Alphabet Soup: LPN, RN, APRN, NP - Making Sense of Nursing Roles & Scope of Practice

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Nursing is riddled with various roles, career paths, and backgrounds. There is no one way to become a nurse, and there are so many different kinds of these invaluable healthcare professionals! While this is such a beautiful thing about the field, it can at first seem a little confusing, especially as you start learning about all the different acronyms: LPN, RN, APRN, NP, and on and on. This article attempts to elucidate the nurse “alphabet soup” so that you can make informed decisions about which role you’d like to pursue.

Overview: What’s in a Name?

The letters you see after a nurse’s name typically come from their education, licensure, certification, or a special achievement—and they should appear in that order. Typically only the highest level of each credential is included. Once you understand this alphabet soup, it can quite quickly reveal a lot about someone’s experience.

For example, Dr. Ferrara, a nurse practitioner at Columbia University, lists his credentials as “Stephen Ferrara, DNP, FNP-BC, FAANP.” From these letters, we know his education (doctor of nursing practice) and certification (family nurse practitioner), and we know that he is a fellow (an esteemed position) of the American Association of Nurse Practitioners (AANP).

Likewise, Dr. Adams, a nurse practitioner at Vanderbilt University, lists her credentials as “Susie Adams, PhD, APRN, PMHNP, FAANP, FAAN.” From these letters, we know her education (doctor of philosophy), licensure (advanced practice registered nurse), and certification (psychiatric mental-health nurse practitioner), and we know she is also a fellow of the AANP, as well as the American Academy of Nurses (AAN).

Education Letters

Let’s start with education letters. Unlike most professions, it’s common for healthcare professionals to list their highest level of education after their name. The most common professional degrees that nurses have include:

  • Associate’s degree in nursing (ADN)
  • Bachelor of science in nursing (BSN)
  • Master of science in nursing (MSN)
  • Doctor of nursing practice (DNP)
  • Doctor of philosophy (PhD)

Prior to the DNP degree, nurses also may pursue other professional doctorates including the doctor of nursing science (DNS or DNSc) and nursing doctor (ND), so you might find some clinicians with these letters as well. Additionally, some nurses pursue a master’s of business administration (MBA), a master’s or doctorate in education (MEd or EdD), or a master’s or doctorate in public health (MPH or DrPH) degrees, which they may list after their name too.

License Letters

The education earned determines the type of nurse you become and your scope of practice. Scope of practice refers to the procedures, actions, and processes that a health care provider is legally permitted to perform or follow within the terms of their professional license.

There are three types of nurses, each with different scopes of practice:

  1. Licensed practical nurse (LPN)
  2. Registered nurse (RN)
  3. Advanced practice registered nurse (APRN)

Practical Nurse

Licensed practical nurses (LPNs)—also called licensed vocational nurses (LVNs) in Texas and California—graduate with either a diploma in nursing or an associate’s degree in nursing. To become licensed, they must pass the NCLEX-PN (National Council Licensure Examination-Practical Nurse) exam. To provide care, they must be supervised by a registered nurse, and they typically focus on providing basic nursing care such as checking vital signs, inserting catheters, and comforting patients. These nurses often do not specialize, and instead work mostly in long-term care centers, outpatient clinics, or medical-surgical units at a hospital.

Registered Nurse

Registered nurses (RNs), graduate with either an associate’s degree or a bachelor of science degree in nursing degree. To become licensed, they must pass the NCLEX-RN (National Council Licensure Examination-Registered Nurse) exam. Their scope is much broader than an LPN, and includes administering medications, determining nursing diagnoses, and providing extensive patient education. Registered nurses often pursue a specialty area and are found in settings such as emergency rooms, critical care units, and psychiatric hospitals.

Of note, research demonstrates the higher the percentage of baccalaureate nurses on a unit, the lower the morbidity and mortality of patients. As a result, the Institute of Medicine recommended that 80 percent of the nursing workforce have a BSN degree. In fact, just recently, New York state passed their “BSN in 10” law, which requires all nurses to earn a bachelor of science degree within ten years of receiving their RN license.

Advanced Practice Registered Nurse

Advanced practice registered nurses (APRNs) typically graduate with either a master of science in nursing or a doctor of nursing practice degree.

There are four types of APRNs:

  1. Nurse practitioner (NP)
  2. Nurse midwife (CNM, where the “C” is for “Certified”)
  3. Nurse anesthetist (CRNA, where the “CR” is for “Certified Registered”)
  4. Clinical nurse specialist (CNS)

All these providers specialize in a particular patient population such as pediatrics, geriatrics, neonatal, or mental health. The scope of practice for APRNs is the broadest of all nurses, and it includes the assessment, diagnosis, and treatment of medical conditions. These providers can prescribe medication and equipment, and they can order and interpret diagnostic exams like blood work and MRIs.

The NP license has different names in different states. Other names include:

  • Advanced registered nurse practitioner (ARNP)
  • Certified registered nurse practitioner (CRNP)
  • Certified nurse practitioner (CNP)
  • Licensed nurse practitioner (LNP)
  • Nurse practitioner certified (NPC)

Certification Letters

Some registered nurses and all APRNs earn certifications in their specialty area. Certifications demonstrate one’s proficiency in a particular subject matter. The certification letters are where it can get really tricky because there are so many.

A common set of certification letters seen with registered nurses is “RN-BC.” This stands for “registered nurse board-certified.” All certifications for RNs from the American Nurses Credentialing Center award these letters; however, it could mean they are board-certified in anything from pain management to rheumatology to informatics. Another common set of certification letters for registered nurses is CCRN, which stands for “certified in critical care” and is awarded by the American Association of Critical-Care Nurses.

You’ll also often see registered nurses who certify in education topics such as diabetes (CDE) and asthma (AE-C), or nurses who certify in a particular procedure such as wound care (CWON), cardiac surgery (CSC), and radiology (CRN). Registered nurses may also certify in a particular setting such as corrections (CBHC), schools (NCSN), and public health (PHNA).

Nurse practitioners are required to specialize in a patient population, and they have the option to subspecialize. Of note, certifications are awarded by national organizations. Sometimes two different organizations offer the same certification, but with different letters. For example, both the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP) offer a certification in adult-gerontology primary care. The different credential letters are AGPCNP-BC and A-GNP, respectively.

Nurse practitioner specialties include:

  • Adult-Gerontology Acute Care (AGACNP-BC or ACNPC-AG)
  • Adult-Gerontology Primary Care (AGPCNP-BC or A-GNP)
  • Family (FNP-BC or FNP)
  • Neonatal (NNP-BC)
  • Women’s Health-Gender Related (WHNP-BC)
  • Pediatric Primary Care (PPCNP-BC or CPNP-PC)
  • Pediatric Acute Care (CPNP-AC)
  • Psychiatric-Mental Health (PMHNP-BC)

Examples of subspecialties include:

  • Dermatology (DCNP)
  • Oncology (AOCNP)
  • Emergency (ENP-BC or ENP)
  • Palliative Care (ACHPN)
  • Orthopedics (ONP-C)

Achievement Letters

Nurses can earn special recognitions for their contribution to the profession. These are typically called “fellows” and are awarded by national organizations. These include Fellow of the American Academy of Nursing (FAAN) and Fellow of the American Association of Nurse Practitioners (FAANP).

Bottom Line: A Summary of Nursing Letters

Even after writing this article, I’m a bit miffed with the nursing alphabet soup! The table below summarizes the education, licensure, certification, and achievement letters for each type of nurse, as well as a brief explanation of their scope of practice.

Education Letters License Letters Scope of Practice Certification Letters Achievement Letters
Practical Nurse (PN) ADN (associates degree in nursing) LPN (licensed practical nurse)
LVN (licensed vocational nurse)
Focus on fundamental skills such as taking patient vital signs and providing comfort; must be supervised by a registered nurse None None
Registered Nurse (RN) ADN (associate’s degree in nursing)
BSN (bachelor of science in nursing)
MSN (master of science in nursing)
RN (registered nurse) Complete patient assessments, interpret patient data, recommend treatment plans, provide patient education, and determine nursing diagnoses Not required but there are many! Most commonly in a medical specialty (e.g., critical care, CCRN), practice setting (e.g., school, NCSN), knowledge area (e.g., diabetes, CDE), or procedure (e.g., cardiac survey, CSC) FAAN (Fellow of the American Academy of Nurses)
Advanced Practice Registered Nurse (APRN) MSN (master of science in nursing)
DNP (doctor of nursing practice)
APRN (advanced practice registered nurse)
ARNP (advanced registered nurse practitioner)
CRNP (certified registered nurse practitioner)
CNP (certified nurse practitioner)
LNP (licensed nurse practitioner)
NPC (nurse practitioner certified)
Can assess, diagnose, treat medical conditions, prescribe medications, and order and interpret diagnostic tests; in some states, they must be supervised by a physician AGACNP-BC or ACNPC-AG (Adult-Gerontology Acute Care)
AGPCNP-BC or A-GNP (Adult-Gerontology Primary Care)
FNP-BC or FNP (Family)
NNP-BC (Neonatal)
WHNP-BC (Women’s Health-Gender Related)
PPCNP-BC or CPNP-PC (Pediatric Primary Care)
CPNP-AC (Pediatric Acute Care)
PMHNP-BC (Psychiatric-Mental Health)
FAANP (Fellow of the American Association of Nurse Practitioners)
Dr. Melissa DeCapua, DNP, PMHNP-BC

Dr. Melissa DeCapua, DNP, PMHNP-BC

Author

Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. She has a background in child and adolescent psychiatry as well as psychosomatic medicine. Uniquely, she also possesses a bachelor’s degree in studio arts, which she uses to enhance patient care, promote the nursing profession, and solve complex problems. Melissa currently works as the Healthcare Strategist at a Seattle-based health information technology company where she guides product development by combining her clinical background and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Melissa, check out her blog www.melissadecapua.com and follow her on Twitter @melissadecapua.