What is an Advanced Practice Nurse?

The Texas Board of Nursing, Rules and Regulations §221.1(3) and §222.1(1) defines Advanced Practice Nurse (APN) and describes the practice of APNs with these words:

Advanced Practice Nurse (APN) - A registered nurse, approved by the board to practice as an advanced practice nurse based on completing an advanced educational program acceptable to the board. The term includes a nurse practitioner, nurse-midwife, nurse anesthetist, and a clinical nurse specialist. The advanced practice nurse is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public and private clinics, and private practice. The advanced practice nurse acts independently and/or in collaboration with other health care professionals in the delivery of health care services.


TYPES OF ADVANCED PRACTICE NURSES
Nurse Practitioners (NPs)

Over 7,000 nurse practitioners are recognized by the Texas Board of Nursing. NPs specialize in such areas as pediatrics, geriatrics, family, or women's health. They perform physical exams and treat patients who have acute and chronic illnesses. NPs teach patients about their conditions and how to help themselves stay healthier.

Nurse practitioners provide health care within their scope of practice and collaborate with or refer patients to physicians when needed. About half of the patients to whom NPs provide health care are underserved Texans. Some of these Texans have no other source of health care, but most want to see a NP because they prefer the added value they receive. Not only do they have their condition treated competently, but they enjoy the extra time NPs spend teaching them how to manage the condition and stay healthier.


Certified Registered Nurse Anesthetists (CRNAs)

Almost 3,000 CRNAs are qualified to deliver anesthesia in Texas. CRNAs administer more than half of the anesthetics in the state and are the sole anesthesia providers in 77 rural Texas counties. Their services are essential to maintain obstetrical, surgical and emergency care for rural Texans. 48% of hospitals in Texas rely on independent CRNAs as their only anesthesia providers.

CRNAs have provided quality, cost-effective anesthesia services for well over 125 years. CRNAs in Texas are recognized as licensed independent practitioners. With an order for an anesthetic by a physician, dentist, or podiatrist, CRNAs are authorized to provide anesthesia services without direction or supervision, within the scope of their licensure and in accordance with clinical privileges.


Certified Nurse Midwifes (CNMs)

Currently about 350 CNMs are in active practice in Texas. Their practice is defined as the independent management of women's health care. It focuses on pregnancy, childbirth, postpartum care, newborn care, and the family planning and gynecological needs of women. CNM practices are structured to allow for consultation, collaboration, and referral to other health care providers for care outside the nurse-midwives' expertise.

In 1999, CNMs in Texas attended 13,202 hospital births, 594 births in free-standing birth centers, and 129 home births. 96% of births attended by nurse-midwives in Texas occur in hospitals. They continue to demonstrate a model of prevention, patient education, and family-centered care that has been very successful in lowering health care costs and improving outcomes.


Clinical Nurse Specialists (CNSs)

There are about 1400 CNSs in Texas. They earn master or doctoral degrees to become expert clinicians in specialty areas such as geriatric, critical care, oncology, or psychiatric-mental health care. CNSs develop improved methods of nursing care delivery to individuals and populations, teach nurses and other health care professionals, and act as clinical consultants. Some CNSs also assess and manage individuals’ health problems and prescribe medications. Therefore, in some settings, CNS and NP roles are similar. Research on CNS practice demonstrates positive outcomes including reduced hospital costs, reduced frequency of emergency room visits, and reduced medical complications in critical care patients.

Reference: Coalition for Nurses in Advanced Practice 2009