What is an Advanced Practice Registered Nurse?  

Advanced Practice Registered Nurses, or APRNs, hold both a registered nursing license and a master’s or doctoral degree. APRNs have an expanded scope of practice and may deliver specialized care to patients. 

Key Takeaways

  • There are four main categories of APRNs: Nurse Practitioner, Certified Nurse Midwife, Clinical Nurse Specialist, and Certified Registered Nurse Anesthetist.

  • APRNs are an invaluable resource for patients and healthcare workers. Yet, several institutional challenges continue to weigh on the APRN profession. 

What is an Advanced Practice Registered Nurse

The 4 Categories of APRNs 

  • Nurse Practitioner

    • According to the American Association of Nurse Practitioners, NPs can order tests, diagnose, prescribe and oversee treatment plans. During their graduate training, NP students complete tailored training for their specialty of choice  (i.e. Pediatrics).

    • In 27 states, NPs are required to practice under the supervision of a physician. More on this concept below. 

  • Certified Nurse Midwife 

    • CNMs specialize in women’s health, often focusing on pregnancy, delivery and postpartum care. CNMs can also perform routine services such as annual gynecological exams. 

    • CNMs will not handle or deliver pregnancies with high chances for complications. Instead, CNMs only manage and deliver low-risk pregnancies.

    • In 25 states, CNMs can prescribe and practice without physician supervision, so long as they remain within their scope of practice.

  • Clinical Nurse Specialist

    • A CNS undergoes additional training in a specialized area of focus. CNS’ often work in a hospital or office settings working with certain conditions or populations (i.e. adults with Dementia). Other CNSs may specialize in different areas of healthcare (i.e. healthcare administration or education). 

    • In 31 states, CNS’ cannot prescribe medication. In 22 states, CNS’ can practice as independent providers.

  • Certified Registered Nurse Anesthetist

    ARPNs & the Larger Healthcare Landscape

    The Association of Medical Colleges predicts a physician shortage between 54,100 and 139,000 physicians, including shortfalls in both primary and specialty care by 2033. APRNs are critical members of the healthcare system, as they help mitigate staffing shortages and can step in to provide patients with high-quality, accessible and specialized care. 

    APRNs also play consultative roles by offering opinions that help physicians and other healthcare professionals provide safe and effective patient care. 

    Challenges in Advanced Practice Nursing

    Collaboration Rules 

    APRNs are considered independent providers if they are permitted to practice without a collaboration agreement. A collaboration agreement is a supervision program in which APRNs are paired with physicians who oversee some or all of their practice. 

    While collaboration rules vary between APRN categories, let’s use the above CRNA example: certain states allow CRNAs to independently practice without a supervising physician, while others don’t. Challenges for CRNAs subject to collaboration rules include difficulty finding a willing physician, limited autonomy and a need to modify their practice if licensed in multiple states. 


    In response to anesthesia shortages during the Covid-19 pandemic, the federal government implemented a temporary waiver permitting CRNAs to practice independently.  While this was an incredible achievement for CRNAs, it also raises a question – why do some APRN categories receive expansions while state-imposed restrictions limit others? For reference, roughly half of all states limit full practice for both NPs and CNMs


    Another challenge APRNs face is advocating for professional equality and trust amongst other stakeholders. Since APRNs are trained to perform many services similar to those of physicians, such as diagnosing, prescribing and seeing their own patient caseloads, their work can help alleviate the impact of physician shortages and burnout

    However, some patients may not be familiar with the scope of practice or expertise an APRN has and may not be ready to undergo their care. Some health systems utilize APRN skills to see more patients with more routine and general concerns while reserving those with more chronic or complex problems for physicians. 

    Tying It Together

    Both APRNs and physicians play an enormous role in our healthcare system. In return for their devotion and skill, politicians, healthcare administrators and other healthcare providers must advocate for and support both of these provider types so they can continue to provide excellent care in a collaborative way that prioritizes patients and clinical outcomes. 


    Outside the Huddle


    Reviewed by Geetika Rao, MPH | Edited by Nidhi Mahagaokar, MPH | Fact checked by Chris Yang