TABLE 1-1 Types of Advanced Practice Registered Nurses (APRNs)

Who Are They?

How Many in United States?

What Do They Do?

Nurse Practitioners (NPs)

153,348

Take health histories and provide complete physical exams; diagnose and treat acute and chronic illnesses; provide immunizations; prescribe and manage medications and other therapies; order and interpret lab tests and x-rays; provide health teaching and supportive counseling.

Clinical Nurse Specialists (CNSs)

59,242*

Provide advanced nursing care in hospitals and other clinical sites; provide acute and chronic care management; develop quality improvement programs; serve as mentors, educators, researchers, and consultants.

Certified Registered Nurse Anesthetists (CRNAs)

34,821

Administer anesthesia and provide related care before and after surgical, therapeutic, diagnostic, and obstetrical procedures, as well as pain management. Settings include operating rooms, outpatient surgical centers, and dental offices. CRNAs deliver more than 65% of all anesthetics to patients in the United States.

Certified Nurse Midwives (CNMs)

18,492

Provide primary care to women, including gynecological exams, family planning advice, prenatal care, management of low-risk labor and delivery, and neonatal care. Practice settings include hospitals, birthing centers, community clinics, and patient homes.

*APRNs are identified by their responses to the National Sample Survey of Registered Nurses, and this number may not reflect the true population of CNSs.

SOURCE: AARP, 2010. Courtesy of AARP. All rights reserved.

tem. Restrictions on scope of practice and professional tensions have undermined the nursing profession’s ability to provide and improve both general and advanced care. Producing a health care system that delivers the right care—quality care that is patient centered, accessible, evidence based, and sustainable—at the right time will require transforming the work environment, scope of practice, education, and numbers and composition of America’s nurses. The remainder of this section examines the role of the nursing profession in health care reform according to the same three parameters by which all other health care reform initiatives are evaluated—quality, access, and value.

Nurses and Quality

Although it is difficult to prove causation, an emerging body of literature suggests that quality of care depends to a large degree on nurses (Kane et al., 2007; Lacey and Cox, 2009; Landon et al., 2006; Sales et al., 2008). The Joint Commission, the leading independent accrediting body for health care organizations, believes that “the future state of nursing is inextricably linked to the strides



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