Four categories of advanced practice nurses practice at PinnacleHealth, each with distinctively different practice characteristics. All four groups, Clinical Nurse Specialists (CNSs), Nurse Practitioners (CRNPs), Nurse Anesthetists (CRNAs) and Nurse-Midwives (CNMs), have origins within professional and statutory definitions of nursing. Each group’s practice has expanded and specialized in diverse ways to meet different aspects of the health needs of individuals, families, and groups. Each category of advanced practice nursing has a knowledge base unique to the practice and supports distinctive contributions. Each group’s unique practice functions within the healthcare system to deliver cost-effective quality outcomes.
Clinical Nurse Specialist (CNS)
The Clinical Nurse Specialist is a licensed registered nurse who has graduate preparation (Master’s or Doctorate) in nursing as a Clinical Nurse Specialist. The CNS is an expert clinician in a specialized area of nursing practice and may be credentialed through a certification exam. The specialty may be identified in terms of:
- Population (e.g. pediatrics, women’s health
- Setting (e.g. critical care, emergency room)
- Disease or medical subspecialty (e.g. diabetes, oncology)
- Type of care (e.g. psychiatric, rehabilitation)
- Type of problem (e.g. pain, wounds, stress)
At PinnacleHealth, the CNS collaborates with nurses and physicians to plan and implement quality care for patients. The CNS mentors staff nurses in the pursuit of certification, the Career Development Pathway, and the research process. The CNS also plays an integral role in the Magnet designation process.
Certified Registered Nurse Practitioner (CRNP)
The Certified Registered Nurse Practitioner is a licensed registered nurse who has graduate preparation (Master’s or Doctorate) in nursing as a Nurse Practitioner. The CRNP is a primary care provider who practices in primary care, acute and long term care settings. The CRNP has specialized advanced nursing and medical education and clinical competency to provide health and medical care for diverse populations. The CRNP may be nationally certified in a specialty area. The CRNP is an expert healthcare provider who provides complete, accessible, affordable, quality care.
At PinnacleHealth, the CRNP performs a wide variety of clinical services:
- Assesses a patient and documents the medical history Completes a physical examination
- Diagnoses and treats acute and chronic diseases (e.g. injuries, diabetes, hypertension)
- Prescribes medications
- Assists in the birthing process
At PinnacleHealth, the CRNP:
Certified Registered Nurse Anesthetist (CRNA)
- Emphasizes patient and family education, increasing the ability of the individual to participate in self care
- Promotes optimal health through disease prevention
- Promotes a safe environment and draws on community resources to support the individual
The Certified Registered Nurse Anesthetist is a licensed registered nurse who has graduate preparation (Master’s or Doctorate) in nursing as a Nurse Anesthetist. The CRNA administers anesthesia for all types of surgical cases and practices in every setting in which anesthesia is delivered: traditional hospital operating rooms and obstetrical delivery rooms; dentist, podiatrist, ophthalmologist, and plastic surgeon offices; and ambulatory surgical centers. At PinnacleHealth, the CRNA practices as a member of the anesthesia care team. The CRNA collaborates with an anesthesiologist to provide a wide variety of anesthesia services. The CRNA:
- Performs a pre-anesthetic evaluation
- Implements an anesthetic plan of care
- Administers a planned anesthetic that might include general anesthesia, regional, or intravenous sedation
- Monitors the patient’s physiologic status
- Adjusts the anesthesia to maintain stability and corrects abnormal responses to the
- Anesthetic or surgery
- Manages a patient’s airway (places an endotracheal tube)
At PinnacleHealth, the CRNA provides anesthesia for patients of all ages for all types of procedures including orthopedics, kidney transplants, neurosurgical procedures, and cardiothoracic procedures.
Certified Nurse-Midwife (CNM)
The Certified Nurse-Midwife is a licensed registered nurse who has baccalaureate preparation in Nursing as a Midwife or holds a post-baccalaureate certificate as a Certified Nurse-Midwife. The CNM provides care, as defined by the American College of Nurse-Midwives (ACNM), which includes antepartum, intrapartum, postpartum, neonatal, family planning, non-surgical gynecology and primary care. At PinnacleHealth the CNM practices in collaboration with an obstetrical/gynecological physician who has admitting privileges with the system. The CNM:
- Provides primary, preventive care which includes gynecologic care
- Attends births that occur in hospitals, in freestanding birth centers and in the home
- Performs a complete history and physical examination on a patient
- Provides care to a neonate
The CNM provides access to timely, comprehensive midwifery care.
- Alliance of Advanced Practice Nurses. Advanced Practice Nurses Perform Full Scope of Practice. An Action Agenda For The Commonwealth Of Pennsylvania. February 2005.
- American College Of Nurse-Midwives. Philosophy of the American College of Nurse-Midwives. September 2004.
- National Association Of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. 2nd edition. 2004.