Two nursing roles are higher than a Registered Nurse (RN): the Advanced Practice Registered Nurse (APRN) and the Doctor of Nursing Practice (DNP). These roles require more extensive education, advanced clinical training, and often come with greater autonomy and responsibility within the healthcare system.
Understanding the Nursing Hierarchy
The field of nursing offers various levels of education and practice, each with distinct qualifications and scopes of practice. Understanding this hierarchy helps clarify career progression paths within nursing.
Here's a general overview of the primary nursing levels, from entry-level to the highest clinical practice and academic degrees:
| Nursing Level | Acronym | Typical Education Required | Key Responsibilities |
|---|---|---|---|
| Certified Nursing Assistant | CNA | Certificate (typically 4-12 weeks) | Basic patient care (e.g., bathing, feeding, vital signs) |
| Licensed Practical Nurse | LPN | Diploma (1-2 years) | Basic medical care under RN/physician supervision |
| Registered Nurse | RN | ADN (2 years) or BSN (4 years) | Comprehensive patient care, medication administration, care planning |
| Advanced Practice Registered Nurse | APRN | MSN or DNP | Diagnose, treat, prescribe, specialize in various patient populations |
| Doctor of Nursing Practice | DNP | Doctoral Degree (DNP) | Highest clinical practice, leadership, health system improvement |
Advanced Practice Registered Nurse (APRN)
An Advanced Practice Registered Nurse (APRN) represents a significant step up from the traditional RN role. APRNs hold at least a master's degree (Master of Science in Nursing - MSN) or a doctoral degree (Doctor of Nursing Practice - DNP) in a specialized area of nursing. They are highly skilled clinicians who provide comprehensive care, often with a greater degree of independence than RNs.
Types of APRNs
APRNs specialize in various areas of patient care, each with a unique focus:
- Nurse Practitioner (NP): NPs provide primary and specialty healthcare services. They can diagnose and treat acute and chronic illnesses, order and interpret diagnostic tests, and prescribe medications in most states. NPs often focus on specific populations like family health, pediatrics, adult-gerontology, or psychiatric-mental health. Learn more about Nurse Practitioners from the American Association of Nurse Practitioners.
- Clinical Nurse Specialist (CNS): CNSs are experts in a specific patient population, setting, disease, type of care, or problem. They provide direct patient care, but also focus on improving healthcare outcomes through staff education, research, and system-level changes.
- Certified Nurse-Midwife (CNM): CNMs provide comprehensive women's healthcare, including gynecological exams, family planning services, prenatal care, labor and delivery, and postpartum care. They are skilled in normal physiological processes and focus on supporting natural childbirth. The American College of Nurse-Midwives offers more insights.
- Certified Registered Nurse Anesthetist (CRNA): CRNAs administer anesthesia and provide anesthesia-related care before, during, and after surgical, obstetrical, and diagnostic procedures. They are highly specialized and often work in operating rooms, birthing centers, or pain management clinics. Explore the role further with the American Association of Nurse Anesthetists.
Doctor of Nursing Practice (DNP)
The Doctor of Nursing Practice (DNP) is the highest clinical degree in nursing. While some APRN roles can be attained with an MSN, the DNP prepares nurses for advanced clinical practice, leadership roles, and the application of evidence-based research to improve healthcare outcomes at a systems level.
Key Aspects of a DNP
- Focus on Practice: Unlike a Ph.D. in nursing, which focuses on research and generating new nursing theory, the DNP emphasizes clinical practice, leadership, and the translation of research into practice.
- Leadership and Systems Improvement: DNP-prepared nurses are equipped to lead healthcare initiatives, improve patient safety and quality of care, and implement health policy changes.
- Advanced Clinical Skills: Many DNP programs are designed for current APRNs looking to deepen their clinical expertise and leadership skills, or for BSN-prepared nurses to become APRNs with a doctoral-level education.
- Rising Standard: The DNP is increasingly becoming the preferred or required degree for entry into advanced nursing practice roles. The American Association of Colleges of Nursing provides extensive information on DNP education and its impact.
In summary, both the Advanced Practice Registered Nurse (APRN) and the Doctor of Nursing Practice (DNP) represent educational and professional advancements beyond the Registered Nurse (RN) level, offering increased autonomy, specialized skills, and opportunities for leadership in healthcare.
