The 4 Advanced Practice (APRN) Careers in Nursing
Advanced Practice Registered Nurses (APRNs) are shaping the future of healthcare. With expanding clinical responsibilities, greater autonomy, and high demand across specialties, APRNs are central to addressing modern healthcare challenges, particularly in underserved areas. According to the U.S. Bureau of Labor Statistics (BLS), employment of APRNs is projected to grow 38% from 2022 to 2032, significantly faster than the average for all occupations. The growth reflects increasing healthcare demands and a shift toward preventative and holistic models of care.
This guide outlines the four main APRN roles: Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and Clinical Nurse Specialist (CNS). It provides essential information on duties, education paths, salaries, and future opportunities to help current and aspiring nurses evaluate the best route for advanced clinical practice.
What Is an APRN?
An Advanced Practice Registered Nurse is a registered nurse who has earned at least a master's degree in nursing and has completed additional clinical training and national certification in a specialized role. According to the National Council of State Boards of Nursing (NCSBN), APRNs provide primary, acute, and specialty healthcare services, often serving as a patient's primary healthcare provider.
Each APRN role requires a strong foundation in advanced clinical practice, leadership, and evidence-based care. While all APRNs share a commitment to improving patient outcomes, each career path offers distinct responsibilities, patient populations, and work environments.
1. Nurse Practitioner (NP)
Nurse Practitioners are among the most versatile APRNs. These providers diagnose and treat acute and chronic conditions, prescribe medications, and focus on health promotion and disease prevention. NPs work independently or collaboratively with physicians in clinics, hospitals, and private practices. The American Nurses Association (ANA) notes that NPs are essential providers of primary care in many settings.
NP Specialties
| Specialty | Common Practice Settings |
| Family (FNP) | Primary care clinics, urgent care centers |
| Adult-Gerontology | Internal medicine, long-term care facilities |
| Pediatrics | Pediatric clinics, schools |
| Psychiatry/Mental Health (PMHNP) | Behavioral health clinics, telehealth |
| Women's Health | OB-GYN clinics, reproductive health centers |
NP Education Path
- Earn a BSN (Bachelor of Science in Nursing)
- Obtain RN licensure
- Complete an MSN or DNP (Doctor of Nursing Practice) program
- Pass a national certification exam in a chosen specialty
NP Salary and Outlook
| Year | Average Salary |
| 2025 | $128,000–$145,000 |
NPs are increasingly integral to addressing the national shortage of primary care providers, especially in rural and medically underserved areas.
2. Certified Registered Nurse Anesthetist (CRNA)
Certified Registered Nurse Anesthetists are critical members of surgical and procedural teams. They administer anesthesia, monitor patient responses, and ensure safe recovery in settings ranging from operating rooms to outpatient centers. CRNAs often work with a high level of autonomy and technical precision. The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) oversees national certification and continuing education for this role.
CRNA Education Path
- Earn a BSN and maintain a strong GPA
- Gain at least one year of RN experience in an intensive care unit (ICU)
- Complete a DNP or DNAP (Doctor of Nurse Anesthesia Practice)
- Pass the National Certification Examination (NCE)
CRNA Salary and Outlook
| Year | Average Salary |
| 2025 | $215,000–$240,000 |
Due to their advanced skill set, CRNAs are among the highest-paid nursing professionals. Demand is especially strong in rural hospitals and surgical centers where CRNAs may be the sole anesthesia providers.
3. Certified Nurse Midwife (CNM)
Certified Nurse Midwives specialize in women's reproductive health, prenatal care, and childbirth. CNMs emphasize evidence-based, patient-centered care and often build long-term relationships with patients. They practice in hospitals, birthing centers, and occasionally in home birth settings. The Accreditation Commission for Midwifery Education (ACME) ensures the quality of midwifery education programs in the U.S.
CNM Scope of Practice
| Service Area | Examples of Care |
| Maternity Care | Prenatal, labor, delivery, postpartum |
| Women's Health | Annual exams, contraception, menopause support |
| Family Planning | Fertility counseling, birth control |
CNM Education Path
- Earn a BSN and RN license
- Complete an ACME-accredited MSN or DNP program
- Pass the AMCB certification exam
CNM Salary and Outlook
| Year | Average Salary |
| 2025 | $115,000–$130,000 |
The growing interest in holistic and lower-intervention birth practices has increased the demand for CNMs, particularly in maternity care teams seeking continuity and patient-centered approaches.
4. Clinical Nurse Specialist (CNS)
Clinical Nurse Specialists serve as expert clinicians, educators, and systems consultants. They improve patient outcomes through leadership in clinical practice, quality improvement, and evidence-based interventions. CNSs typically work in hospitals, academic medical centers, and health systems.
CNS Specialty Areas
| Specialty | Focus Area |
| Acute Care | Hospital inpatient units |
| Oncology | Cancer centers, palliative care |
| Mental Health | Psychiatric hospitals, outpatient mental health |
| Geriatrics | Long-term care, geriatric care coordination |
CNS Education Path
- Earn a BSN and RN licensure
- Complete a master's or doctoral degree with a CNS focus
- Obtain national certification if required by state
CNS Salary and Outlook
| Year | Average Salary |
| 2025 | $110,000–$125,000 |
CNS professionals are vital to value-based care delivery, contributing to clinical innovation, workforce development, and enhanced nursing practice models.
Choosing the Right APRN Role
Selecting an APRN career involves aligning personal interests and professional goals with patient populations and clinical environments. Factors to consider include:
- Preferred level of patient interaction
- Interest in specialty populations (e.g., women's health, critical care, behavioral health)
- Comfort with high-autonomy decision-making
- Readiness for advanced education and licensure requirements
Shadowing professionals, reviewing program prerequisites, and evaluating work-life balance are useful steps toward informed decision-making.
Advancing an APRN Career
After choosing a path, nurses can take the following actions to advance professionally:
- Enroll in an accredited graduate nursing program aligned with board certification standards
- Gain relevant clinical experience in the chosen specialty area
- Prepare for and pass national certification exams
- Consider earning a DNP for expanded leadership opportunities
Real-world example: A pediatric RN who enjoys longitudinal care may choose to become a Pediatric Nurse Practitioner (PNP), completing a DNP program while continuing part-time work in a clinic.
Making a Long-Term Impact
Advanced practice nursing offers a unique combination of clinical leadership, autonomy, and service. Each APRN role enables professionals to lead quality initiatives, expand access to care, and mentor the next generation of nurses. In a healthcare environment increasingly focused on efficiency and outcomes, APRNs are well-positioned to deliver transformational care.
Exploring these four APRN paths clarifies how to elevate a nursing career and meet the evolving demands of patients and healthcare systems.
Sources
- U.S. Bureau of Labor Statistics (BLS) – APRN Careers
- American Nurses Association (ANA) – APRN Practice
- National Council of State Boards of Nursing (NCSBN) – APRN Information
- Accreditation Commission for Midwifery Education (ACME)
- National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
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