An Advanced Practice Registered Nurse (APRN) is a nurse who has earned a graduate-level degree, such as a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP), in a distinct role and patient population, has passed a national certification exam, and acquired a license to practice. APRNs are prepared for a career in nursing through coursework and hands-on learning to evaluate, diagnose and treat patient problems. These courses and clinical hours also prepare an APRN to prescribe medications and order tests.

According to the APRN Consensus Model, APRNs can be Certified Registered Nurse Anesthetists (CRNA), Certified Nurse Midwives (CNM), Clinical Nurse Specialists (CNS), or Certified Nurse Practitioners (NP). To obtain a license to practice in any of these four APRN fields, a nurse must complete a related formal education program. 

Certified Registered Nurse Anesthetists (CRNA)

CRNAs can usually be found in the surgery wing or center of a hospital, administering anesthesia for patients undergoing medical procedures. These nurses are expected to understand and manage anesthesia care and anesthesia-related care for patients in a variety of demographics. 

These APRNs have completed a master’s in nursing or a master’s degree in another related field, as well as a graduate-level degree in anesthesia. These nurses are also certified by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

Certified Nurse Midwives (CNM)

A CNM specializes in childbirth and may be trained to do a variety of medical services or treatments for women. These services vary from gynecologic care and preconception care to prenatal care, postpartum care, childbirth and the care of a newborn. CNM care is offered in a variety of settings ranging from community or public health clinics to private doctor’s offices. 

Licensed CNMs are certified by the American Midwifery Certification Board. They have completed a master’s in nursing and a graduate-level midwifery program, as well as a mandatory national certification examination with recertification stipulations. 

Clinical Nurse Specialists (CNS) 

A CNS delivers high-level clinical expertise in a chosen specialty of nursing. These RNs provide leadership and are educated at an advanced level to provide top-notch patient care. The CNS will diagnose and treat many critical health conditions and illnesses. These nurses learn to manage long-term diseases and also practice illness prevention. They can prescribe medication if they apply to do so and many are primary care providers. 

To be recognized as a CNS, completion of a master’s in nursing or a post-master’s certificate in nursing is required. Prerequisites will depend on which state you are trying to obtain a license. 

Certified Nurse Practitioners (NP)

NPs provide advanced, comprehensive care in a wide variety of settings. These nurses are expected to understand and execute disease prevention, health promotion and education, and diagnosis and management of acute and chronic diseases. This typically requires initial and ongoing patient care to a variety of patients and conditions. 

Nurse practitioners have completed a master’s in nursing, a higher degree in nursing or a related field with a primary focus in nursing. Nursing requirements vary by state, but these nurses are typically certified by a state committee and medical board and the Board of Nursing, and have completed a certification by one of the following:

There are several focuses NPs can enter to become family nurse practitioners, psychiatric nurse practitioners and more.

When registered nursing and advanced practice nursing were first being separated into two clearly defined roles, there wasn’t a national licensure examination for APRNs. Nursing boards started to use certification examinations to evaluate APRNs and their ability to practice. 

In fact, most boards of nursing use APRN certifications as a requirement for licensure. Data released in 2007 by the National Council of State Boards of Nursing (NCSBN) indicates 45 out of 57 boards of nursing in the U.S. use APRN certification exams as a prerequisite to practice for nurse practitioners and 38 state nursing boards use these certifications as a prerequisite for clinical nurse specialists. Now that the industry has adopted the APRN Uniform Requirements (PDF, 95 KB), the number of boards that require nurses to pass certification exams is expected to rise.

Although most nursing boards require certification examinations, some do not. This has resulted in an unclear distinction between certification and licensure. There have even been cases where a nurse received a certification but did not apply for licensure because they assumed they were fully qualified to practice as an APRN after the certification exam. 

Most of the time, APRN certification is a voluntary process where a nurse takes an exam in an area of specialty to be recognized as an expert in that subject matter. Licensure, on the other hand, is required to practice. 

In most cases, a certification in your area of specialty will be required to obtain an APRN license. There are some specialties that do not require any certification(s), but having one may indicate you have received additional education and training in patient care or that you are an expert in the subject matter. 

Depending on the area of specialty, each certification exam will have its own requirements and study materials. It is also likely that to keep your certification(s) up to date, renewals will be required every few years. Sometimes additional clinical practice and/or education materials may be required for certification renewal.

APRN certification exams are intended to measure the preparedness of a nurse for the desired professional APRN role. It is beneficial to showcase your related skills and comprehension to practice in this specialty during the examination process. Exam materials will be limited to questions with a clear relationship to public safety. 

To practice as an APRN, you must have a license. A license authorizes the legal scope of your work including the use of your title and the standards of your practice. Nurses who do not practice within this scope may face disciplinary action set by the state board of nursing. 

To receive an APRN license, you must apply through the state to enact a nurse practice act. From there, a state legislature will pass authority to the board of nursing in your state to enforce your nurse practice act and to issue your nursing license. This process is designed to regulate nursing and to protect public health and safety. 

Prerequisites for an APRN license will differ depending on which state you live in, but nurses typically must complete a nursing education program from an approved list and receive a passing score on the NCLEX-RN. 

It is likely you will need all of the following to qualify for APRN licensure:

These licensure examinations are designed to measure entry-level practice. Each year, the exams are reviewed for currency, validity, cultural bias and more. Some exams may be predominantly clinical practice-related and many are graded using a pass/fail system. 

Most Nursing jobs may require an APRN certification exam to be eligible for the position, but there are some specialties or job positions that don’t. Having a certification(s) can indicate you are an expert in the subject matter or nursing specialty. In many cases, these certifications can provide additional career opportunities or advancements.

Nurses can obtain certifications in an area that aligns with their specialty, including oncology nursing, emergency department nursing or informatics. Once certified, nurses can use initials at the end of their title to indicate a level of understanding or certification in a specialty. This is a way for nurses to differentiate from one another. 

APRNs who fit into a specialty such as family nurse practitioners or psychiatric nurse practitioners may be required to take one of the following certification exams: 

Pediatric Certificate Exam

Most advanced pediatric nurses are required to pass a certification exam to obtain a license. The following agencies are nationally recognized and offer pediatric nurse practitioner certification:

Pediatric Nursing Certification Board (PNCB)

The American Nurses Credentialing Center (ANCC)

Family Nurse Practitioner Certificate Exam

Family nurse practitioners (FNPs) focus on patients of all demographics. They are advanced-practice nurses and their skills are in high demand. Most of the time NP certification is required to obtain a license to practice. These certifications also look great on a resume and can open doors to additional job opportunities.

The following organizations offer certifications for NPs and FNPs:

American Academy of Nurse Practitioners (AANP)

American Nurses Credentialing Center (ANCC)

Gerontology Certificate Exam

Geriatric nurses learn patient care for older demographics and play an important role in helping the elderly with mobility and improving general quality of life. Some common conditions geriatric nurses treat include osteoporosis, cancer and Alzheimer’s disease. 

The ANCC Gerontological Nursing board certification exam assesses entry-level knowledge of the gerontological specialty. Upon passing this exam, you will receive the title of Registered Nurse-Board Certified (RN-BC). This certification is valid for five years. 

Neonatal Care Certificate Exam

Neonatal nurses and nurse practitioners provide care to neonates, infants and toddlers. Some cases include treating critically ill newborns or babies. These nurses can be found in labor and delivery departments, neonatal ICUs and other types of acute care settings. To receive a neonatal care certificate, there are several organizations you can turn to, including:

The American Association of Critical Care Nurses (AACN)

National Certification Corporation (NCC)

Emergency Nurse Practitioner Certification

The life of a trauma nurse is thrilling and fast-paced. Emergency Nurse Practitioners (ERNPs) can be found at the hospital, in trauma centers, urgent care centers, on the scene as first responders and in many other emergency health service settings. Most ERNPs get certified to obtain a license in the state where they want to practice. 

NPs can also obtain these certifications to expand their practice. For example, a pediatric nurse may pursue an ERNP certification so they can work on kids who come into the ER or urgent care. The following agencies offer emergency nurse practitioner certification:

The American Academy of Nurse Practitioners Certification Board (AANP)

The American Nurses Credentialing Center (ANCC) – Recertification Only

Last Updated August 2020