Question: What is the difference between registered nurses (RNs) and advanced practice registered nurses (APRNs) and how do their responsibilities differ?

Answer: Both APRNs and RNs perform health evaluations and diagnoses, and support patients through consultations, treatment administration, and medical procedures to address mild to severe health conditions. However, APRNs have specialized training and knowledge to make medical decisions that RNs may not have the training or experience to make. Their role also focuses more on analyzing patient data to determine plans of care, while RNs focus on implementing these plans of care.

RNs and APRNs work in concert to achieve the same mission: competent and compassionate patient care. However, their roles in achieving this mission are generally distinct. RNs deliver direct patient care as specified in a patient’s medical plan, while APRNs create this patient care plan alongside other advanced practice providers, and supervise other medical staff, including RNs and medical assistants. APRNs also generally have broader patient oversight, in that they often have a larger patient load than do RNs, and may have longer-term relationships with patients, depending on the medical setting. For example, APRNs in primary care settings can often serve as the primary care provider for a set of patients, and therefore may work with a given patient for months, if not years.

RNs provide medical support and preventative care to patients at the bedside, fulfilling the necessary tasks to monitor and maintain patients’ health. Their responsibilities include conducting physical assessments, ordering labs, operating medical equipment, and administering medications. Though they do not typically receive academic training to work with specific patient populations, RNs can sometimes focus on particular types of patients or medical conditions. For example, Critical Care RNs work in intensive care settings with severely injured or ill patients, while Labor and Delivery RNs work with pregnant mothers and their newborn children.

APRNs fulfill all of the above responsibilities that RNs do, but with the additional responsibilities of coordinating patient care and using specialized knowledge to manage complex patient conditions. Types of APRNs include nurse practitioners (NPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs). Below is a brief summary of each type of APRN:

  • Nurse Practitioners (NPs) are specialized health care providers and leaders who have the training and expertise to care for patients in much the same way that physicians do, in that they provide direct care and also coordinate care. Their tasks vary depending on their specialization and the setting in which they work, but typically include evaluating a patient’s health status and medical history to create a medical care plan, coordinating patient discharges and transfers to other medical units, directing registered nurses and medical assistants in the collaborative care of patients, performing procedures and administering medical treatments as necessary, and educating patients about preventative health and management of their conditions. Nurse practitioners tend to specialize in the care of specific populations, such as children, geriatric patients, women, families, or psychiatric patients. After earning their MSN or DNP, registered nurses who wish to become nurse practitioners will typically sit for a certification examination in their desired specialty through either the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP).
  • Certified Nurse Midwives (CNMs) specialize in caring for women before, during, and after pregnancy, supporting women in labor and delivery, and caring for newborn infants. They provide gynecological exams, prenatal care, and family planning services. They also advise women during their reproductive years about maintaining their reproductive health, and counsel pregnant women on how to care for themselves during their pregnancy. After graduating from their graduate degree program in nurse midwifery, prospective CNMs must take and pass a certification examination administered by the American Midwifery Certification Board (AMCB).
  • Certified Registered Nurse Anesthetists (CRNAs) administer anesthesia to patients who are undergoing surgery, are in need of trauma stabilization and treatment, or require palliative care. CRNAs are also responsible for developing an anesthesia plan for each patient with whom they work, and counseling patients on the anesthesia procedure prior to administration. After completing their graduate education in nurse anesthesia, RNs must pass a national certification examination administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).
  • Clinical Nurse Specialists (CNSs) are similar to nurse practitioners in that they provide direct patient care, while also taking on more administrative and leadership responsibilities to improve systems of care in the setting in which they work. Clinical nurse specialists, like nurse practitioners, often specialize in helping a particular sector of the overall patient population, such as women, psychiatric patients, or underserved communities. After completing their graduate nursing education, RNs who wish to become clinical nurse specialists must sit for a certification examination administered by the ANCC.

The Core Differences Between Staff Nursing and Advanced Practice Nursing

As the career descriptions above illustrate, all APRNs must obtain advanced certification in a specific area of nursing practice, and have the academic training and additional clinical experience to oversee all aspects of their patients’ medical care. In addition, APRNs must utilize more of their analytical and organizational skills relative to their direct bedside care skills when stepping into an advanced practice provider role. Due to their increased responsibilities in the areas of care coordination, medical data analysis, and team leadership, APRNs do not generally fulfill bedside care responsibilities as often as do staff nurses. Transitioning from being an RN to being an APRN requires delegating responsibilities to others on a team, and removing oneself to some extent from the direct caretaker role.

Taking the place of these direct care tasks are increased care management responsibilities, which often involve a longer-term relationship with patients even if direct-care contact is reduced. For example, APRNs who serve as patients’ primary care providers (such as family nurse practitioners, pediatric primary care nurse practitioners, or adult-gerontology primary care nurse practitioners) may maintain a working relationship with their patients for months if not years, while RNs in primary care settings may only see patients briefly during their check-ups or to address mild to moderate ailments. In acute or intensive care settings, APRNs such as adult-gerontology acute care nurse practitioners or psychiatric mental health nurse practitioners may follow a patient from their admittance into the hospital through their discharge or transfer to another medical institution, while RNs in these settings generally do not continue working with patients beyond fulfilling bedside care tasks.

APRNs complete several years of graduate-level training and this training prepares them to address complex patient health issues that RNs may not have the preparation to identify and treat. For example, while a labor and delivery staff nurse may be prepared to fulfill tasks in order to support the health of a mother in labor, certified nurse midwives have the training to oversee a mother’s health throughout her pregnancy, and to provide care to a mother before, during, and after labor. Similarly, while an acute care staff nurse may be adept at stabilizing patients and giving them the treatments they need, an acute care nurse practitioner is qualified to diagnose patient health issues and oversee a patient’s care throughout his or her tenure in inpatient or intensive care.

In addition, APRNs have the credentials to operate largely independently of supervision. At present, 22 states and the District of Columbia grant APRNs full practice authority, while 16 states grant reduced practice authority and 12 states grant restricted practice authority. Even in states that still require APRNs to be supervised by a physician, APRNs are qualified to direct staff nurses and other members of the medical team, and do not require the same degree of oversight or direction that RNs do in the same medical environment. With this increased autonomy comes both increased accountability and responsibility, which may prove stressful during times when difficult or complex decisions must be made about a patient’s care. However, many APRNs find the ability to independently evaluate, diagnose, counsel, and treat patients, and to develop patient care plans and guide medical staff in the delivery of care, to be rewarding on a professional and personal level.

Despite these differences between registered nurses and APRNs, it is important to note that the heart of advanced practice registered nursing is the same as that of registered nursing, in that both focus on competent, timely, and attentive patient care. Both types of roles also require strong listening, clinical, and critical thinking skills. Furthermore, the role and responsibilities of RNs and APRNs can overlap depending on the medical setting, individuals’ degree of experience, and other factors. For example, some APRNs may take on more direct clinical responsibilities that overlap with the tasks of their RN colleagues, while some RNs who have a great deal of experience in a particular field may assume leadership and care coordination responsibilities insofar as their position and credentials allow.