Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and may provide primary and specialty healthcare. The scope of practice varies from state to state.

Duties

Advanced practice registered nurses typically do the following:

  • Take and record patients' medical histories and symptoms
  • Perform physical exams and observe patients
  • Create patient care plans or contribute to existing plans
  • Perform and order diagnostic tests
  • Operate and monitor medical equipment
  • Diagnose various health problems
  • Analyze test results or changes in a patient’s condition and alter treatment plans, as needed
  • Give patients medicines and treatments
  • Evaluate a patient’s response to medicines and treatments
  • Consult with doctors and other healthcare professionals, as needed
  • Counsel and teach patients and their families how to stay healthy or manage their illnesses or injuries
  • Conduct research

APRNs work independently or in collaboration with physicians. In most states, they can prescribe medications, order medical tests, and diagnose health problems. APRNs may provide primary and preventive care and may specialize in care for certain groups of people, such as children, pregnant women, or patients with mental health disorders.

APRNs have some of the same duties as registered nurses, including gathering information about a patient’s condition and taking action to treat or manage the patient’s health. However, APRNs are trained to do other tasks, including ordering and evaluating test results, referring patients to specialists, and diagnosing and treating ailments. APRNs focus on patient-centered care, which means understanding a patient’s concerns and lifestyle before choosing a course of action.

Some APRNs also conduct research or teach staff about new policies or procedures. Others may provide consultation services based on a specific field of knowledge, such as oncology, which is the study of cancer.

The following are types of APRNs:

Nurse anesthetists (CRNAs) administer anesthesia and provide care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and some emergency services. Before a procedure begins, nurse anesthetists discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have, so that anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or administer a regional or local anesthesia to numb an area of the body. During the procedure, they monitor the patient’s vital signs and adjust the anesthesia as necessary.

Nurse midwives (CNMs) provide care to women, including gynecological exams, family planning services, and prenatal care. They deliver babies, manage emergency situations during labor, repair lacerations, and may provide surgical assistance to physicians during cesarean births. Nurse midwives may act as primary maternity care providers for women. They also provide wellness care, educating their patients on how to lead healthy lives by discussing topics such as nutrition and disease prevention. Nurse midwives also provide care to their patients’ partners for sexual or reproductive health issues.

Nurse practitioners (NPs) serve as primary and specialty care providers, delivering advanced nursing services to patients and their families. They assess patients, determine how to improve or manage a patient’s health, and discuss ways to integrate health promotion strategies into a patient’s life. Nurse practitioners typically care for a certain population of people. For instance, NPs may work in adult and geriatric health, pediatric health, or psychiatric and mental health.

Although the scope of their duties varies by state, many nurse practitioners work independently, prescribe medications, and order laboratory tests. Nurse practitioners consult with physicians and other health professionals when needed.

See the profile on registered nurses for more information about clinical nurse specialists (CNSs), also considered to be a type of APRN.

Work Environment

Nurse anesthetists, nurse midwives, and nurse practitioners held about 240,700 jobs in 2018. Employment in the detailed occupations that make up nurse anesthetists, nurse midwives, and nurse practitioners was distributed as follows:

Nurse practitioners                                                                       189,100
Nurse anesthetists 45,000
Nurse midwives 6,500

The largest employers of nurse anesthetists, nurse midwives, and nurse practitioners were as follows:

Offices of physicians 47%
Hospitals; state, local, and private 27
Outpatient care centers 9
Educational services; state, local, and private                              4
Offices of other health practitioners 3

Some advanced practice registered nurses (APRNs) provide care in patients’ homes. Some nurse midwives work in birthing centers, which are a type of outpatient care center.

APRNs may travel long distances to help care for patients in places where there are not enough healthcare workers.

Injuries and Illnesses

APRN work can be both physically and emotionally demanding. Some APRNs spend much of their day on their feet. They are vulnerable to back injuries because they must lift and move patients. APRN work can also be stressful because they make critical decisions that affect a patient’s health.

Because of the environments in which they work, APRNs may come in close contact with infectious diseases. Therefore, they must follow strict guidelines to guard against diseases and other dangers, such as accidental needle sticks or patient outbursts.

Work Schedules

Most APRNs work full time. In physicians’ offices, APRNs typically work during normal business hours. In hospitals and other healthcare facilities, they may work in shifts—including nights, weekends, and holidays—to provide round-the-clock patient care. Some APRNs, especially those who work in critical care or those who deliver babies, also may need to be on call.

Education and Training

Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), must have at least a master’s degree in their specialty role. APRNs also must be licensed registered nurses in their state, pass a national certification exam, and have a state APRN license.

Education

Nurse anesthetists, nurse midwives, and nurse practitioners must have at least a master’s degree from an accredited program. These programs include classroom education and clinical experience. Courses in subjects such as advanced health assessment, pathophysiology, and pharmacology are common as well as coursework specific to the chosen APRN role.

An APRN must have a registered nursing (RN) license before pursuing education in one of the advanced practice roles, and a strong background in science is helpful.

Most APRN programs prefer candidates who have a bachelor’s degree in nursing. However, some schools offer bridge programs for registered nurses with an associate’s degree or diploma in nursing. Graduate-level programs are also available for individuals who did not obtain a bachelor’s degree in nursing but in a related health science field. These programs prepare the student for the RN licensure exam in addition to offering the APRN curriculum.

Although a master’s degree is the most common form of entry-level education, APRNs may choose to earn a Doctor of Nursing Practice (DNP) or a Ph.D. The specific educational requirements and qualifications for each of the roles are available on professional organizations’ websites.

Prospective nurse anesthetists must have 1 year of experience working as registered nurse in a critical care setting as a prerequisite for admission to an accredited nurse anesthetist program.

Licenses, Certifications, and Registrations

States’ requirements for APRNs vary. In general, APRNs must have a registered nursing license, complete an accredited graduate-level program, pass a national certification exam, and have an APRN license. Details are available from each state’s board of nursing.

To become licensed and use an APRN title, most states require national certification.

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the National Certification Examination (NCE). Certified registered nurse anesthetists (CRNAs) must maintain their certification through the Continued Professional Certification (CPC) Program.

The American Midwifery Certification Board offers the Certified Nurse-Midwife (CNM). Individuals with this designation must recertify via the Certificate Maintenance Program.

There are several different certifications for nurse practitioners, including those available from the American Academy of Nurse Practitioners Certification Board(AANPCB), the American Nurses Credentialing Center (ANCC), and the Pediatric Nursing Certification Board (PNCB). Each of these certifications requires periodic renewal.

In addition, APRN positions may require cardiopulmonary resuscitation (CPR), basic life support (BLS), or advanced cardiac life support (ACLS) certification.

Advancement

Some APRNs take on managerial or administrative roles; others go into academia. APRNs who earn a doctoral degree may conduct independent research or work on an interprofessional research team.

Personality and Interests

Nurse anesthetists, nurse midwives, and nurse practitioners typically have an interest in the Thinking and Helping interest areas, according to the Holland Code framework. The Thinking interest area indicates a focus on researching, investigating, and increasing the understanding of natural laws. The Helping interest area indicates a focus on assisting, serving, counseling, or teaching other people.

If you are not sure whether you have a Thinking or Helping interest which might fit with a career as a nurse anesthetist, nurse midwife, and nurse practitioner, you can take a career test to measure your interests.

Nurse anesthetists, nurse midwives, and nurse practitioners should also possess the following specific qualities:

Communication skills. Advanced practice registered nurses must be able to communicate with patients and other health care professionals to ensure that the appropriate course of action is understood.

Critical-thinking skills. ARPNs must be able to assess changes in a patient’s health, quickly determining the most appropriate course of action and if a consultation with another health care professional is needed.

Compassion. Nurses should be caring and sympathetic when treating patients who are in pain or who are experiencing emotional distress.

Detail oriented. APRNs must be responsible and detail oriented because they provide various treatments and medications that affect the health of their patients. During an evaluation, they must pick up on even the smallest changes in a patient’s condition.

Interpersonal skills. Advanced practice registered nurses must work with patients and families as well as with other health care providers and staff within the organizations where they provide care. They should work as part of a team to determine and execute the best possible healthcare options for the patients they treat.

Leadership skills. Advanced practice registered nurses often work in positions of seniority. They must effectively lead and sometimes manage other nurses on staff when providing patient care.

Resourcefulness. APRNs must know where to find the answers that they need in a timely fashion.

Pay

The median annual wage for nurse anesthetists, nurse midwives, and nurse practitioners was $115,800 in May 2019. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $82,460, and the highest 10 percent earned more than $184,180.

Median annual wages for nurse anesthetists, nurse midwives, and nurse practitioners in May 2019 were as follows:

Nurse anesthetists $174,790
Nurse practitioners                                                                        109,820
Nurse midwives 105,030

In May 2019, the median annual wages for nurse anesthetists, nurse midwives, and nurse practitioners in the top industries in which they worked were as follows:

Hospitals; state, local, and private $122,420
Outpatient care centers 118,530
Offices of physicians 113,190
Offices of other health practitioners 112,590
Educational services; state, local, and private                               108,790

Most advanced practice registered nurses (APRNs) work full time. In physicians’ offices, APRNs typically work during normal business hours. In hospitals and other healthcare facilities, they may work in shifts—including nights, weekends, and holidays—to provide round-the-clock patient care. Some APRNs, especially those who work in critical care or those who deliver babies, also may need to be on call.

Job Outlook

Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 26 percent from 2018 to 2028, much faster than the average for all occupations. Employment growth will vary by occupation. Because nurse midwives is a small occupation, however, the fast growth will result in only about 1,000 new jobs in this occupation over the 10-year period.

Growth will occur because of an increase in the demand for healthcare services. Several factors will contribute to this demand, including an increased emphasis on preventive care and demand for healthcare services from the aging population.

Advanced practice registered nurses (APRNs) perform many of the same services as physicians. APRNs will be increasingly used in team-based models of care, particularly in hospitals, offices of physicians, clinics, and other ambulatory care settings, where they will be needed to provide preventive and primary care.

APRNs will also be needed to care for the large baby-boom population. As baby boomers age, they will experience ailments and complex conditions that require medical care. APRNs will be needed to keep these patients healthy and to treat the growing number of patients with chronic and acute conditions.

As states change their laws governing APRN practice authority, APRNs are being allowed to perform more services. APRNs also are being recognized more widely by the public as a source for primary healthcare.

Job Prospects

About 16,900 openings for nurse practitioners, 3,200 openings for nurse anesthetists, and 500 openings for nurse midwives are projected each year, on average, over the decade.  

Many of those openings are expected to result from the need to replace workers who exit the labor force, such as to retire, and from the need to replace workers who transfer to different occupations.

Overall, job opportunities for advanced practice registered nurses are likely to be excellent. APRNs will be in high demand, particularly in medically underserved areas such as inner cities and rural areas.

For More Information

For more information about nurse anesthetists, including a list of accredited programs, visit

American Association of Nurse Anesthetists

For more information about nurse midwives, including a list of accredited programs, visit

American College of Nurse-Midwives

For more information about nurse practitioners, including a list of accredited programs, visit

American Association of Nurse Practitioners

For more information about registered nurses, including credentialing, visit

American Nurses Association

For more information about nursing education and being a registered nurse, visit

National League for Nursing

For more information about undergraduate and graduate nursing education, nursing career options, and financial aid, visit

American Association of Colleges of Nursing

For more information about states’ Boards of Nursing, visit

National Council of State Boards of Nursing

For more information about certification, visit

American Academy of Nurse Practitioners Certification Board

American Association of Critical-Care Nurses

American Midwifery Certification Board

American Nurses Credentialing Center

National Certification Corporation

National Board of Certification and Recertification for Nurse Anesthetists

Pediatric Nursing Certification Board

CareerOneStop

For career videos on nurse anesthetists, nurse midwives, and nurse practitioners, visit

Nurse Anesthetists

Nurse Midwives

Nurse Practitioners

 

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FAQ

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