Understanding the Differences Between NP vs APRN

As healthcare needs continue to evolve, the demand has grown for nurses with an expanded scope of practice. According to the Bureau of Labor Statistics, advanced practice nursing careers are growing much faster than average, at a projected rate of 40% between 2021 and 2031.¹

The terms “NP” and “APRN” are sometimes used interchangeably. However, the key difference is that APRN refers to a category of nurses, while an NP is just one type of APRN. Three other types of APRs include certified nurse anesthetists (CRNAs), certified nurse midwives (CNMs), and clinical nurse specialists (CNSs).

Nurse practitioners (NPs or CNPs) serve as primary and specialty care providers, offering enhanced healthcare services to their patients. They often concentrate on specific patient populations, such as children or elderly people.

Nurse anesthetists play a vital role during procedures such as surgery and obstetrics. They may administer anesthesia, help with pain management, and monitor patients throughout procedures.

Nurse midwives provide healthcare services primarily to women. They may perform gynecological exams, deliver babies, and more.

Clinical nurse specialists are advanced practice nurses with proficiency in a particular area, such as pediatrics, neonatal, or adult gerontology. They provide direct patient care, diagnosing and treating diseases within their specific field.

This article explores differences between NPs and other APRN roles in areas such as education, certification and licensing, scope of practice, and salary/job growth.

Education, Licensing, and Certification Requirements for NPs and other APRNs

The educational requirements for NPs and other APRNs are similar in many ways. ARPNs must have completed the initial nursing education required for registered nurses (RNs), and they must hold at least a master’s degree to practice. However, there may be some differences between requirements for NPs and other APRN practitioners.

Educational requirements for NPs

Nurse practitioners generally have three options for pursuing their advanced nursing education:

Master of Science in Nursing (MSN). An advanced practice nursing degree at the master’s level typically includes both classroom education and clinical experience. NP candidates in an MSN degree program typically choose from a number of concentrations within their master’s degree program. Examples include:

• Family Nurse Practitioner (FPN)
• Adult-Gerontology Nurse Practitioner (AGNP)
• Pediatric Nurse Practitioner (PNP)
• Psychiatric Nurse Practitioner (PMHNP)
• Women’s Health Nurse Practitioner (WHNP)

Doctor of Nursing Practice (DNP). This is a terminal nursing degree—in other words, the highest attainable level of nursing education. DNP programs expand on the typical MSN curriculum and help to prepare nurses with the theory and practice they may need to pursue leadership, research, education, and other higher-level positions. There is a push by the National Organization of Nurse Practitioner Faculties (NONPF) and other organizations to require all NPs to earn a doctorate in nursing.

Bridge programs. Nursing bridge programs are designed to help students complete their desired degree outcome in less time by condensing existing degree programs . Common bridge programs for aspiring NPs include BSN-DNP, which is for RNs who haven’t earned a BSN degree, and MSN-DNP, which allows NPs who have completed a master’s to concentrate on a particular area of interest.

Educational requirements for other APRNs

Those wishing to pursue other APRN roles could also choose from an MSN, DPN, or bridge program. Nurse anesthetists might also complete a DNAP (Doctor of Nurse Anesthesia Practice) program. The specifics of these degree programs tend to vary depending on the desired outcome.

For example, nurse midwifery or nurse anesthetist graduate programs are usually designed to build knowledge and skills in those respective areas. Aspiring clinical nurse specialists typically choose a primary population concentration of either adult/gerontology, pediatric, or neonatal nursing.

Note that by 2025, all new CRNAs will be required to have a doctorate degree.

Differences in required certifications and licenses

While states’ requirements for APRNs may vary, in general, all APRNs must meet the following criteria, regardless of their concentration:

• Hold a registered nursing license in their state
• Complete an accredited graduate-level APRN program
• Pass a national certification exam
• Earn an APRN license

Where NPs and other APRNs differ is the kind of national certification they must earn:

• NPs can typically earn one of several different certifications for nurse practitioners. These include certifications from the American Academy of Nurse Practitioners Certification Board (AANPCB), the American Nurses Credentialing Center (ANCC), and the Pediatric Nursing Certification Board (PNCB).
• Nurse anesthetists must pass the National Certification Examination (NCE) offered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
• Nurse midwives must earn the Certified Nurse-Midwife (CNM) credential from the American Midwifery Certification Board.

Other requirements may include becoming certified in skill areas such as CPR, basic life support (BLS), or advanced cardiac life support (ACLS).

The importance of continuing education

APRNs need to keep up with the ever-changing healthcare field through continuing education. Continuing education is also generally a requirement for maintaining national certification, which is necessary for continuing to work as an NP or other type of APRN. Recertification might also involve engaging in a specified number of practice hours.

The recertification board, as well as specific requirements, may vary by type of APRN and the certifying board.

Scope of Practice for NPs and other APRNs

Scope of practice refers to the services and activities that a healthcare provider may legally perform. For NPs and other APRNs, the scope varies depending on the healthcare role and the state in which the role is being performed. However, although NPs and other APRNs may provide some overlapping services, there are also typically some distinct differences.

Defined scope of practice for NPs and other APRNs

The following brief descriptions discuss the general scope of practice for each type of APRN.

Nurse practitioners: The scope of NP practice encompasses a broad range of responsibilities, including but not limited to diagnosing and treating acute, chronic, or episodic illness; ordering, performing, or interpreting diagnostic tests such as X-rays and lab work; and, in some cases, prescribing medication. NPs may also focus on health promotion and disease prevention.

Nurse anesthetists: CNAs administer anesthesia to patients, monitor them while under anesthesia, and oversee their recovery from anesthesia. They may work with anesthesiologists, surgeons, or dentists.

Nurse midwives: CNMs oversee and coordinate all aspects of the birthing process. They may either work independently or as part of a healthcare team.

Clinical nurse specialists: Clinical nurse specialists work within specific areas such as pediatrics or acute care. They provide direct care and may also engage in consultation, system leadership, collaboration, coaching of staff, research, and interpretation of evidence.

Limitations and restrictions on practice

APRNs may be limited in their scope of practice by the state they live in. Many states permit APRNs to engage in full practice, meaning that they could order and interpret medical tests, diagnose patients, prescribe medications, and more—much like physicians. In other states, APRNs are reduced or restricted in the kinds of activities they may engage in. For instance, they may be required to work under a physician’s supervision.

Roughly 70% of states give nurse practitioners, nurse midwives, and clinical nurse specialists full-practice authority. About 50% of states give nurse anesthetists full authority.

Prescriptive authority for NPs and other APRNs

Prescriptive authority is the ability to prescribe medications, including controlled substances. Physicians with either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) credentials have the highest degree of prescriptive authority. However, Prescriptive authority for NPs and other APRNs varies by state.

Roughly 60% of states give nurse practitioners independent prescriptive authority, with 50% for nurse anesthetists and nurse midwives and 40% for clinical nurse specialists. Note that CNAs and CNSs are not allowed to prescribe at all in about 20% of the states.

Collaboration with physicians and other healthcare providers

Many APRNs serve as part of larger healthcare teams. They may collaborate with physicians and other healthcare providers in team-based models of care. As mentioned above, in some states, it is the law for APRNs to work in collaboration with physicians, either all the time or during their first few years of practice.

Regardless of state requirements, however, interdisciplinary collaboration could be an important part of the job for NPs and other APRNs, and many work as part of larger healthcare teams. After all, the field of healthcare continually evolves, and no single practitioner could be an expert on everything. Consulting with other healthcare professionals or referring patients to the appropriate specialists could help APRNs ensure that patients get the services they need.

Patient Population and Care Settings

NPs and other APRNs sometimes differ when it comes to where they work and the patient populations they serve.

APRNs often concentrate on caring for a particular group of people. For instance, nurse practitioners and clinical nurse specialists may focus on a particular patient population or healthcare field, such as:

• Pediatric health
• Adult health
• Geriatric health
• Mental health and psychiatric services

Nurse midwives typically offer services for women, particularly those who are pregnant, while nurse anesthetists might have clients in many demographics.

Practice settings for NPs and other APRNs

Nearly half of all APRNs work in physicians’ offices, according to the Bureau of Labor Statistics. 25% worked in state, local, and private hospitals, and 9% worked at outpatient centers. Some APRNs may travel to patients’ homes or to areas where there are not enough healthcare workers.

While there may be differences in practice settings for NPs and other types of APRNs, the Bureau of Labor Statistics groups all APRNs together when providing statistics on where these skilled nurses work.

Differences in care provided by NPs and other APRNs

The differences in the type of care provided by nurse anesthetists and nurse midwives are pretty clear. However, the type of care provided by nurse practitioners and clinical nurse specialists seems to be similar in many ways. Both provide direct, primary care, and both have areas of concentration. What, then, differentiates the two?

NPs tend to have more practice and prescriptive authority and have greater earning potential. CNSs, however, typically have considerable input in managing patient care. They work closely with medical personnel, consulting, educating, and supporting with the intention of improving nursing care.

Reimbursement and Salary

Some APRNs may earn an hourly wage or annual salary. For others—such as those with independent practices—their income may depend on reimbursement from insurance companies for the services they provide to their patients.

Differences in salary for NPs and other APRNs

The Bureau of Labor Statistics reported differing median annual wages for nurse anesthetists, nurse midwives, and nurse practitioners as of May 2022 (the most recent data):

• Nurse practitioners: $121,610²
• Nurse anesthetists: $203,090³
• Nurse midwives: $120,880⁴

Salaries may also vary depending on place of employment, with outpatient care centers and hospitals paying the highest median annual wages.

Salary differences based on education and experience

The highest 10% of APRNs earned more than $200,540 median annual salary, according to the Bureau of Labor Statistics.⁵ While different factors may play a role in what these skilled nurses earn, two potential factors are education and experience. For instance, workers across all occupations with a doctorate degree report 20% more in median weekly earnings than workers with a master’s degree, according to the Bureau of Labor Statistics.⁶ So, it’s possible that having more education could help APRNs reach a higher earning potential.

Role of insurance and government policies

Various insurance and government policies may also play a role in what APRNs earn. For instance, the current Medicare reimbursement policy for NPs lets these nurses directly bill Medicare for the services they provide. However, until recently, NPs were reimbursed at a lower rate than physicians received for the same services. Fortunately, some states have started to take steps to advocate for pay parity. So, NPs and other APRNs may have the opportunity to command higher earnings now or in the future.

Job Outlook and Demand

Projected demand for APRNs, including NPs, is much higher than the average for all occupations, according to the Bureau of Labor Statistics. For all APRN professions, projected growth is 40% between 2021 and 2031.¹ However, job outlook varies by APRN type:⁷

• Nurse practitioners: 46% projected job growth between 2021 and 2031
• Nurse anesthetists: 12% projected job growth between 2021 and 2031
• Nurse midwives: 7% projected job growth between 2021 and 2031

Not only is the projected growth rate for NPs higher than for other APRN roles, there is also a greater demand according to the numbers. The projected employment for NPS in 2031 is 359,400; for all other APRNs combined it is 59,300.⁷

Opportunities for Growth

APRNs might pursue the next step in their career by seeking managerial or administrative roles. Another potential option is to go into academia and help educate the next generation of advanced practice registered nurses. Some APRNs, particularly those who earn a doctoral degree, may go on to perform research—including as part of an interprofessional research team. Their work could lead to new understandings in the field of nursing care and help promote better patient outcomes in the future.

Conclusion

Nurse practitioners are one type of APRN, as are nurse anesthetists, nurse midwives, and clinical nurse specialists. While NPs are similar to other APRNs in many ways, they may differ in some aspects of their education, scope of practice, responsibilities, earning potential, and job outlook. If you’re considering a future as an NP or other APRN, understanding these differences may help you make a decision that fits your life and career goals.

Want to learn more about APRNs? Check out the following resources.

Professional Associations
American Association of Nurse Practitioners
American Nurses Association
American Association of Nurse Anesthesiology
American College of Nurse-Midwives
National Association of Certified Professional Midwives
Gerontological Advanced Practice Nurses Association
Nurse Practitioners in Women’s Health
National Association of Pediatric Nurse Practitioners
American Academy of Emergency Nurse Practitioners
American Association of Critical Care Nurses

Certification Boards
American Academy of Nurse Practitioners Certification Board
American Nurses Credentialing Center
Pediatric Nursing Certification Board
National Board of Certification and Recertification for Nurse Anesthetists
American Midwifery Certification Board

FAQs

1. Are NPs and APRNs the same thing?
   No. APRN, which stands for Advanced Practice Registered Nurse, is a broad category that includes nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists.
2. Do NPs and other APRNs work independently?
   The scope of practice for NPs and other APRNs varies by state. In some states, NPs and other APRNs may work independently, while in other states, they must work under the supervision of a physician.
3. How do NPs and other APRNs differ from physicians?
   NPs and other APRNs are not physicians, but they do have a higher level of education than RNs and may provide many of the same healthcare services as physicians. However, unlike physicians, APRNs may be limited in their scope of practice, prescriptive authority, and other responsibilities.
4. Do NPs and other APRNs earn the same salary?
   Salaries for NPs and other APRNs generally vary based on factors such as their role, where they work, and how much experience they have. Nurse anesthetists earned the highest median annual salary in 2022 at $203,090³; nurse practitioners came in second at $121,610.²
5. What is the demand for NPs and other APRNs?
   The demand for NPs and other types of APRNs is expected to grow at a combined projected rate of 40% between 2021 and 2031, according to the Bureau of Labor Statistics. There is a greater demand for NPs according to the numbers. The projected employment for NPS in 2031 is 359,400; for all other APRNs combined, it is 59,300.⁷

Sources:
¹https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-1
²https://www.bls.gov/oes/current/oes291171.htm
³https://www.bls.gov/oes/current/oes291151.htm
⁴https://www.bls.gov/oes/current/oes291161.htm
⁵https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-5
⁶https://www.bls.gov/emp/chart-unemployment-earnings-education.htm
⁷https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-6

Based on national data, not school-specific information. Conditions in your area may vary. Accessed 5/10/2023

This is an offer for educational opportunities that may lead to employment and not an offer or guarantee of employment and that may help prepare students to meet the licensing or certification requirements of the field they choose to study. Students should check with the appropriate licensing or certifying body to make sure the program they apply to will help meet any licensing or certification requirements. Students should also consult with a representative from the school they select to learn more about career opportunities in that field. Program outcomes vary according to each institution’s specific program curriculum