Nurse Practitioners (NPs) are advanced practice registered nurses who provide comprehensive care to patients. Not only do nurse practitioners provide diagnostic care and treatment, but 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.
- Diagnosis and Treatment:
- Nurse practitioners are qualified to diagnose and treat patients, providing essential healthcare services.
- They perform various procedures, ensuring comprehensive patient care.
- Holistic Patient Care:
- Nurse practitioners adopt a holistic approach, addressing physical, psychosocial, and environmental factors in patient care.
- They gather comprehensive patient information to understand the broader context of their health.
- Patient Education:
- Skilled in education, nurse practitioners teach patients and families about disease processes, treatments, and preventive healthcare measures.
- They empower patients to make informed decisions about their health.
- Cost-Effective Care:
- Nurse practitioners can help lower healthcare costs; patients using NPs as primary care providers experience fewer emergency room visits and shorter hospital stays.
- They fill the primary care physician shortage gap, improving healthcare accessibility.
- High Patient Satisfaction:
- Nurse practitioners often receive high patient satisfaction scores due to their personalized, patient-centered approach.
- Patients appreciate the comprehensive care, education, and attention they receive from nurse practitioners.
Becoming a nurse practitioner is a big decision, but the rewards can make it a worthwhile career advancement. We’ve broken down the process into three steps below.
Step 1: Choose Your NP Educational Route
To advance to a master's degree or doctoral in nursing, a student must have completed an accredited nursing program and obtained a Bachelor's of Science in Nursing (BSN). Some RN to MSN bridge programs are available for those with an Associate’s Degree in Nursing (ADN) or nursing diploma, but these will usually be accelerated, intensive programs. Completing the NCLEX-RN exam is necessary for licensure upon graduating with a nursing degree.
How Long Will an MSN or DNP Nurse Practitioner Program Take?
The time it takes to obtain an MSN or DNP depends on the nurse's starting point. We'll assume here that you already have at least an ADN degree or nursing diploma – if not, you'll need to factor in the time it takes for that or a traditional BSN degree. The timelines below are general estimates of popular program routes – the actual time it takes to complete a degree program will be determined by factors such as full-time or part-time attendance, prior education/credits completed, and whether or not it's considered an accelerated program:
- RN to BSN takes about 1-2 years
- RN to MSN takes about 2 years
- BSN to MSN takes about 1-2 years
- BSN to DNP takes 3-4 years
- MSN to DNP takes 1-2 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.
Research nurse practitioner programs.
Where Can I Enroll in a Nurse Practitioner Program?
MSN and DNP-level nurse practitioner degree programs are commonly found across the United States in the following institutions:
- Specialized nursing schools
Reputable schools with established nursing departments and strong healthcare affiliations often offer these programs. Prospective nurse practitioners can pursue accredited MSN or DNP degrees in renowned universities, both traditional brick-and-mortar institutions and online platforms, which provide flexibility for working professionals.
Step 2: Choose a Nurse Practitioner Program Specialty
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 patient care team members. Some NP programs include training in certain specialties; otherwise, certification can be obtained through the American Nurses Credentialing Center (ANCC). See our grid of popular nurse practitioner specialties below to learn more:
|Common Work Settings
|Available as MSN or DNP?
|Acute Care Nurse Practitioner
|Managing acute and chronic illnesses in adult patients.
|Adolescents to elderly adults
|Diagnosing and treating complex medical conditions, collaborating with multidisciplinary teams for critical care.
|Hospitals, Intensive Care Units (ICUs)
|Both MSN and DNP
|Adult Gerontology Nurse Practitioner
|Addressing healthcare needs of elderly patients.
|Managing age-related conditions, promoting wellness, and providing end-of-life care.
|Nursing homes, Geriatric clinics, Home healthcare
|Both MSN and DNP
|Family Nurse Practitioner
|Providing comprehensive healthcare to individuals of all ages.
|Diagnosing and treating various medical conditions, focusing on preventive care and health promotion.
|Primary care clinics, Private practices
|Both MSN and DNP
|Neonatal Nurse Practitioner
|Caring for newborn infants, especially those born prematurely or with medical complications.
|Providing specialized medical care, monitoring neonatal development, and supporting families.
|Neonatal Intensive Care Units (NICUs)
|Both MSN and DNP
|Pediatric Nurse Practitioner
|Specializing in healthcare for infants, children, and adolescents.
|Infants to adolescents
|Diagnosing and treating pediatric illnesses, vaccinations, growth monitoring, and developmental assessments.
|Pediatric clinics, Hospitals, Schools
|Both MSN and DNP
|Psychiatric Nurse Practitioner
|Mental health and psychiatric care, including therapy and medication management.
|Adolescents to adults
|Assessing mental health conditions, providing therapy, and prescribing psychiatric medications.
|Mental health clinics, Hospitals, Private practices
|Both MSN and DNP
|Women’s Health Nurse Practitioner
|Focusing on women’s reproductive and gynecological health.
|Adolescents to elderly adults
|Performing women’s health exams, managing reproductive health issues, family planning, and prenatal care.
|Women’s health clinics, OB/GYN offices
|Both MSN and DNP
Post-master’s certificate programs and nursing certifications are available for current NPs wishing to switch or expand specialties.
Step 3: Nurse Practitioner Licensure, Examination, and Certification
- NP Licensure Process:
- Licensure is distinct from certification and is essential for nurse practitioners to practice legally in their state of residence.
- State nursing boards outline specific licensure requirements, which can differ from state to state.
- Certified nurse practitioners must apply for licensure with the state board after meeting the specified requirements, allowing them to practice their specialized nursing skills within the state.
- NP Certification Info:
- Nurse practitioners can pursue certification in a specialty area concurrently within the MSN/DNP program or through independent study from organizations like ANCC or other learning institutes.
- Some specialties may not offer formal certifications, allowing NP students to focus on areas of specialization during their program to gain clinical competency.
- Eligibility criteria for certifications obtained outside of an MSN/DNP program vary, and students are advised to research specific requirements for their chosen specialty.
- NP Certification Examination:
- Upon completing a specialty program, nurse practitioners can take a certification examination, such as the Family Nurse Practitioner Exam, to earn titles like FNP-C (Family Nurse Practitioner Certified).
- Certification signifies competence in an NP’s chosen specialty area, demonstrating advanced knowledge and skills in patient care.
Nurse practitioners are valuable members of the healthcare team. As providers, teachers, leaders, and patient advocates, nurse practitioners holistically approach patient care to ensure patient needs are met at the time of visit.
What Are the Responsibilities and Duties of a Nurse Practitioner?
NPs have many responsibilities and duties. These may include:
- Provide acute (i.e. illness) and preventive care (check-ups)
- Take a patient’s 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
What Are Specialty Nurse Practitioner Careers Like?
There are many areas in which a nurse practitioner can specialize. The table below depicts popular nurse practitioner specializations, and what these careers may entail; click on each specialty for more career information:
|Acute Care NP
|Emergency room, ICU, urgent care clinic, operating room
|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
|Clinics, long-term care facilities, specialty departments
|Performing routine physicals, ordering preventive tests/screenings, managing chronic conditions, educating patients and families on preventive health
|Emergency departments, urgent care departments
|Diagnosing and treating patients needing emergent care, admitting patients from the ED to the floor, ordering diagnostic tests/treatments
|Family Nurse Practitioner
|Primary care clinics, hospitals, specialty departments, long-term care facilities
|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
|Pediatric clinics, hospitals, specialty pediatric departments, primary care clinics
|Diagnosing and treating pediatric illnesses, vaccinations, growth monitoring, developmental assessments
|Mental health clinics, hospitals, private practices
|Assessing mental health conditions, providing therapy, prescribing psychiatric medications
|Women’s Health NP
|Women’s health clinics, OB/GYN offices
|Performing women’s health exams, managing reproductive healthcare, family planning, prenatal care
As baby boomers age, and healthcare needs continue to grow, nurse practitioner opportunities are expanding nationwide. According to the Bureau of Labor Statistics, nurse practitioner careers are expected to increase by 38 percent between 2022 and 2032, a growth rate that is much faster than most professions.
What Are Working Conditions Like for Nurse Practitioners?
The environment in which a nurse practitioner works can be fast-paced and challenging, but nurse practitioners are also highly valued members of healthcare teams. See what to expect from working conditions below.
- High patient load and critical decisions can cause stress for nurse practitioners.
- Pressure to avoid errors and irregular schedules, including swing or graveyard shifts and on-call duties, can be demanding.
- Potential Risks:
- Exposure to workplace violence, bloodborne pathogens, and chemicals in high-risk areas.
- Mandatory safety training in all work areas, with organizations prioritizing worker health and safety.
- Respected Professionally:
- Nurse practitioners are highly respected for their holistic patient care approach.
- Both physicians and patients appreciate the collaborative team approach that NPs provide.
- Necessary in Healthcare:
- Nurse practitioners are filling the gaps due to the projected physician shortage.
- Per the AANP, 88% of NPs are certified in an area of primary care, addressing the growing and aging population’s healthcare needs.
What Is the Salary and Employment Outlook for Nurse Practitioners?
|Nurse Practitioner (General)
|Average Annual Salary (2022, BLS)
|Employment Outlook (BLS)
|38% Growth (Projected, 2022-2032)
Because of the physician shortage, aging population, and healthcare legislation, demand for nurse practitioners is expected to rise at a rate that is faster than average. The Bureau of Labor Statistics projects that 123,600 additional nurse practitioners will be working in the field from now to 2032.
Nationally, average salaries for nurse practitioners can come in at over $100,000. The Bureau of Labor Statistics reports the highest-paying states for NPs (as of 2022) are:
- New Jersey
Salary also depends on any specialty certifications, years of experience, and the organization where the NP is employed.
Nurse practitioners practice under the rules and regulations of the Nurse Practice Act of the state in which they work. NPs can prescribe medication in every state and in the District of Columbia. The degree of independence with which they can prescribe drugs, medical devices (crutches, boots, etc.), or medical services varies from state to state. In many states and the District of Columbia, NPs have what is called "Full Practice Authority" - meaning they can practice independently without physician collaboration or supervision. Many nurse practitioners have their own practices and can be reimbursed by Medicare, Medicaid, or other third parties.
States that don’t allow Full Practice Authority for NPs may fall under what is called “Reduced Practice Authority”. This means that NPs must have a collaborative agreement with a supervising physician in order to practice and prescribe meds.
States that don’t fall into either of these two categories are considered Restricted Practice states, which require even more regulations, including career-long oversight, delegation, or management by another medical team member.
There are many organizations that advocate for full practice authority for nurse practitioners to include prescriptive privileges, including the American Association of Nurse Practitioners (AANP).
The short answer is…yes!
Nurse Practitioners (NPs) are able to treat patients in most cases without the supervision of a doctor, ruled by guidelines on what they can and cannot treat. Nurse practitioners play a crucial role in helping administer medical attention to individuals in need, including women in labor. Their training teaches many aspects of health care, and the delivery of babies is among those aspects.
While RNs who work in labor and delivery might deliver a baby if the doctor doesn't make it into the room fast enough, the only nurses specifically trained and legally allowed to deliver babies are Certified Nurse-Midwives, also known as CNMs. Certified Nurse-Midwives assist at around 8 percent of all deliveries in the United States, according to the American College of Nurse-Midwives. Certified Nurse-Midwives advocate for client-driven birth choices with minimal medical intervention.
In some states, a collaborative agreement may be required for a nurse practitioner to practice. This agreement is a document that establishes a “joint practice” between the NP and MD. It usually includes:
- The parties involved
- Date of initiation of the agreement
- The scope of practice of the NP with regards to diagnosing, treating, and prescribing (specific scope of practice is regulated by each state)
- Documentation review requirements
- Physician availability requirements
Based on the state of practice, the amount of time closely spent with an MD is variable. Some states allow NPs to practice and prescribe independently, and they can even open and run their medical clinic. Other states require physician oversight and periodic documentation review. Some states require physicians to be on-site while others allow for telephonic consultation.
Regardless of state requirements, nurse practitioners should feel comfortable collaborating with physicians if needed. For example, if faced with a challenging case, the NP should collaborate with a physician to ensure the proper treatment is rendered. For the most part, nurse practitioners and physicians have a cohesive, respectful relationship. Physicians appreciate the high-quality care they deliver to patients, as well as the assistance they provide to an MD’s practice.
A DEA number is a number assigned to specific healthcare providers that allows them to prescribe medications, including controlled substances, legally. It includes a series of numbers and letter which identifies the type of provider; for example, nurse practitioner, physician, dentist, etc.
To obtain a DEA number online, the NP must first be licensed in the state in which they practice. Applicants must complete six different sections:
- Section 1 includes personal information, i.e. name, address, SSN, etc.
- Section 2 requires the applicant to report the business activity and drug schedule information. For example, which medications the NP plans to prescribe. The NP must be cognizant of any state restrictions on which controlled medications they can prescribe (Schedule III, IV, etc.)
- Section 3 requires licensure information
- Section 4 requires the applicant to provide background information about controlled substances
- Section 5 is the payment section. According to the DEA website, an NP can expect to pay $731 for a three-year period
- Section 6 is for confirmation, in which the applicant reviews/edits all entries and submits the application
Once submitted, it can take four to six weeks to obtain a DEA number. It is crucial that nurse practitioners begin the application process as soon as possible to prevent delays in practice.
Advanced directives and Physicians Orders for Life-Sustaining Treatment (POLST) forms are used to ensure a patient’s healthcare wishes are carried out in the event that they cannot make decisions on their own. These directives are extremely important not just to honor the wishes of patients, but for healthcare providers to avoid legal difficulties as well.
In a nutshell, yes - nurse practitioners can sign advanced directives or POLST forms depending on their state.
Nurse practitioners have a different scope of practice depending on the state in which they practice. Operating at the level of an MD in many states, signing Advanced Directives and POLST forms should not be excluded from their duties. However, the ability to sign these forms is specific to each state. Nurse practitioners should find the state’s specific scope of practice laws to find out if this is within their scope.
The American Association of Nurse Practitioners has information on NP scope of practice by state. It outlines which states have full, reduced, or restricted practice. NPs can click on their state and find a link to the state’s nurse practice act, which delineates if advanced directives / POLST forms can be completed independently.
Registered nurses looking to advance to nurse practitioners must first start with a bachelor of science degree (BSN) in nursing. This takes about four years to complete.
The minimum degree needed for an entry-level NP is a master’s degree in nursing (MSN), which takes an additional two or more years beyond the BSN. Some programs allow for online, classroom, or hybrid (both online and classroom) learning. The Family Nurse Practitioner program at Samuel Merritt University, for example, outlines the curriculum based on full or part-time status, and whether learning is hybrid or online. Semesters can range from five to eight depending on full or part-time status.
This depends on each student's needs. Some employers support and work with nurses as they advance their career, and allow time off for classes and study time. However, some cannot accommodate employees without interrupting operational need. Moreover, sometimes it is not financially possible for nurses to reduce hours, or family obligations are too great for them to take on the demand of graduate school. Nurses should discuss with their employer and families to see if, and which type of NP program would work to meet their individualized needs.
It can take two to four years to obtain an MSN depending on the student’s starting point. This is if the student attends full-time. Generally, the first semester is primarily lecture/classroom courses. Clinicals may be one or two days a week. Online NP programs allow for more flexibility and self-directed learning, which is an excellent choice for nurses who work.
Because NP programs can be demanding, it can be difficult to work full time. However, the beauty of being an RN is that there are a variety of positions available. Nursing is not always a nine-to-five job. Nurses can work nights, evenings, weekends, on-call, or per diem. Luckily, this allows for more flexibility in terms of going back to school.
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