Advanced Nursing Practice and Related Roles


With the healthcare system and governments facing many challenges such as the shortage of professionals, rising costs, and difficult access to care, it has never been more essential to have the right staff that is educated and competent to deliver quality care. Nurses in advanced practice are adequately positioned to respond to the evolution of healthcare. Advanced nursing practice is a general word used describing an advanced clinical nursing level that capitalizes on the use of a graduate educational background, comprehensive nursing knowledge, and skill in delivering care (DiFazio & Vessey, 2014). Despite its global uniform development, the understanding of what advanced nursing practice entails varies among countries. This paper aims to examine the various advanced practice roles, the advantage the clinical nurse practitioner role has over other roles, future personal plans for clinical practice, and role transition.

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Four Advanced Practice Nurse (APN) roles

Advanced nursing practice roles range from clinical nurse specialists (CNS), clinical nurse practitioners (CNP), certified nurse-midwives (CNM), to certified registered nurse anesthetics (CRNA). A CNP is a registered nurse (RN) with a master or doctoral degree in nursing and is licensed by both a national and state licensing board (DiFazio & Vessey, 2014). CNPs possess a higher level of autonomy hence, they can independently diagnose, request for, and evaluate diagnostic tests, prescribe medication, and conduct other procedures that fall within their approved scope of practice (DiFazio & Vessey, 2014). Therefore, in many instances, CNPs have their primary care practices.

A CNS has a similar educational background with a CNP, however, their master’s program explicitly focuses on the clinical nursing specialty. Their role is to apply expert knowledge and experience to specific patient populations in specific clinical settings. Therefore, they often serve as consultants and educators to other nursing staff hence ensuring evidence-based practice and quality patient outcomes (DiFazio & Vessey, 2014).

On the other hand, CNMs are registered nurses who have pursued a master’s or doctoral program in Nursing. They are responsible for general gynecological and primary healthcare of women from adolescence through to menopause (DiFazio & Vessey, 2014). Last but not least is the CRNA who is regarded as a registered nurse with a graduate or doctoral educational background. They work in an array of clinical care settings which include, but are not limited to medical centers, community hospitals, dentist offices, and pain clinics. Their scope of practice entails administering general and local anesthesia, sedation, spinal, epidural, or peripheral nerve blocks (DiFazio & Vessey, 2014).

The rationale for choosing CNP Role over CRNA role

Both CNPs and CRNAs require a minimum of a master’s degree to work in their respective fields and provide care to patients. Nevertheless, they differ on the kind of care administered, and the patient population served. For instance, the role of CRNAs is mainly to administer anesthesia and sedation; thus, they are secluded to specific hospital settings. However, CNPs can work in a variety of hospital environments such as cardiac, orthopedic, pediatric, neonatal, psychiatric and mental health, family, oncology, and adult-gerontology care.

Plans for Clinical Practice

Initially, I was confused about the titles, that is, NP and CNS, and lacked role clarity on their scope of practice as they are profoundly similar. However, after researching these roles, I gained an in-depth understanding of their educational requirements and job functions; therefore, I was capable of properly delineating their respective roles. I came to understand that NPs spend most of their time providing direct patient care as compared to professional development, research, leadership, and education. Moreover, their clinical functions have expanded such that they can perform additional tasks that were traditionally executed by doctors. As a result, I decided to reconsider my plans for clinical practice after graduation. I intend to specialize as an orthopedic nurse practitioner after graduation since I have an aspiration to help the elderly.

Role Transition

Role transition to an NP begins in the graduate education program when RNs are socialized into the role through to their first year of practice when the complete adjustment to the role is achieved. Over the years, the position of an NP has gained considerable attention in the U.S (Barnes, 2015). This was also instigated by the American government, calling for an increase in the proportion of healthcare practitioners since the proportion of individuals eligible for health insurance has also increased (Barnes, 2015). Surprisingly, the field is characterized by a turnover rate that is twice that of physicians, and this is attributed to poor transition experiences (Barnes, 2015). Several factors affect the transition from the role of an RN to that of an NP.

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However, the two main factors include experience and expert mentoring and guidance. Moreover, some strategies can be embraced to facilitate a successful transition from the RN to NP. They are mastery of self-efficacy and confidence and receiving formal support (Tracy, 2017). RNs interest in becoming NPs should naturally possess a passion for growing their knowledge base and training, thereby furthering their skills mastery. Moreover, when it comes to receiving formal support, mentors and preceptors have been found to make the transition easier as it gives the RNs to have an experienced insight and to know the preference for different cases (Tracy, 2017).


There is a global increase in the number of advanced nursing practitioners (APNs) as providers of healthcare. In the U.S., the four main types of advanced nursing partitioning roles include CNS, CNP, CNM, and CRNA. For an RN to be regarded as an APN, they have to a minimum of a master’s degree in nursing and considerable experience. The transition process predetermines the success of an NP.


Barnes H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition. The journal for nurse practitioners : JNP, 11(2), 178–183.

DiFazio, R., & Vessey, J. (2014). Advanced practice registered nurses: Addressing emergency needs in emergency care. African Journal of Emergency Medicine, 4(1), pp. 43-49.

Tracy, A. (2017). Perceptions of Certified Registered Nurse Anesthetists on factors affecting their transition from student. AANA Journal, (85)6), pp. 438-444.

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