If you're an experienced nursing professional, there are a number of opportunities in advanced practice nursing you could pursue.
Advanced practice nurses fall into four categories: nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs) and clinical nurse specialists (CNSes). All require advanced education (typically leading to a master's degree) and clinical experience. After that, certification and state licensing requirements vary. So do salaries, which differ according to location, educational levels and practice setting.
Nurse Practitioners
The American College of Nurse Practitioners estimates that there were about 145,000 NPs in the US as of 2006. Even so, NPs are in short supply, especially since they are increasingly finding themselves on the front lines when it comes to providing primary healthcare. Among their responsibilities:
- Conducting physicals.
- Making diagnoses and providing treatment.
- Writing prescriptions (in all 50 states, plus the District of Columbia).
- Managing patients' chronic conditions, such as diabetes and hypertension.
With such diverse duties, NPs, who must hold a master's degree and a state license as well as be knowledgeable about prescription medications, need to be versatile. They must also be self-reliant since it's not unusual for them to be an area's only source of primary care, especially in rural settings.
Salaries for NPs vary but continue to rise. The average NP salary is more than $83,000, according to the Salary Wizard. A salary survey conducted by Advance for Nurse Practitioners showed that NPs who own their practices can make almost $95,000, but the survey reports that establishing such practices is difficult due to state and legal restrictions and the reluctance of some managed-care organizations to credential NPs. To boost income without establishing a practice of your own, consider specializing in areas such as women's health or gerontology.
Certified Registered Nurse Anesthetists
The nation's 30,000 CRNAs are among the most highly educated and highly compensated of advanced nurse professionals, earning average salaries of more than $146,000, according to the Salary Wizard. To further sweeten the income pot, CRNAs are now so well-trusted that their malpractice liability premiums are 39 percent lower than they were 15 years ago. In addition, some states are allowing CRNAs to practice without physician supervision.
CRNAs work in all settings, from hospitals to private offices. Most states require CRNAs to hold an MSN from an accredited program in the field. CRNAs must also be licensed and certified.
Certified Nurse-Midwives
Approximately 7,000 CNMs provide prenatal and gynecological care to women, deliver babies and provide postpartum care. In 2006, the most current year for which data is available from the National Center for Health Statistics, there were more than 317,000 CNM-attended births in the US.
While the majority of midwife-attended births still occur in hospitals, CNMs also practice in birthing centers and oversee home births. Many work as independent businesspeople, either as solo practitioners or in partnership with an OB/GYN or other CNMs. Most states require CNMs to be RNs, master's prepared.
Independent practices offer two major advantages, say CNMs. First, their generally well-educated patients tend to treat nurse-midwives -- whom they view as healthcare partners -- with confidence and respect. Second, the CNM can provide continuity of care into the postpartum setting. The downside? Some independent CNMs say they earn less than they would in a hospital. The American College of Nurse-Midwives estimates that full-time CNMs make approximately $60,000 to $90,000 a year.
Clinical Nurse Specialists
CNSes are "expert clinicians in a specialized area of nursing," according to the National Association of Clinical Nurse Specialists (NACNS). CNSes can specialize in a specific disease (such as cancer), population (such as women or children), setting (such as an ER), type of care (such as rehab) or type of problem (such as pain).
The NACNS reports that almost 70,000 RNs have received the education (a master's or PhD) and certification to practice as CNSes, and more than 14,000 are also nurse practitioners. Average CNS salaries exceed $81,000, according to the Salary Wizard. The NACNS has information on state requirements and various specialty certifications.
If one of these opportunities appeals to you, interview colleagues currently practicing in your area of interest and check with professional associations to determine the next steps you must take to advance your career.
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