Advanced practice registered nurse (APRN)

An advanced practice registered nurse (APRN) is a medical professional who has completed graduate-level nursing training. Training to a master's level or above qualifies the APRN to take on responsibilities beyond those of a registered nurse (RN), who has a bachelor's degree, or a licensed practical nurse (LPN), who completes a special program focused on nursing skills. An APRN fulfills an important role in the health care system, handling both primary and specialty needs. There are different laws that govern what functions an APRN can carry out, some dependent on what aspect of nursing the APRN is practicing. The need for APRNs is expected to increase in the future, and the profession is expected to grow in both scope and compensation.

Background

The role of nurses has been in flux for almost as long as the profession has existed. In the early part of the twentieth century, nurses who made house calls would sometimes dispense basic medicines to patients during their visits. Nurses also sometimes made treatment decisions, such as those involved in improving the sanitation in the patient's home or in recommending dietary changes. Such decisions were based on their own experience and made without the specific input of a physician.

This was particularly the case in rural areas where there were few or no doctors and nurses provided the majority of medical care. Over time, however, laws were passed that drew specific lines that identified what a nurse was allowed to do and what type of care must be handled by a physician. In general, the practices of diagnosing conditions and prescribing medications were limited to physicians.

In the 1960s, interest began to increase around the role of nurse practitioners. A Colorado pediatrician named Henry Silver was concerned about the gap in medical care for poorer families. Loretta Ford, his assistant nursing professor, shared Silver's concern. The pair began working on filling the gap by training nurses to provide well-child care and treatment for common childhood illnesses in clinics in rural areas. This was the beginning of the new role of nurse practitioner, in which the nurse becomes the primary care provider for patients. However, the role was seen as supplementing the role of the physician, not replacing it.

While some people welcomed nurse practitioners and saw them as an important link in the health care chain, the role also met opposition. The issue was subject to debate in the medical community and led to legal challenges. Some nurse practitioners who worked to the limits of the position were even charged with practicing medicine without a license. The Missouri Supreme Court decision in the 1983 case Sermchief v. Gonzales determined that the role of advanced practice nurses (APNs) could evolve to include new functions and responsibilities. This helped pave the way for more certified nurse practitioner programs and led to greater interest in and respect for these medical professionals.

At this time, there were more than fifteen thousand nurse practitioners in America. In 1985, the American Academy of Nurse Practitioners was formed. However, these medical professionals did not have the type of legal status that would allow them to be directly reimbursed for their services. Nurse practitioners had to be on the payroll of a medical facility to be paid. This changed in 1989 when federal legislation was signed that allowed direct reimbursement to nurse practitioners. In 1993, the organization that would become the American College of Nurse Practitioners was formed. During this time, the roles of nurse practitioners and APRNs increasingly gained both respect and recognition in the health care field.

Overview

There are four main categories of APRN providers:

• Nurse practitioners serve as primary care providers for routine and acute or urgent care in clinics, schools, medical facilities, and other locations. They can diagnose and treat routine injuries and common illnesses and provide services such as physical exams, immunizations, and ongoing care for chronic conditions, such as diabetes and high blood pressure.
• Certified nurse-midwives serve the needs of pregnant women and new mothers. They can deliver babies at home, in special birthing centers, and in hospital settings. Nurse-midwives can also provide routine gynecological care for otherwise healthy women.
• Certified registered nurse anesthetists provide anesthesia to patients undergoing surgery.
• Clinical nurse specialists, much like specialist physicians, provide care for specific types of conditions, such as cardiac care, pediatric, oncology, neonatal, and obstetrics/gynecology.

In nearly every state, APRNs can prescribe medications, and more than a dozen states have laws in place allowing APRNs to practice without oversight from a physician. More than 65 percent of all surgical anesthesia administered each year is done by an APRN, and one third of all hospitals use only APRNs to administer anesthesia. In December of 2016, the US Department of Veterans Affairs (VA) granted APRNs full authority to practice medicine to the full extent of their training and without the direct supervision of a physician regardless of the laws in their state, as long as they work within the parameters of their VA employment.

Many people, including those associated with the American Association of Colleges of Nursing, see APRNs as critical to the future of health care in the United States. Supporters of an expanded role for APRNs say that these nurses deliver high quality health care at a lower cost than care directed by physicians. This makes routine health care more affordable and accessible. Affordable, accessible routine medical treatment curbs the cost of health care by identifying potential problems before complications develop.

According to the US Department of Labor, the demand for APRNs will grow by 31 percent by the year 2024, a rate much higher than most professions. The average pay for the position in 2015 was nearly $105,000, or more than $50 per hour. Becoming an APRN requires a master's degree or doctorate. APRNs must also pass state and national licensing requirements.

Bibliography

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"APRNs in the U.S." National Council of State Boards of Nursing, www.ncsbn.org/aprn.htm. Accessed 8 Apr. 2017.

"Expanded Roles for Advanced Practice Nurses." American Association of Colleges of Nursing, www.aacn.nche.edu/media-relations/fact-sheets/apn-roles. Accessed 8 Apr. 2017.

"The History of Nurse Practitioners in the United States." Simmons School of Nursing and Health Services, 13 Nov. 2014, onlinenursing.simmons.edu/nursing-blog/history-nurse-practitioners/. Accessed 8 Apr. 2017.

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"Nursing Anesthetists, Nurse Midwives, and Nurse Practitioners." US Department of Labor, Bureau of Labor Statistics, www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm. Accessed 8 Apr. 2017.

"VA Grants Full Practice Authority to Advance Practice Registered Nurses." US Department of Veterans Affairs, 14 Dec. 2016, www.va.gov/opa/pressrel/pressrelease.cfm?id=2847. Accessed 8 April 2017.