Advanced Nurse Careers are nursing roles that include responsibilities beyond that of a clinical staff nurse or the first levels of nursing management. Here is an overview of seven Advanced Nursing Careers:
- Four Advanced Practice Registered Nurse (APRN) Roles,
- Clinical Nurse Leader (CNL),
- Nurse Educator (NE), and
- Advanced Nursing Leadership Roles.
Advanced Practice Registered Nurse (APRN) Roles
Four of the seven Advanced Nurse Careers are Advanced Practice Registered Nurse (APRN) patient-care roles. These are:
Alternatively, these four roles are known as Certified Registered Nurse Practitioners (CRNPs).
The ability to practice in these roles begins with earning an advanced nursing degree or certificate. These degrees or certificates include:
- Doctor of Nursing Practice (DNP),
- Master's-Level Nursing Degree, or
- Post-Master's or Post-Doctoral Nursing Certificate.
Advanced Practice Registered Nurses must obtain Registered Nurse (RN) and APRN licenses for the state where they practice. Both RN and APRN licenses are transferrable between states. The Nurse Licensure Compact and APRN Compact ease the transfer of licenses between participating states.
Each state’s Scope of Practice regulations establish APRNs’ degree of practice independence. Some states do not recognize APRN roles.
Certified Nurse Midwife (CNM)
The Certified Nurse Midwife (CNM) is an Advanced Practice Registered Nurse (APRN) who provides care for women during pregnancy and childbirth. Practice as a CNM requires training and specialized education at the master’s or doctorate levels and board certification.
The Certified Nurse Midwife is a primary healthcare provider for relatively healthy women whose births are considered uncomplicated. Each state has established a Scope of Practice that establishes CNM Practice Autonomy and Prescriptive Authority. Read more...
- Certification required for a state license to practice – Yes
- Subject to state Scope of Practice regulations – Yes
- State RN license is required to practice – Yes
- State APRN license is required to practice – Yes
Certified Registered Nurse Anesthetist (CRNA)
The Certified Registered Nurse Anesthetist (CRNA) holds an advanced degree and board certification in anesthesia. The CRNA administers anesthesia in collaboration with qualified healthcare professionals such as surgeons, anesthesiologists, dentists, podiatrists, ophthalmologists, and pain management specialists.
CRNAs work in various practice settings, such as hospital surgical suites, ambulatory surgical centers, and private practice offices. Each state has established a Scope of Practice that establishes Practice Autonomy and Prescriptive Authority for CRNAs. Read more...
- Certification required for a state license to practice – Yes
- Subject to state Scope of Practice regulations – Yes
- State RN license is required to practice – Yes
- State APRN license is required to practice – Yes
Clinical Nurse Specialist (CNS)
The Clinical Nurse Specialist (CNS) is an Advanced Practice Registered Nurse (APRN) in a specialized clinical nursing practice area. The CNS holds an advanced degree at the master’s or doctorate level and certifications in their area of expertise.
The Clinical Nurse Specialist performs in several roles:
- Educator – as a mentor to other nurses, enabling them to advance their nursing practice,
- Clinical Expert – as the bed-side expert to improve patient outcomes, and
- Practice Expert – as the clinical expert to bring about system changes to advance patient care and improve patient outcomes.
As an APRN, the CNS performs several of the same duties as a Physician. Each state has established a Scope of Practice that establishes Practice Autonomy and Prescriptive and Signature Authority for the CNS. Read more...
- Certification required for a state license to practice – Yes
- Subject to state Scope of Practice regulations – Yes
- State RN license is required to practice – Yes
- State APRN license is required to practice – Yes
Nurse Practitioner (NP)
A Nurse Practitioner (NP) is an Advanced Practice Registered Nurse (APRN) with advanced training and education at the master’s or doctorate levels. This advanced education qualifies them to act as a patient’s primary healthcare provider. Of all advanced nursing careers, the role of Nurse Practitioner has seen and will continue to see the most growth.
The NP is qualified to diagnose medical conditions, issue medication prescriptions, and make referrals for many acute and chronic medical problems. Nurse Practitioners are required to obtain certification in their area of practice.
The Nurse Practitioner performs many of the same duties as a Physician. Each state has Scope of Practice regulations establishing Practice Autonomy and Prescriptive and Signature Authority for the NP. Read more...
- Certification required for a state license to practice – Yes
- Subject to state Scope of Practice regulations – Yes
- State RN license is required to practice – Yes
- State APRN license is required to practice – Yes
Clinical Nurse Leader (CNL)
The Clinical Nurse Leader (CNL) is a relatively new nursing role and the most recently created of the 7 Advanced Nursing Careers. This role provides a single point of focus for coordinating the treatment and care of a patient. The CNL monitors patient outcomes, assesses risk factors, and has the authority, based on Evidence-Based Practice , to modify care plans. The Clinical Nurse Leader works with various healthcare professionals, forming an inter-professional team. This team focuses on bringing the latest innovations and technologies to improve patient care. Read more...
- Certification required for a state license to practice – No, but may be required by an employer as a condition of employment.
- Subject to state Scope of Practice regulations – No
- State RN license is required to practice – Yes, if an employer requires the individual to be an RN
- State APRN license is required to practice – No
Nurse Educator (NE)
The Nurse Educator (NE) possesses many of the same skills as a Clinical Nurse Specialist in knowledge and expertise. However, the Nurse Educator is primarily a teacher and focuses on the education of the nursing staff. This education ranges from orientation for new nurses to advanced nursing practice updates for experienced staff members. Unlike the CNS, the duties of the Nurse Educator do not overlap with those of a Physician.
The Nurse Educator qualifies as one of the 7 Advanced Nursing Careers due to the need for graduate-level nurses. The need for graduate-level Nurse Educators is due to the increasing complexity of patient care practice. This complexity comes from higher patient acuity, implementation of Evidence-Based Practice , and advances in patient care technologies. Read more...
- Certification required for a state license to practice – No, but may be required by an employer as a condition for employment.
- Subject to state Scope of Practice regulations – No
- State RN license is required to practice – Yes, if an employer requires the individual to be an RN.
- State APRN license is required to practice – No
Advanced Nursing Leadership Roles
Nurse leaders are responsible for the many aspects of providing excellent patient care, including:
- Ensuring delivery of top-notch patient care,
- Working with regulatory agencies,
- Maintaining positive physician relationships,
- Recruiting and hiring top nursing talent, and
- Acting as a liaison between nursing staff and senior administration.
Nursing leadership positions above the first management level increasingly require a master’s level degree at the minimum. Driving this requirement are the many advances that have expanded the role of nursing in healthcare delivery from the smallest Critical Access Hospitals to large hospital systems.
- Certification required for a state license to practice – No, but may be required by an employer as a condition for employment.
- Subject to state Scope of Practice regulations – No
- State RN license is required to practice – Yes, if an employer requires the individual to be an RN.
- State APRN license is required to practice – No
Unit Level Nurse Directors
Unit Level Nurse Directors provide leadership for one or more units of specific clinical specialization. Examples of clinical specialization include oncology, surgery, cardio-vascular, and labor and delivery, to name a few. While these Directors remain knowledgeable of the latest clinical practices within their specialization, their primary responsibilities are administrative. Read more...
Nurse Executives
Nurse Executives provide a strategic vision for patient care services in hospitals and healthcare systems as senior leadership team members. While usually reporting to the Chief Executive Officer (CEO), the Nurse Executive works in a peer relationship with the CMO, CFO, and other C-level executives. Read more...
Advancements in healthcare delivery in recent years have greatly expanded the role of Unit Level Nurse Directors and Nurse Executives in the design, development, and administration of healthcare delivery systems.
The application of Transformational Nursing Leadership into healthcare delivery has greatly expanded the role of Unit Level Nurse Directors and Nurse Executives in the design, development, and administration of patient care systems.
- Certification required for a state license to practice – No, but may be required by an employer as a condition of employment.
- State RN license is required to practice – Yes, if an employer requires the individual to be an RN.
Academia and Research
Colleges and universities are the locations of most academic and research positions. In this environment, academia and research work overlap. Research in nursing science develops new practices while Academic instruction prepares students as future nurses in various practice specialties and roles. Nursing science research also provides the foundation for developing Evidence-Based Practice in nursing.
An improved teaching curriculum emerges from the results of nursing science research. New teaching curricula apply to all degree levels, including LPN, LVN, BSN, Master's-level Nursing, Doctor of Nursing Practice (DNP), and Doctor of Philosophy (PhD) - Nursing Science degrees.
Careers in full-time or tenured Academic or Research roles usually require a doctoral degree. The doctoral degree may be a Doctor of Nursing Practice (DNP) or Doctor of Philosophy (PhD) - Nursing Science degree. It is not uncommon for practicing Advanced Practice Registered Nurses, Nurse Educators, Clinical Nurse Leaders, or Nursing Leadership Directors or Executives to provide instruction part-time or as adjunct professors.