

Occupational employment projections are developed for all states by Labor Market Information (LMI) or individual state Employment Projections offices. All state projections data are available at www.projectionscentral.com. Information on this site allows projected employment growth for an occupation to be compared among states or to be compared within one state. In addition, states may produce projections for areas; there are links to each state’s websites where these data may be retrieved.

CareerOneStop

CareerOneStop includes hundreds of occupational profiles with data available by state and metro area. There are links in the left-hand side menu to compare occupational employment by state and occupational wages by local area or metro area. There is also a salary info tool to search for wages by zip code.

Contacts for More Information About this section

For more information about nurse anesthetists, including a list of accredited programs, visit

American Association of Nurse Anesthetists

For more information about nurse midwives, including a list of accredited programs, visit

American College of Nurse-Midwives

For more information about nurse practitioners, including a list of accredited programs, visit

American Association of Nurse Practitioners

For more information about registered nurses, including credentialing, visit

American Nurses Association

For more information about nursing education and being a registered nurse, visit

National League for Nursing

For more information about undergraduate and graduate nursing education, nursing career options, and financial aid, visit

American Association of Colleges of Nursing

For more information about the Consensus Model and for a list of the states’ Boards of Nursing, visit

National Council of State Boards of Nursing

For more information about certification, visit

National Board of Certification and Recertification for Nurse Anesthetists

American Midwifery Certification Board

American Nurses Credentialing Center

Pediatric Nursing Certification Board

For career videos on nurse anesthetists and nurse practitioners, visit

Nurse Anesthetists

Nurse Practitioners