APRN Specialties and Programs

Advanced Practice Registered Nurse (APRN) Specialties and Programs: How to Choose the Right One for You

If you’re a nurse who is considering going back to school to become an advanced practice registered nurse (APRN), reviewing programs and researching which specialty fits your goals, aspirations and budget can be overwhelming.

There are several APRN specialties and programs, including nurse practitioner (NP) specializations in a variety of areas, clinical nurse specialist (CNS) with specializations in different disciplines, certified nurse-midwife (CNM) and certified registered nurse anesthetist (CRNA).

If you’re not sure which specialty is right for you, visit the websites of several schools and their programs. Read the descriptions of the type of work and patient populations the specialty serves to see which fits you best.

From a financial standpoint, you’ll want to compare the tuition costs, availability of scholarships and loans, and the location of classes (if you have to attend on-site). If you have a family, learning the location of clinicals can help in planning the logistics of child care on days you need to see patients.

You also can visit the websites of the various professional organizations of each specialty. These sites are packed with detailed information describing the type of care delivered in the role, essential duties typically performed, expected salaries and more.

Nurse practitioners

Nurse practitioners are advanced practice registered nurses who are educated, trained and licensed to conduct physical examinations, diagnose conditions, order lab and diagnostic tests, provide treatment and education and prescribe medications for patients as a healthcare provider. All NPs must complete a master’s or doctoral degree program.

Depending on the program you choose, the options for work settings are acute care, long-term care and primary care.

As an NP student, your goal is to successfully complete a program that is approved in the state where you plan on practicing. If your program is not approved by your state’s nursing board, you will not be able to practice in that state. Next, you’ll need to sit for your state nursing board’s examination to earn your NP license.

Some states have given NPs full practice authority, while others require them to work under the supervision of a physician. NPs have prescriptive authority in all 50 states and the District of Columbia (independently or collaboratively with a physician), including the ability to prescribe controlled substances.

Sitting for a national certification exam in the specialty you choose also is a goal but not always required. If you successfully pass your board exam, you’ll be board certified, and the letters BC can then be used after your NP degree.

NP programs are offered in various pathways:

• RN to MSN
• RN to DNP
• BSN to MSN
• BSN to DNP
• Post-master’s certificate
• MSN to DNP

Three NP program formats

When you research options, you’ll notice that in addition to the on-site clinical training NP programs require, the didactic portions of various programs are offered in different educational formats.

These include:

• On-site: Some programs are purely in a classroom. You’ll need to attend a brick and mortar school for all of your lectures and classes, on top of your external clinical requirements.
• Online: These NP programs are purely online with only an occasional, routinely scheduled on-campus meeting required for specific training and hands-on skills testing, in addition to clinical rotations.
• Hybrid: These programs are designed to offer both online and on-site classes throughout the program, in addition to your clinicals.

NP specialty options

Not every school offers every type of program. When you research NP programs, you’ll find the following specialties offered at different schools:

• Family nurse practitioner (FNP)
• Adult Gerontology Nurse Practitioner (AGNP), which includes options for acute care (AGACNP) and primary care (AGPCNP)
• Pediatric nurse practitioner (PNP)
• Neonatal nurse practitioner (NNP)
• Women’s health care nurse practitioner (WHCNP) and women’s health nurse practitioner (WHCP)
• Psychiatric-mental health care nurse practitioner (PMHNP)

Care overview for different specialties

Additional APRN roles include the following:

Clinical nurse specialists

Clinical nurse specialists also are APRNs. Just like NPs, CNSs practice in different disciplines and a variety of settings. They also can diagnose, treat and manage patients’ care.

CNSs also are involved with educating hospital staff on best practices in providing evidence-based nursing care to patients. Some have prescriptive authority, depending on the state in which they practice.

They are hospital-based, caring for a variety of patient populations across the lifespan and in different specialties, such as pediatrics, adult, gerontology, psychiatry and oncology, to name a few.

Most states require CNSs to become board certified, based on the patient population they serve, in order to practice. There are three population groups available for certifications — adults and gerontology, neonatal and pediatric patients.

Three organizations that offer board exams and CNS certifications are the American Association of Critical-Care Nurses (AACN), which offers three CNS certifications; the American Nurses Credentialing Center (ANCC), which offers one; and the Oncology Nursing Certification Board (ONC), which offers an oncology certification.

Certified nurse-midwife (CNM)

Becoming a certified nurse-midwife (CNM) is another APRN career option. CNMs care for healthy, low-risk mothers before, during and after an expected normal childbirth. They provide care to expectant moms during the prenatal, intrapartum and postpartum periods.

CNM programs are master’s level and generally require a BSN for entry, in addition to the many other requirements of APRN programs.

A state license as an RN and CNM is required to practice. CNMs also need to be board certified. The American Midwifery Certification Board (AMCB) has a helpful online chart discussing the requirements for certification.

Certified registered nurse anesthetist (CRNA)

Certified registered nurses anesthetists administer anesthesia to patients before, during and after a wide variety of surgical and medical procedures.

They work in hospitals, ambulatory surgery centers and various practice settings. CRNAs are often the only anesthesia providers in many rural communities.

CRNAs can diagnose and treat, as well as prescribe medications for patients.

When searching CRNA schools, you’ll find some consist of master’s programs, while others are doctoral programs. Typically, most schools require a bachelor’s degree to apply, in addition to other requirements.

In addition to holding a state license, CRNAs are required to earn board certification before they can practice. For information on becoming board certified, visit the National Board of Certification and Recertification of Nurse Anesthetists.

To learn about becoming a CRNA, visit the American Association of Nurse Anesthetists (AANA) online.

Accelerated and entry-level programs

Some schools offer accelerated programs whereby if you have an RN license, you can earn a BSN and MSN in a full-time program in 15 months. Or, if you have a BSN, other programs offer a full-time MSN in 12 months. These are not offered in all specialties, however.

Entry-level programs are another option if you have a non-nursing bachelor’s degree and want to become an RN and earn an MSN in an APRN specialty. The American Association of Colleges of Nursing provides information on accelerated and entry-level nursing programs here.

Confirm your school is accredited

When you’re considering schools for any APRN program, make sure the school is accredited. Accreditation for nursing schools in the U.S. is performed by two organizations that award either the CCNE or ACNE. They are:

• The American Association of Colleges of Nursing (AACN), which provides an accreditation by their board of commissioners known as the Commission on Collegiate Nursing Education (CCNE)
• The Accreditation Commission for Nursing Education (ACNE)

Both of these organizations offer public, online access to their database for current and prospective students to verify if a school is accredited, when it was accredited and how long the accreditation will last.

Considerations and requirements

Once you decide on which APRN role and type of educational format you want, now you need to apply. Consider applying to more than one program, just in case your first choice does not offer you a slot.

You’ll want to make sure you go to each school’s website to find out specific requirements you must meet before application.

In general, most schools will require a grade-point average (GPA) of 3.0 on previous course work, one or more letters of reference, a resume and experience working as an RN for a specific amount of time, unless you’re choosing an entry-level program.

Some APRN schools and programs require you take the Graduate Writing Exam (GRE).

In addition, most schools usually require the completion of specific courses, such as anatomy and physiology and statistics before your application, as well as an RN license (if you’re applying to a traditional program) and specific degrees.

Some programs, such as CRNA and acute care NP programs, will typically require one year of recent critical care experience as an RN. If you’re pursuing an RN to MSN, the requirements will differ somewhat from that of a BSN to MSN program. For example, a BSN to MSN program will require a BSN as one of the qualifications to apply.

An APRN program that culminates in a doctor of nursing practice (DNP) will also have more requirements you’ll need to meet before you can apply.

Make sure to review each school’s website for their specific program, as they can vary.

Depending on your role as an APRN, you may soon be prescribing. If so, our course Advanced Practice Nursing Pharmacology offers a great review. In your quest for more education, if you’re considering a DNP for one of your APRN degrees, our course weighing a DNP versus a PhD can be helpful.