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Advanced Practice Nurses Fill Important Healthcare Role

As the nation's citizens continue to live longer and face potential health care problems, the demand for registered nurses (RNs) as well as advanced practice nurses (APNs) is expected to increase.

Q: What, exactly, is an advanced practice nurse?
The advanced practice nurse (APN) is an umbrella term given to a registered nurse who has a graduate degree in nursing or a related field and certification in their particular area of specialization. Under this umbrella, there are four principal types of APNs: certified nurse practitioner (CNP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS).

Q: What is a certified nurse practitioner allowed to do?
A certified nurse practitioner (CNP) is certified by either the American Nurses Credentialing Center, the National Certification Corporation or the National Board of Pediatric Nurse Practitioners and Associates. There are a variety of specialties within the realm of certified nurse practitioner, including that of adult nurse practitioner, pediatric nurse practitioner, family nurse practitioner, acute care nurse practitioner, and a school nurse practitioner.

An experienced nurse may wish to become a CNP in order to build on previous nursing knowledge and skill. A CNP may do advanced practice within his or her area of specialty, such as emergency care or pediatric care. For example, a CNP may prescribe medications, perform diagnostic procedures, interpret laboratory and diagnostic reports and perform intensive patient histories and physical examinations. CNPs serve as case managers and patient advocates, and they work with other health care professionals. Nurse practitioners work in hospitals, physician offices, and outpatient surgical settings, and some even have their own practices.

Q: I've heard that midwives can now deliver babies. Is that true?
A: Generally, yes. A certified nurse midwife (CNM) is certified by the American College of Nurse-Midwives. A nurse midwife is trained in women's health care management, and focuses particularly on low-risk pregnancies, wellness and prevention, family planning, and gynecological needs of women. Nurse-midwifery care is primarily intended for healthy women; however, even when women experience medical, gynecological, and/or obstetrical complications, the CNM can continue to help with their care.

Q: What are certified registered nurse anesthetists?
Certified registered nurse anesthetists (CRNAs) are anesthesia specialists who administer 65 percent of the anesthetics delivered to patients each year in the United States.They are certified by the Council on Certification of Nurse Anesthetists and recertified every two years by the Council on Recertification of Nurse Anesthetists of the American Association of Nurse Anesthetists.CRNAs administer every type of anesthetic and practice in every type of setting in which anesthesia is delivered, working closely with surgeons, anesthesiologists, dentists, podiatrists or other qualified healthcare professionals.Some states require physician supervision of CRNAs, including Ohio; however, most states do not.When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine.

Q: What does a clinical nurse specialist do?
A clinical nurse specialist (CNS) provides direct nursing care to individuals, families, and groups, and manages complex problems in accordance with standards established by the profession. Specialists demonstrate an in-depth understanding of complex medical-surgical problems, and may intervene to manage and improve patient care. A clinical nurse specialist is certified by the American Nurses Credentialing Center.

Q: Can advanced practice nurses prescribe medicine?
 Yes, if they have the necessary education and have obtained a certificate to prescribe. A law passed in 2000 created the Committee on Prescriptive Governance to establish an approved listing of drugs that may be prescribed by advanced practice nurses. The committee consists of advanced practice nurses, physicians and pharmacists. The listing has been developed, and advanced practice nurses began prescribing medications in 2002.


Law You Can Use is a weekly consumer legal information column provided by the Ohio State Bar Association. This article was prepared by Renee Mallett, Esq., Director of Patient Safety at The Ohio State University Medical Center.

Articles appearing in this column are intended to provide broad, general information about the law. Before applying this information to a specific legal problem, readers are urged to seek advice from an attorney.

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