In the modern healthcare system, hiring practitioners with various backgrounds and competencies is a solid initiative to improve patient outcomes and reduce costs. Understanding advanced practice nursing (APN) roles is critical due to the expanded scope of practice during the last several decades and its direct impact on patient safety and decision-making. One of the most stressful career changes is the transition from registered nurse (RN) to APN, characterized by increased anxiety and turnover and the importance of promoting safe practice for patients (Reebals et al., 2021). Among the existing variety of APN roles, the position of a certified nurse practitioner (CNP) is commonly preferred due to the possibility of working with patients directly, continuous development, and multi-level cooperation. This paper aims to discuss APN roles, share rationales for CNP choice, and explain clinical practice plans and role transition challenges. The CNP role transition will be less stressful if emotional support and professional coaching are equally distributed among practitioners.
Four APN Roles
CNP is one of the graduate nursing roles in today’s healthcare environment. These nurses should work alongside a physician to help patients with physical assessment, diagnosis, medication prescription, and follow-up (Mohr & Coke, 2018). Educational preparedness covers a master’s or doctorate from a particular nurse practitioner (NP) program or a postmaster’s NP certificate program licensed by the American Nurses Credentialing Center (ANCC) with a minimum of 500 clinical hours (Mohr & Coke, 2018). The CNP work environment is within the frames of primary and acute care settings in private practice, long-term care facilities, school-based clinics, and hospitals.
Clinical nurse specialists (CNSs) are involved in activities to prevent illnesses, examine risk factors, and learn human behaviors. CNS certification is similar to CNP’s, which is an ANCC license and 500 direct clinical hours (Mohr & Coke, 2018). CNSs may usually work in any part of a hospital, an educational institution, or private practice and cooperate with a large medical team to concentrate on patient needs, the overall care system, and community health.
A certified registered nurse anesthetist (CRNA) aims to administrate anesthesia in various medical settings. CRNAs usually cooperate with surgeons and anesthesiologists responsible for patients’ well-being during surgery, pain management, and physical stabilization. They need a master’s or doctoral degree and national certification with at least three years of experience and specialized graduate preparation (Elisha et al., 2020). These nurses can work in hospitals, surgical clinics, dentistry, and outpatient care centers where they should perform their roles strictly in the chosen field.
As well as CRNAs, certified nurse midwives (CNMs) have specific responsibilities in treating women during childbirth and promoting reproductive health care. Midwifery education programs vary in graduate degrees, but the most common requirements are master’s degrees in midwifery, nursing, and public health (Hastings-Tolsma et al., 2018). In addition to hospitals and private practices, CNM work environments are birthing centers and specific health departments where counseling for pregnant women is required.
The Rationale for Choosing CNP Role
The rationale for choosing the CNP advanced practice role compared to the CRNA role lies in the possibility of expanding responsibilities and working directly with patients. CRNAs are trained within one particular area, anesthesia, while CNPs obtain a broad range of care knowledge. It is always interesting to develop skills in the CNP field and cooperate with nurses and other healthcare providers across all hospital departments. In CRNA’s case, the work environment also varies but is limited to anesthesia-related services. CRNAs should coordinate their work with other employees involved in care processes. CNPs focus on health promotion, disease prevention, diagnosis, treatment, counseling, and follow-ups. They are independent clinicians who make decisions and define their scope of work autonomously.
Plans for Clinical Practice
After researching the four ANP roles, it is expected to change some aspects of understanding NP practice, provoking additional changes within clinical practice plans. First, it is important for nurses not only to manage their knowledge and find practical applications but to deal with emotional challenges. Second, despite the level of obtained knowledge, supervision, and support cannot be ignored to remove insufficient care delivery. Therefore, a plan for clinical practice after graduation should include two steps: to find a professional team for supervision and experience exchange for the next several months and to pay enough attention to personal emotional well-being. Face-to-face communication, participation in forums, and TED talks are the best sources to find credible and easy-to-comprehend information.
The transition from RN to NP is not simple due to unpredictability and poor self-control. The two common factors affecting this process are emotional exhaustion and the necessity to become more independent in decision-making. RNs have cooperated with colleagues and solved problems together, addressing common knowledge and observations for a long time. Now, they become CNPs – independent practitioners and consultants – which increases their level of responsibility and anxiety (Mohr & Coke, 2018). The strategies to promote a successful transition include an additional source of emotional support and professional coaching within the same facility. Coaching will be based on didactic clinical experiences to evaluate the setting and help new nurses assess their skills (Reebals et al., 2021). These steps are not difficult to take if appropriate communication skills are developed.
Understanding the differences between APN roles is a critical step for a nurse in choosing a specialty and deciding which work environment is a better option. CNPs, CNSs, CRNAs, and CNMs have certain similarities and differences, but the reasons for preferring the CNP role are a variety of responsibilities and involvement in direct patient care processes. An effective transition from RN to NP is based on professional counseling and emotional support to reduce stress, anxiety, and uncertainty.
Elisha, S., Bonanno, L., Porche, D., Mercante, D. E., & Gerbasi, F. (2020). Development of a common clinical assessment tool for evaluation in nurse anesthesia education. AANA Journal, 88(1), 11-17.
Hastings‐Tolsma, M., Foster, S. W., Brucker, M. C., Nodine, P., Burpo, R., Camune, B., Griggs, J., & Callahan, T. J. (2018). Nature and scope of certified nurse‐midwifery practice: A workforce study. Journal of Clinical Nursing, 27(21-22), 4000-4017.
Mohr, L. D., & Coke, L. A. (2018). Distinguishing the clinical nurse specialist from other graduate nursing roles. Clinical Nurse Specialist, 32(3), 139-151.
Reebals, C., Wood, T., & Markaki, A. (2021). Transition to practice for new nurse graduates: Barriers and mitigating strategies. Western Journal of Nursing Research, 44(4), 416-429.