An advanced nurse practitioner, formally called an advanced practice registered nurse (APRN), is a registered nurse with graduate-level education and clinical training who can diagnose conditions, order tests, prescribe medications, and manage treatment plans. The term covers four distinct roles in healthcare, though “nurse practitioner” (NP) is the one most patients encounter. With a median annual salary of $132,050 and job growth projected at 35% over the next decade, it’s one of the fastest-growing roles in American healthcare.
The Four Types of APRNs
Advanced practice nursing isn’t a single job title. It includes four specialized roles, each with its own scope and patient population.
- Nurse Practitioners (NPs) provide primary, acute, and specialty care across the lifespan. They assess, diagnose, and treat illnesses and injuries, and they’re the most common type of APRN working in outpatient clinics, urgent care centers, and hospitals.
- Certified Registered Nurse Anesthetists (CRNAs) deliver the full range of anesthesia and pain management services, often in surgical settings.
- Certified Nurse-Midwives (CNMs) provide primary care along with gynecological and reproductive health services, including prenatal care and labor support.
- Clinical Nurse Specialists (CNSs) diagnose and manage patients while also driving practice changes within healthcare organizations, ensuring teams follow evidence-based care standards.
When most people search for “advanced nurse practitioner,” they’re asking about the NP role specifically. The rest of this article focuses primarily on nurse practitioners, since that’s the role you’re most likely to see as a patient or pursue as a career.
What Nurse Practitioners Actually Do
Nurse practitioners function as primary and specialty care providers. In a typical visit, an NP can evaluate your symptoms, run or order diagnostic tests like bloodwork or imaging, interpret the results, make a diagnosis, write prescriptions (including controlled substances in many states), and create a treatment plan. For many patients, an NP is the only provider they see for routine and chronic care.
NPs choose a population focus area when they train, and that specialty determines which patients they treat. The eight recognized focus areas are:
- Family (all ages, the most common specialty)
- Adult-Gerontology Primary Care
- Adult-Gerontology Acute Care
- Pediatric Primary Care
- Pediatric Acute Care
- Neonatal
- Psychiatric-Mental Health
- Women’s Health
A family NP can see patients of any age for a wide range of issues. A psychiatric-mental health NP focuses on diagnosing and treating conditions like depression, anxiety, PTSD, and substance use disorders. Neonatal NPs work in intensive care units with critically ill newborns. The specialization you choose shapes your entire career trajectory, and switching later requires additional education and a new certification exam.
Education and Clinical Training
Becoming a nurse practitioner requires a graduate degree. Currently, most NPs hold a Master of Science in Nursing (MSN), though the field is moving toward making a Doctor of Nursing Practice (DNP) the standard entry-level degree. The National Organization of Nurse Practitioner Faculties called for this shift by 2025, and the American Association of Colleges of Nursing endorsed the move to doctoral-level preparation back in 2004. In practice, both MSN and DNP graduates can become licensed NPs today.
Before entering a graduate program, you need a Bachelor of Science in Nursing and an active RN license. Graduate NP programs typically take two to four years depending on whether you pursue a master’s or doctoral track, and whether you attend full or part time. Every NP student must complete a minimum of 500 supervised direct patient care clinical hours during their program. Many programs exceed this minimum significantly, especially DNP programs that incorporate quality improvement projects and leadership training alongside clinical rotations.
Certification and Licensing
After finishing a graduate program, NPs must pass a national board certification exam in their chosen specialty. The two primary certifying bodies are the American Academy of Nurse Practitioners Certification Board (AANPCB) and the American Nurses Credentialing Center (ANCC). The exam you take depends on your specialty area. Certification isn’t a one-time event: NPs must recertify every five years, which requires ongoing continuing education and clinical practice hours.
State licensing adds another layer. Each state’s board of nursing issues NP licenses, and the rules for what NPs can do vary considerably depending on where they practice.
How Practice Authority Varies by State
One of the most significant factors shaping an NP’s daily work is which state they practice in. States fall into three categories:
- Full practice states allow NPs to evaluate patients, diagnose, order and interpret tests, and prescribe medications (including controlled substances) independently, under the authority of the state board of nursing alone.
- Reduced practice states require NPs to maintain a career-long collaborative agreement with a physician or another provider before they can deliver patient care. At least one element of practice is restricted without that agreement.
- Restricted practice states require ongoing supervision, delegation, or team management by another provider for the NP to see patients.
More than 30 states now grant NPs some form of independent practice, and the trend over the past decade has been toward expanding NP authority, particularly in states with physician shortages in rural areas. If you’re considering NP care or an NP career, the state you’re in meaningfully affects what that looks like.
How NPs Compare to Physicians
This is the question patients often have in the back of their minds: is the care as good? A large review published in The Journal for Nurse Practitioners analyzed data from 37 studies spanning two decades. Across all 11 patient outcomes measured, NP care was comparable to or better than physician care. Patient satisfaction, functional status, blood pressure control, blood glucose management, emergency department visits, hospitalizations, and mortality rates were all similar between the two. One area where NPs showed a measurable edge was in managing cholesterol levels in primary care settings.
The training models differ in important ways, though. NPs are trained in a nursing framework that emphasizes holistic patient care, health promotion, and disease prevention alongside clinical diagnosis and treatment. Physicians complete medical school followed by residency, with more total clinical hours before independent practice. In day-to-day primary care, patients often can’t tell the difference in the quality of a visit.
How NPs Differ From Physician Assistants
NPs and physician assistants (PAs) fill similar roles in many healthcare settings, but the regulatory and training structures are different. NPs are regulated by state nursing boards, trained in a nursing model, and choose a population focus during their education. PAs are regulated by state medical boards, trained in a medical model, and can practice across specialties without formal recertification in a new area.
The biggest practical difference is autonomy. NPs can practice independently in more than 30 states. PAs nearly always work under the supervision or collaborative authority of a physician, though some states have begun loosening those requirements. For patients, the care experience with either provider is often similar in primary care and urgent care settings.
Salary and Job Growth
The Bureau of Labor Statistics groups NPs with nurse anesthetists and nurse-midwives for salary reporting. The combined median annual wage was $132,050 as of May 2024. CRNAs tend to earn at the higher end of that range, while NPs and CNMs typically earn somewhat less, though still well above the national median for all occupations.
Employment across all three APRN roles is projected to grow 35% from 2024 to 2034. That’s dramatically faster than the average for all U.S. jobs. The growth is driven by an aging population, expanded insurance coverage, physician shortages in primary care and rural areas, and the ongoing push to use NPs to fill gaps in access to care. Psychiatric-mental health NPs are in particularly high demand given the nationwide shortage of mental health providers.