Advanced Practice Nursing in the United States


APN Role Exists in Country Today:

Nurse Practitioner
Nurse Anesthetist
Nurse Midwife
Clinical Nurse Specialist

Nationally Certified:

Recognize Foreign Licensure:

Treatment Authority:

Prescribing Authority:

Autonomy of Practice:
Yes in 36 states, No in 24 states (see here for List)

American Academy of Nurse Practitioners
American Academy of Colleges of Nursing


The role of APN’s in the United States has existed since the 1960’s and is of the oldest in the world today.  There are various forms of advanced practice nurses, of which the greatest numbers are Nurse Practitioners, and also include Nurse Midwives, Nurse Anesthetists, and Clinical Nurse Specialists.  Additional other advanced roles are available for nurses who are registered, and certification programs for nursing specialization.  The role of the APN in the United States varies according to state.

The roles can be further identified as:

  • Nurse Practitioner (NP) – 1.) Diagnose and treat patients in both primary and acute care.  2.) Provide initial and ongoing care including comprehensive histories, perform physical examinations, and other health assessment and screening activities.  3.) Treats and manages patients with acute and chronic diseases including ordering laboratory studies, prescribing medication, and making appropriate referrals for patients and families.  4.) Provide health promotion, disease prevention, health education, and counseling.
  • Nurse Anesthetists (CRNA) – 1.) Administer anesthesia.
  • Nurse Midwife – 1.) Provide medical care to women from puberty through menopause, for antepartum, intrapartum, postpartum, and nonsurgically related obstetric and gynecologic care. 2.) Consult, collaborate with other specialties. (The Pennsylvania, n.d.)
  • Clinical Nurse Specialist (CNS)


While the number of states requiring physician supervision has been quickly decreasing, still some states including California and New York still require some form of physician supervision.

Education and Certification

APN roles require a minimum of Master-level preparation offered by many universities throughout the country.  There is an organized body of credentialling, the ANCC, that provides guidelines for advanced nursing programs.  Once graduated, APN’s in the Nurse Practitioner, Nurse Anesthetist, and Nurse Midwife roles are required to pass a national certification exam to practice (with a few exceptions).  These certification exams require the students to have had a specific number of hours of on-the-job experience throughout their program in order to take the exam.

For individuals seeking to immigrate to the United States and gain registration/certification as an APN, Sheer (2007) significantly describes the process required, as an individual will need to have a registered nursing license, and then apply for an APN license through the specific state one is desiring to work.


Individuals in the Nurse Practitioner role have the option to specialize in various different roles, including geriatrics, pediatrics, acute care, and family care.  While individuals may not take a specific certification for additional medical specialties, they may work in the various specialized fields (i.e. dermatology, cardiology) and often regard themselves as a specialized individual in that category.

Have information to add to this page?

The Pennsylvania (n.d.) Midwife Practice Guidelines.  Retrieved from:

Sheer, B. (2007).  Nurse practitioners on the move: The journey to the United States.  Topics In Advanced Nursing eJournal. 7(2).  Retrieved from:


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