Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and may provide primary and specialty healthcare. The scope of practice varies from state to state.
Advanced practice registered nurses typically do the following:
APRNs work independently or in collaboration with physicians. In most states, they can prescribe medications, order medical tests, and diagnose health problems. APRNs may provide primary and preventive care and may specialize in care for certain groups of people, such as children, pregnant women, or patients with mental health disorders.
APRNs have some of the same duties as registered nurses, including gathering information about a patient’s condition and taking action to treat or manage the patient’s health. However, APRNs are trained to do other tasks, including ordering and evaluating test results, referring patients to specialists, and diagnosing and treating ailments. APRNs focus on patient-centered care, which means understanding a patient’s concerns and lifestyle before choosing a course of action.
Some APRNs also conduct research or teach staff about new policies or procedures. Others may provide consultation services based on a specific field of knowledge, such as oncology, which is the study of cancer.
The following are types of APRNs:
Nurse anesthetists (CRNAs) administer anesthesia and provide care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and some emergency services. Before a procedure begins, nurse anesthetists discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have, so that anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or administer a regional or local anesthesia to numb an area of the body. During the procedure, they monitor the patient’s vital signs and adjust the anesthesia as necessary.
Nurse midwives (CNMs) provide care to women, including gynecological exams, family planning services, and prenatal care. They deliver babies, manage emergency situations during labor, repair lacerations, and may provide surgical assistance to physicians during cesarean births. Nurse midwives may act as primary maternity care providers for women. They also provide wellness care, educating their patients on how to lead healthy lives by discussing topics such as nutrition and disease prevention. Nurse midwives also provide care to their patients’ partners for sexual or reproductive health issues.
Nurse practitioners (NPs) serve as primary and specialty care providers, delivering advanced nursing services to patients and their families. They assess patients, determine how to improve or manage a patient’s health, and discuss ways to integrate health promotion strategies into a patient’s life. Nurse practitioners typically care for a certain population of people. For instance, NPs may work in adult and geriatric health, pediatric health, or psychiatric and mental health.
Although the scope of their duties varies by state, many nurse practitioners work independently, prescribe medications, and order laboratory tests. Nurse practitioners consult with physicians and other health professionals when needed.
See the profile on registered nurses for more information about clinical nurse specialists (CNSs), also considered to be a type of APRN.
Nurse anesthetists, nurse midwives, and nurse practitioners held about 263,400 jobs in 2019. Employment in the detailed occupations that make up nurse anesthetists, nurse midwives, and nurse practitioners was distributed as follows:
| Nurse practitioners | 211,300 |
| Nurse anesthetists | 44,900 |
| Nurse midwives | 7,200 |
The largest employers of nurse anesthetists, nurse midwives, and nurse practitioners were as follows:
| Offices of physicians | 47% |
| Hospitals; state, local, and private | 27 |
| Outpatient care centers | 8 |
| Educational services; state, local, and private | 4 |
| Offices of other health practitioners | 3 |
Some advanced practice registered nurses (APRNs) provide care in patients’ homes. Some nurse midwives work in birthing centers, which are a type of outpatient care center.
APRNs may travel long distances to help care for patients in places where there are not enough healthcare workers.
APRN work can be both physically and emotionally demanding. Some APRNs spend much of their day on their feet. They are vulnerable to back injuries because they must lift and move patients. APRN work can also be stressful because they make critical decisions that affect a patient’s health.
Because of the environments in which they work, APRNs may come in close contact with infectious diseases. Therefore, they must follow strict guidelines to guard against diseases and other dangers, such as accidental needle sticks or patient outbursts.
Most APRNs work full time. In physicians’ offices, APRNs typically work during normal business hours. In hospitals and other healthcare facilities, they may work in shifts—including nights, weekends, and holidays—to provide round-the-clock patient care. Some APRNs, especially those who work in critical care or those who deliver babies, also may need to be on call.
Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), must have at least a master’s degree in their specialty role. APRNs also must be licensed registered nurses in their state, pass a national certification exam, and have a state APRN license.
Nurse anesthetists, nurse midwives, and nurse practitioners must have at least a master’s degree from an accredited program. These programs include classroom education and clinical experience. Courses in subjects such as advanced health assessment, pathophysiology, and pharmacology are common as well as coursework specific to the chosen APRN role.
An APRN must have a registered nursing (RN) license before pursuing education in one of the advanced practice roles, and a strong background in science is helpful.
Most APRN programs prefer candidates who have a bachelor’s degree in nursing. However, some schools offer bridge programs for registered nurses with an associate’s degree or diploma in nursing. Graduate-level programs are also available for individuals who did not obtain a bachelor’s degree in nursing but in a related health science field. These programs prepare the student for the RN licensure exam in addition to offering the APRN curriculum.
Although a master’s degree is the most common form of entry-level education, APRNs may choose to earn a Doctor of Nursing Practice (DNP) or a Ph.D. The specific educational requirements and qualifications for each of the roles are available on professional organizations’ websites.
Prospective nurse anesthetists must have 1 year of experience working as registered nurse in a critical care setting as a prerequisite for admission to an accredited nurse anesthetist program.
States’ requirements for APRNs vary. In general, APRNs must have a registered nursing license, complete an accredited graduate-level program, pass a national certification exam, and have an APRN license. Details are available from each state’s board of nursing.
To become licensed and use an APRN title, most states require national certification.
The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) offers the National Certification Examination (NCE). Certified registered nurse anesthetists (CRNAs) must maintain their certification through the Continued Professional Certification (CPC) Program.
The American Midwifery Certification Board offers the Certified Nurse-Midwife (CNM). Individuals with this designation must recertify via the Certificate Maintenance Program.
There are several different certifications for nurse practitioners, including those available from the American Academy of Nurse Practitioners Certification Board (AANPCB), the American Nurses Credentialing Center (ANCC), and the Pediatric Nursing Certification Board (PNCB). Each of these certifications requires periodic renewal.
In addition, APRN positions may require cardiopulmonary resuscitation (CPR), basic life support (BLS), or advanced cardiac life support (ACLS) certification.
Communication skills. Advanced practice registered nurses have to be able to communicate with patients and other healthcare professionals to ensure the appropriate course of action.
Critical-thinking skills. APRNs must be able to assess changes in a patient’s health, quickly determine the most appropriate course of action, and decide if a consultation with another healthcare professional is needed.
Compassion. APRNs should be caring and sympathetic when treating patients.
Detail oriented. APRNs need to be thorough in providing treatments and medications that affect their patients’ health. During an evaluation, they must notice even small changes in a patient’s condition.
Interpersonal skills. APRNs must work with patients and families as well as with other healthcare providers and staff. They work as part of a team to determine and execute healthcare options for the patients they treat.
Leadership skills. APRNs often work in positions of seniority. They must effectively direct and sometimes manage other nurses on staff when providing patient care.
Resourcefulness. APRNs should know where to find the answers that they need.
Some APRNs take on managerial or administrative roles; others go into academia. APRNs who earn a doctoral degree may conduct independent research or work on an interprofessional research team.
Median annual wages, May 2019
The median annual wage for nurse anesthetists, nurse midwives, and nurse practitioners was $115,800 in May 2019. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $82,460, and the highest 10 percent earned more than $184,180.
Median annual wages for nurse anesthetists, nurse midwives, and nurse practitioners in May 2019 were as follows:
| Nurse anesthetists | $174,790 |
| Nurse practitioners | 109,820 |
| Nurse midwives | 105,030 |
In May 2019, the median annual wages for nurse anesthetists, nurse midwives, and nurse practitioners in the top industries in which they worked were as follows:
| Hospitals; state, local, and private | $122,420 |
| Outpatient care centers | 118,530 |
| Offices of physicians | 113,190 |
| Offices of other health practitioners | 112,590 |
| Educational services; state, local, and private | 108,790 |
Most advanced practice registered nurses (APRNs) work full time. In physicians’ offices, APRNs typically work during normal business hours. In hospitals and other healthcare facilities, they may work in shifts—including nights, weekends, and holidays—to provide round-the-clock patient care. Some APRNs, especially those who work in critical care or those who deliver babies, also may need to be on call.
Percent change in employment, projected 2019-29
Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 45 percent from 2019 to 2029, much faster than the average for all occupations. Employment growth will vary by occupation. Because nurse midwives is a small occupation, however, the fast growth will result in only about 800 new jobs in this occupation over the 10-year period.
Growth will occur because of an increase in the demand for healthcare services. Several factors will contribute to this demand, including an increased emphasis on preventive care and demand for healthcare services from the aging population.
Advanced practice registered nurses (APRNs) perform many of the same services as physicians. APRNs will be increasingly used in team-based models of care, particularly in hospitals, offices of physicians, clinics, and other ambulatory care settings, where they will be needed to provide preventive and primary care.
APRNs will also be needed to care for the large baby-boom population. As baby boomers age, they will experience ailments and complex conditions that require medical care. APRNs will be needed to keep these patients healthy and to treat the growing number of patients with chronic and acute conditions.
As states change their laws governing APRN practice authority, APRNs are being allowed to perform more services. APRNs also are being recognized more widely by the public as a source for primary healthcare.
About 24,200 openings for nurse practitioners, 2,900 openings for nurse anesthetists, and 500 openings for nurse midwives are projected each year, on average, over the decade.
Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
Overall, job opportunities for advanced practice registered nurses are likely to be excellent. APRNs will be in high demand, particularly in medically underserved areas such as inner cities and rural areas.
| Occupational Title | SOC Code | Employment, 2019 | Projected Employment, 2029 | Change, 2019-29 | Employment by Industry | ||
|---|---|---|---|---|---|---|---|
| Percent | Numeric | ||||||
SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program |
|||||||
Nurse anesthetists, nurse midwives, and nurse practitioners |
— | 263,400 | 381,100 | 45 | 117,700 | — | |
Nurse anesthetists |
29-1151 | 44,900 | 51,000 | 14 | 6,200 | Get data | |
Nurse midwives |
29-1161 | 7,200 | 8,100 | 12 | 800 | Get data | |
Nurse practitioners |
29-1171 | 211,300 | 322,000 | 52 | 110,700 | Get data | |
For more information about nurse anesthetists, including a list of accredited programs, visit
American Association of Nurse Anesthetists
For more information about nurse midwives, including a list of accredited programs, visit
American College of Nurse-Midwives
For more information about nurse practitioners, including a list of accredited programs, visit
American Association of Nurse Practitioners
For more information about registered nurses, including credentialing, visit
For more information about nursing education and being a registered nurse, visit
For more information about undergraduate and graduate nursing education, nursing career options, and financial aid, visit
American Association of Colleges of Nursing
For more information about states’ Boards of Nursing, visit
National Council of State Boards of Nursing
For more information about certification, visit
American Academy of Nurse Practitioners Certification Board
American Association of Critical-Care Nurses
American Midwifery Certification Board
American Nurses Credentialing Center
National Certification Corporation
National Board of Certification and Recertification for Nurse Anesthetists
Pediatric Nursing Certification Board
For career videos on nurse anesthetists, nurse midwives, and nurse practitioners, visit