Nurse anesthetists, nurse midwives, and nurse practitioners

What Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners Do

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and they may provide primary and specialty health care. 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 and set up plans for patients’ care or contribute to existing plans
  • Perform physical exams
  • Observe patients and diagnose various health problems
  • Perform and order diagnostic tests and analyze results
  • Give patients medicines and treatments
  • Consult with doctors and other healthcare professionals as needed
  • Operate and monitor medical equipment
  • Provide counseling 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. They may provide primary and preventative care and may specialize in care for certain groups of people, such as children, pregnant women, or patients with mental health disorders.

APRNs who work with patients typically perform many of the same duties as registered nurses, gathering information about a patient’s condition and taking action to treat or manage the patient’s health. However, APRNs are also 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 may also 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 examples of types of APRNs:

Nurse anesthetists 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 or 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 provide care to women, including gynecological exams, family planning services, prenatal care, and attendance in labor and delivery. They may act as primary care providers for women and newborns. Many nurse midwives 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, providing advanced nursing services to patients and their families. NPs 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. They 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.

Clinical nurse specialists (CNSs) provide direct patient care to a certain population of people, such as pediatric patients, within one of many nursing specialties, such as orthopedic nursing or oncology nursing. CNSs also provide indirect care by working with other nurses, healthcare teams, and various other staff to improve the quality of care that patients receive. They also work at the system or organizational level to improve the quality of nursing care throughout a facility related to their specialty. Those with a research doctorate may conduct research.

How to Become a Nurse Anesthetist, Nurse Midwife, or Nurse Practitioner

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses, 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 become a licensed registered nurse (RN) before pursuing education in one of the advanced practice roles. Many programs also require some period of clinical experience, 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, many APRNs 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.

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 approved 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 every 2 years, which includes 40 hours of continuing education.

The American Midwifery Certification Board offers the Certified Nurse-Midwife and Certified Midwife designations. Individuals with these designations must recertify 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.

Important Qualities

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

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

Compassion. Nurses 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. Advanced practice registered nurses must work with patients and families as well as with other health care 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. Advanced practice registered nurses 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

Because the APRN designation is in itself an advancement of one’s career, many APRNs choose to remain in this role for the duration of their career. 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.

Job Outlook

Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

Percent change in employment, projected 2012-22

Nurse practitioners

34%

Nurse anesthetists, nurse midwives, and nurse practitioners

31%

Nurse midwives

29%

Nurse anesthetists

25%

Total, all occupations

11%

 
 

Employment of nurse anesthetists, nurse midwives, and nurse practitioners is expected to grow 31 percent from 2012 to 2022, much faster than the average for all occupations. Growth will occur because of an increase in the demand for healthcare services. Several factors, including healthcare legislation and the resulting newly insured, an increased emphasis on preventative care, and the large, aging baby-boom population will contribute to this demand.

The number of individuals who have access to health insurance will increase due to federal health insurance reform legislation. APRNs can perform many of the same services as physicians and may be needed to provide primary care services.

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.

APRNs will also be needed to care for the aging baby-boom generation. 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.

Job Prospects

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

Employment projections data for Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, 2012-22
Occupational Title SOC Code Employment, 2012 Projected Employment, 2022 Change, 2012-22 Employment by Industry
Percent Numeric

SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program

Nurse anesthetists, nurse midwives, and nurse practitioners

151,400 198,900 31 47,600

Nurse anesthetists

29-1151 35,200 43,900 25 8,800

Nurse midwives

29-1161 6,000 7,700 29 1,700

Nurse practitioners

29-1171 110,200 147,300 34 37,100
  Occupation Description Entry-Level Education 2012 Median Pay
Audiologists Audiologists

Audiologists diagnose and treat a patient's hearing and balance problems, using advanced technology and procedures.'

Doctoral or professional degree $69,720
Occupational therapists Occupational therapists

Occupational therapists treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.'

Master's degree $75,400
Physical therapists Physical therapists Physical therapists, sometimes called PTs, help injured or ill people improve their movement and manage their pain. These therapists are often an important part of rehabilitation and treatment of patients with chronic conditions or injuries.' Doctoral or professional degree $79,860
Physician assistants Physician assistants Physician assistants, also known as PAs, practice medicine on a team under the supervision of physicians and surgeons. They are formally educated to examine patients, diagnose injuries and illnesses, and provide treatment.' Master's degree $90,930
Physicians and surgeons Physicians and surgeons Physicians and surgeons diagnose and treat injuries or illnesses. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.' Doctoral or professional degree $0
Registered nurses Registered nurses

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.'

Associate's degree $65,470
Speech-language pathologists Speech-language pathologists

Speech-language pathologists (sometimes called speech therapists) assess, diagnose, treat, and help to prevent communication and swallowing disorders in patients. Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional problems.'

Master's degree $69,870
Ref: bls.gov
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