is a clinical/practice-based doctorate but because it is not the entry degree for the profession of nursing (which includes advanced practice registered nursing), it is a terminal degree. Patient outcomes In 2020 Pain Medicine found that CNPs prescribe opioids at a rate 28 times higher than physician counterparts in states where they practice autonomously. Terminal degrees An APRN may earn a terminal degree in several ways. A terminal degree is generally a doctorate. In some fields, especially those linked to a profession (e.g., medicine, nursing, dentistry, law, optometry, architecture, pharmacy, social work, religious ministry, engineering, accounting, education, etc.), a distinction is to be drawn between a first professional degree, an advanced professional degree, and a terminal academic degree. A first professional degree is generally required by law or custom to practice the profession without limitation. An advanced professional degree provides further training in a specialized area of the profession. A first professional degree is an academic degree designed to prepare the holder for a particular career or profession, fields where scholarly research and academic activity are not the work, but rather the practice of a profession. In many cases, the first professional degree is also the terminal degree because usually no further advanced degree is required for practice in that field even though more advanced professional degrees may exist. Examples of terminal degrees in research are: Doctor of Philosophy (Ph.D.) Doctor of Education (Ed.D.) Doctor of Science (D.Sc.) Doctor of Nursing Science (D.N.Sc., DNS) Examples of terminal professional degrees in nursing are: Doctor of Nursing Practice (DNP) Doctor of Nurse Anesthesia Practice (DNAP) Post-nominal initials The specific titles, credentials and post-nominal initials used by advanced practice nurses will vary greatly by country, state and educational level. A list of post-nominal initials include, but are not limited to: ACNP: Acute Care Nurse Practitioner AGACNP: Adult-Gerontology Acute Care Nurse Practitioner ANP: Adult Nurse Practitioner APHN: Advanced Public Health Nurse APRN: Advanced Practice Registered Nurse (Refers to the four recognized general areas of advanced professional specialization: CRNA, NP, CNM, and CNS) APN: Advanced Practice Nurse (same as Advanced Practice Registered Nurse but not recommended as a legally recognized title) ARNP: Advanced Registered Nurse Practitioner (refers to Nurse Practitioners in some states in the US) C or BC following a title: Certified or Board Certified (i.e., APRN-BC, WHNP-BC, PNP-BC, FNP-C, GNP-C, ANP-BC) CMCN: Certified Managed Care Nurse CNM: Certified Nurse Midwife CNS: Clinical Nurse