Nurse Practitioners (NPs) are advanced-practice registered nurses who provide comprehensive care to patients. Not only do nurse practitioners provide diagnostic care and treatment, they also focus on preventive health maintenance. Nurse practitioners are first and foremost nurses, which means patient education and holistic care is a large part of their practice. Depending on the state in which they practice, oversight by physicians may or may not be required.
Why Are Nurse Practitioners So Important?
Nurse practitioners can diagnose and treat patients as well as perform procedures. They differ from physicians in that their patient care approach is more holistic. Being nurses, they gather information about a patient not only to include physical symptoms, but psychosocial and environmental information as well. They are skilled in education, and therefore can spend time teaching patients and family about disease processes, treatments, and healthcare prevention as well as diagnosing acute health issues.
According to the American Association of Nurse Practitioners, nurse practitioners can also help lower the cost of healthcare, as patients who use NPs as their primary care provider have fewer emergency room visits and shorter hospital stays. Additionally, they help to fill the gap with the primary care physician shortage in the United States. They also tend to have high patient satisfaction.
To advance to a master's degree or doctoral in nursing, a student must complete an accredited nursing program and obtain a Bachelor's of Science in Nursing (BSN). Upon graduating with a nursing degree, successful completion of the NCLEX-RN is needed for licensure. The length of time it takes to obtain an MSN depends on the nurse's starting point:
- Nursing students enrolled in a BSN program complete in about four years
- RN to BSN takes about two years
- BSN to MSN takes about two years
- BSN to DNP takes three to four years
- MSN to DNP takes one to two years
Additionally, both online programs and classroom programs are available to accommodate students. Both types have pros and cons depending on students' needs, therefore researching individual schools is encouraged.
Nurse Practitioner Education Requirements and Training
Nurses who enjoy practicing independently and who wish to diagnose and prescribe while still utilizing nursing skills can advance to the field of advanced-practice nursing. Nurses who seek to pursue their NP should value autonomy, integrity, and leadership.
Some graduate programs require nurses to gain a few years' clinical experience before enrollment. Some schools allow nurses to work concurrently during the program. Regardless, obtaining clinical experience is crucial as it prepares the future nurse practitioner to be able to address a multitude of medical concerns and situations.
Nurses are also required to have a baccalaureate nursing degree (BSN). Nurses who hold an Associate's Degree in Nursing (ADN) will need to obtain a BSN. There are many opportunities to obtain a BSN. Many healthcare organizations also assist employees in advancing degrees and assist in tuition reimbursement, cost of books, and granting time off for nurses.
Nurse Practitioner Program Specialties
There are many clinical areas in which a nurse practitioner can work. From primary care to specialty care, acute care and long-term care, nurse practitioners are valuable members of the patient care team. Some NP programs include training in certain specialties; otherwise, certification can be obtained through the American Nurses Credentialing Center (ANCC). Some areas include:
- Acute care
- Emergency care
- Family medicine
- Neonatal care
- Women's Health
Examination, Licensure, and Certification
Certification in a specific specialty area can be completed concurrently within the MSN/DNP program, or obtained via independent study from the ANCC or other learning institute. Not all specialties offer formal certifications. In this case, the NP student can choose areas of specialization to work on during the program to obtain clinical competency. Eligibility for certifications obtained outside of an MSN/DNP program can differ and students are encouraged to research requirements when choosing a specialty.
Once a specialty program is completed, the nurse may take an examination for certification. For example, a nurse can take the Family Nurse Practitioner Exam to earn an FNP-C (Family Nurse Practitioner Certified) title.
Licensure and certification are different-certification means the NP is competent to perform care in their chosen specialty; licensure means they are legally permitted to practice in their state of residence. For example, a nurse living in California can obtain certification in acute care, but needs to apply for licensure to practice in the state of California. State nursing boards list the requirements for testing and can vary from state to state. The certified nurse practitioner can, after meeting the specified requirements, apply with the state board for licensure.
Nurse practitioners are valuable members of the healthcare team. As providers, teachers, leaders, and patient advocates, nurse practitioners approach patient care in a holistic manner to ensure patient needs are met at the time of visit.
Nurse Practitioner Responsibilities & Duties
NPs have many responsibilities and duties. These may include:
- Provide acute (i.e. illness) and preventive care (check-ups)
- Take a patient history
- Maintain their own patient panel
- Order diagnostic testing/therapies
- Order prescriptions
- Assist in surgery
- Admit, transfer, and discharge hospitalized patients
- Collaborate with specialty departments as needed, refer patients appropriately
- Assess patient/family needs
- Provide education to patients/families
- Promote family-centered patient care
Nurse Practitioner Specialties
There are many areas in which a nurse practitioner can specialize. The following are areas in which an NP can obtain formal certification:
- Acute Care NP: may work in the emergency room, ICU, urgent care clinic, or operating room. They may perform duties such as:
- Rounds on hospitalized patients
- Managing the patient's hospital stay
- Assisting in surgical procedures
- Inserting central lines, intubating, suturing, performing lumbar punctures
- Ordering diagnostic tests/treatment and formulating a plan based on the results
- Writing orders for nursing/ancillary staff
- Adult Gerontology NP: Specializes in young adults to elderly patients. May work in clinics, long-term care facilities, or specialty departments. Specific duties may include:
- Performing routine physicals
- Ordering preventive tests/screenings
- Managing chronic conditions
- Educating patients and families on preventive health
- Emergency NP: primarily works in emergency departments, may also work in urgent care departments. Specific duties may include:
- Diagnosing and treating patients needing emergent care
- Admitting patients from the ED to the floor
- Ordering diagnostic tests/treatments
- Family Nurse Practitioner: may work in primary care clinics, hospitals, specialty departments, or long-term care facilities. Specific duties may include:
- Caring for a patient population from birth through aging/death
- Performing exams on acute complaints
- Performing routine physicals
- Preventive health maintenance
- Ordering diagnostic tests/procedures
As baby boomers age, and health care needs continue to grow, nurse practitioner opportunities are opening up nationwide. According to the Bureau of Labor Statistics, nurse practitioner careers are expected to increase by 31 percent in the next 7-10 years.
The working conditions of nurse practitioners, as with any career, have positive and negative aspects. Nurse practitioners can suffer from stress as they may carry a heavy patient load and have many critical decisions and diagnoses to make. As with physicians, there is no room for error, which can put a lot of pressure on nurse practitioners. Some NPs must work swing or graveyard shifts, and some may need to be on call, leading to erratic schedules that can take their toll.
Additionally, nurse practitioners, as with other healthcare workers, may work in high-risk areas that can expose them to workplace violence, blood borne pathogens, and chemicals.
Not all work areas are risky, such as research and education. Regardless of the chosen work area, workplace safety training is mandatory and ongoing, and most organizations strive to protect the health and safety of its workers.
Nurse practitioners are highly respected and appreciated in their workplaces. They provide a holistic approach to patient care which complements conventional medicine. While NPs may not have full unrestricted practice, the collaborative team approach is appreciated not only by physicians, but by the patients they serve.
Additionally, according the American Association of Medical Colleges (AAMC), there will be a projected shortage of physicians by the year 2030, ranging between 40,800 and 104,900 physicians. Nurse practitioners are already beginning to fill the gaps to meet the needs of the growing and aging population, especially in primary care. The American Association of Nurse Practitioners reports that 89.2% of NPs are certified in primary care medicine. The addition of NPs to primary care helps to offload primary care physicians, while ensuring patient care needs are met.
Salary and Employment
Because of the physician shortage, aging population, and healthcare legislation, demand for nurse practitioners is expected to rise 31 percent by 2024, which is faster than average. There will be an expected 171,700 job opportunities that will be available by 2024.
As for compensation, indeed.com reports the average salary for a nurse practitioner is $101,681. The Bureau of Labor statistics reports the highest-paying states for NPs are California, Alaska, Massachusetts, Hawaii, and New Jersey. Salary is also dependent on any specialty certifications held, years of experience, and the organization in which the NP is employed.