Coalition for Nurses in Advanced Practice

What is an APN?

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 APNs

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.

An excellent article in The Internet Journal of Advanced Nursing Practice effectively defends its thesis: "Nurse Practitioners (NPs) are uniquely qualified with advanced practice skills to meet the increased demand for primary care services." Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services.

For summarized, direct information about APNs, read APNs Meet the Health Care Needs of Texans. This article may be helpful to you as a handout for distribution. It describes specific information about prescriptive authority for APNs in Texas.

The January 31, 2005, issue of US News & World Report is definitely worth reading. It has a series of great articles in a section entitled, Who Needs Doctors? One article specifically helps the public understand scope of practice conflicts and specifically mentions the controversy between professional organizations representing nurse anesthetists and anesthesiologists. More than one of the articles helps the public understand that Advanced Practice Nurses can be part of the cure for an ailing health care system. Access the article on line in the US News & World Report archive, scroll down to 2005, January 31.

For a description of each APN practice role, refer to the following articles:

          o What is a CNM?
          o What is a CNS?
          o What is a CRNA? and the TANA site
          o What is an NP?

    * For a summary of the strengths of each APN practice role supported by research, see the following Research documents. They are suitable for printout and distribution:

          o Cost and Quality Research on CNMs
          o Cost and Quality Research on CNSs
          o Cost and Quality Research on CRNAs
          o Cost and Quality Research on NPs

    * NP Salary Survey 2007 by Advance for Nurse Practitioners