Nurse practitioners are graduate-educated and nationally certified advanced practice registered nurses (APRNs) who provide a full range of primary, acute, and specialty care services. They work both autonomously and in collaboration with other healthcare professionals in settings that range from large hospitals to small independent clinical practices. For experienced RNs interested in entering advanced clinical practice and specializing in a particular patient population focus, becoming a nurse practitioner is often an inevitable step.
Nurse practitioners (NPs) may be referred to as registered nurse practitioners (RNP), or certified nurse practitioners (CNP) or even certified registered nurse practitioners (CRNP), but these are only differences in title. Regardless of what the state licensing body calls them, nurse practitioners all must meet the same general requirements for licensure and all share a very similar scope of practice.
According to the American Association of Nurse Practitioners (AANP), Americans make more than 916 million visits to nurse practitioners every year. These trusted clinicians have been providing quality healthcare services for nearly 50 years, providing patient-centered, accessible care with an emphasis on disease prevention, health promotion, health management, and health education/counseling.
According to 2015 AANP statistics:
- Nearly 87 percent of nurse practitioners are prepared in primary care.
- About 45 percent of nurse practitioners hold hospital privileges, while more than 15 percent have long-term care privileges
- Nurse practitioners have prescription privileges in all 50 states and the District of Columbia, and controlled substance prescription privileges in 49 states; as a result, about 97 percent prescribe medications. NPs in full-time practice write about 21 prescriptions every day.
- About 70 percent of nurse practitioners see three or more patients per hour.
- Currently licensed nurse practitioners have been in practice for an average of 10 years.
How Nurse Practitioners Specialize: Primary Patient Population Focus and the Option for Further Specialization
Rather than practicing as generalists, the nurse practitioner role is unique in that it is always associated with at least one patient population focus:
- Family/Individual Across the Lifespan
- Adult-Gerontology (Acute or primary care)
- Women’s health/gender-related
- Pediatrics (Acute or primary care)
- Psychiatric/Mental Health
In all cases, nurse practitioners are educated at the graduate level and nationally certified in one of these six patient population groups. As such, nurse practitioners typically identify themselves with one of six general titles and credentials that denote the patient population group they work with:
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Nurse Practitioner (AGNP)
- Women’s Health Nurse Practitioner (WHNP)
- Neonatal Nurse Practitioner (NNP)
- Pediatric Nurse Practitioner (PNP)
- Psychiatric/Mental Health Nurse Practitioner (PMHNP)
While choosing a patient population focus is a standard part of preparing for graduate work and national certification as a nurse practitioner, the option for further specialization is elective. Nurse practitioners that would like to further specialize can focus their practice in diverse areas of medicine beyond role and patient population focus:
- Allergy and immunology
- Occupational health
- Sports medicine
Identifying titles and credentials that nurse practitioners use often reflect their chosen area of specialization.
Regardless of the patient population focus and area and specialization, the general job duties and scope of practice for NPs remains the same and always includes:
- Diagnosing and treating acute and chronic conditions
- Managing the overall health of patients
- Counselling patients on disease prevention and positive health and lifestyle choices
- Prescribing medications and other therapies
- Ordering, performing, and interpreting diagnostic tests
The Value of Nurse Practitioners
As of 2015, there were more than 205,000 licensed nurse practitioners in the U.S, but many more are needed due to a number of converging factors:
- Current and impending shortage of physicians in a primary care role
- An increased number of insured Americans due to the Affordable Care Act
- An ever-increasing elderly population that requires more advanced levels of care
These, among other factors, have lead the American Association of Nurse Practitioners (AANP) to project a demand for 244,000 nurse practitioners by 2025. That’s 39,000 RNs that would need to earn a master’s or higher degree, become nationally certified and then state licensed in advanced practice in just a ten-year span.
Nurse practitioners provide comprehensive healthcare services, focusing on the health and well-being of the whole person. These healthcare providers help patients make smarter health and lifestyle choices, thus lowering future healthcare costs related to disease and disability.
According to the AANP, nurse practitioners are valuable members of today’s multidisciplinary healthcare team for a variety of reasons:
- Nurse practitioners provide more than healthcare services; they often serve as educators, administrators, and researchers
- Nurse practitioners provide high-quality care and counseling; patients who see nurse practitioners often have lower medical costs, shorter hospitals stays, and fewer emergency room visits
- Patients that work with nurse practitioners report an extremely high level of satisfaction
MSN Nurse Practitioner Qualifications: Education, Training, and Licensing Requirements
All nurse practitioners must be state licensed. Although state licensing requirements vary somewhat from one state to the next, all require candidates for licensure to possess, at a minimum, a Master of Science in Nursing (MSN) and national certification specific to both their primary role as NP and patient population focus.
In 2013-14, about 17,000 new NPs completed their graduate nursing programs. Depending on the institution, MSN-Nurse Practitioner programs may be offered as:
- Traditional BSN-to-MSN Programs: These programs are designed for BSN-prepared RNs seeking initial APRN licensure as a nurse practitioner and take about two years to complete. There are also practice focused DNP programs for MSN-prepared nurses and accelerated BSN-DNP programs for bachelor’s-prepared RNs
- RN-to-MSN Programs: These MSN programs accommodate RNs with associate degrees in nursing. RN-to-MSN programs encompass the components of both BSN and MSN curriculum and culminate in students earning both degrees in one accelerated program that takes about three years to complete. There are also RN-DNP programs that confer a BSN, MSN and DNP.
- Entry-Level (or Direct-Entry) MSN Programs: Entry-level MSN programs are designed for students that possess a BSN in a discipline other than nursing. Students of these programs first earn their RN and then go on to complete all components of an MSN.
- Post Graduate Certificate Programs: RNs and APRNs in other roles with a master’s degree who wish to pursue a nurse practitioner track can enroll in post-graduate certificate programs that typically take between a year and 18 months to complete.
MSN Nurse Practitioner programs consist of two components: a didactic (classroom) component and a clinical component. MSN programs consist of at least 500 hours of clinical study specific to the student’s chosen patient population focus.
Today’s MSN programs tend to be fairly flexible, with many institutions offering them in a fully or partially online format and/or as part-time programs that are designed to accommodate the schedules of working RNs. Online programs partner with clinical sites all over the country, allowing students to complete the didactic portion of their MSN-Nurse Practitioner program online and then complete the clinical component of their program at sites close to home. In many cases, students can complete clinical sequences at their current place of employment.
Once students have completed their MSN Nurse Practitioner program, they must become nationally certified in their patient population focus through a certifying body recognized by their state board of nursing. All certifying bodies and associated certifications are shown here:
- American Academy of Nurse Practitioners
- Adult nurse practitioner (ANP)
- Family nurse practitioner (FNP)
- American Nurses Credentialing Center
- Acute care nurse practitioner – Board certified (ACNP-BC)
- Adult nurse practitioner – Board certified (ANP-BC)
- Family nurse practitioner – Board certified (FNP-BC)
- Gerontological nurse practitioner – Board certified (GNP-BC)
- Pediatric primary care nurse practitioner – Board certified (PPCNP-BC)
- Psychiatric-mental health nurse practitioner – Board certified (PMHNP-BC)
- Adult psychiatric- mental health nurse practitioner – Board certified (PMHNP-BC)
- Adult-gerontological acute care nurse practitioner (AGACNP-BC)
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care (CPNP-PC)
- Pediatric nurse practitioner acute care (CPNPAC)
- National Certification Corporation
- Women’s health nurse practitioner – Board certified (WHNP-BC)
- Neonatal nurse practitioner – Board certified (NNP-BC)
- Oncology Nursing Certification Corporation
Certification must align with the population focus emphasized in the nurse practitioner’s graduate program.
Once candidates have successfully passed their board certification examination, they must apply for state licensure through their state board of nursing.
Master of Science in Nursing (MSN) Nurse Practitioner Programs
As of 2013, there were more than 400 institutions offering nurse practitioner specialty tracks specific to the six different patient population foci.
A number of institutions have also begun offering unique, dual focus programs that combine other, closely related advanced practice roles and patient population groups, for example, Women’s Health Nurse Practitioner/Certified Nurse-Midwife. These hybrid programs allow students to broaden their scope of practice and qualify for dual national certification and advanced practice state licensure in additional roles.
In 2012, about 80 percent of all NPs were prepared in primary care nurse practitioner programs. The most common areas of primary care preparation during this time were:
- Family: 49 percent
- Adult and geriatrics: 22 percent
- Women’s health: 8 percent
- Pediatrics: 8 percent
Many students also choose to further specialize their MSN-Nurse Practitioner degree by focusing their study on a specific sub-specialty through electives in such areas as oncology, nephrology, palliative care, etc.
Regardless of the patient population focus, all MSN-Nurse Practitioner programs encompass at least three, separate, graduate-level courses in:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced health assessment, including the assessment of all human systems, concepts and approaches, and advanced assessment techniques
- Advanced pharmacology, including:
- Pharmacotherapeutics of all broad categories of agents
MSN-Nurse Practitioner programs also consist of a specialty core of courses related to their chosen NP population and/or practice setting.
Nurse Practitioner Laws and Regulations
The laws and regulations for nurse practitioners vary somewhat from state to state. Nurse practitioners, like other APRNs, are lobbying for full practice autonomy as recommended by the Institute of Medicine and the National Council of State Boards of Nursing.
Full autonomy allows nurse practitioners to practice and prescribe independently to the full extent of their training and education without physician oversight and without the need to enter into a collaborative agreement with a physician. As of 2015, the following states have granted nurse practitioners full independent practice authority, recognizing them as independent healthcare providers:
- Washington D.C.
- New Hampshire
- New Mexico
- North Dakota
- Rhode Island
Additional resources for nurse practitioners include the following professional associations:
- American Association of Nurse Practitioners
- National Association of Pediatric Nurse Practitioners
- Gerontological Advanced Practice Nurses Association
- National Association of Nurse Practitioners in Women’s Health
- American Academy of Emergency Nurse Practitioners
- Dermatology Nurses Association
- National Association of Neonatal Nurse Practitioners
- Nurse Practitioner Associates for Continuing Education