How to Become a Nurse Practitioner (NP)

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Nurse practitioners (NPs) are critical members of any multidisciplinary healthcare team. NPs can assess, diagnose, manage, and treat health conditions, as well as educate patients on wellness and disease prevention. NPs work in a variety of healthcare settings and can serve many functions in patient care. NPs are advanced practice registered nurses (APRNs), which means they have a higher level of practice autonomy than other nursing professionals like registered nurses (RNs) and licensed practical nurses (LPNs). In most states, NPs work as independent providers with full practice rights under the licensure of that state’s board of nursing. Some states require NPs to work either collaboratively with, or under the supervision of, physicians.

Choosing to pursue a career as a nurse practitioner offers individuals the opportunity to have a lucrative and stable career. As contributors to the health and quality of life of individuals and communities, NPs also enjoy work that is quite rewarding.

What Is an NP?

A nurse practitioner is an advanced practice nurse who provides acute, chronic, and primary healthcare services to all types of patients in many different health settings. They, like physicians and physician’s assistants (PAs), are considered advanced practitioners with many overlapping responsibilities. Some of an NPs responsibilities include:

  • Writing and managing prescriptions
  • Administering vaccinations
  • Performing screenings and physical health assessments
  • Assessing, diagnosing, and treating injuries and illnesses
  • Referring patients to specialists as needed
  • Teaching and counseling patients about health, nutrition and lifestyle
  • Obtaining and interpreting diagnostic or laboratory testing

here are several different specializations for advanced practice nurses, including:

  • Acute Care Nurse Practitioner
  • Family Nurse Practitioner
  • Pediatric Nurse Practitioner
  • Adult Gerontological Nurse Practitioner
  • Psychiatric Nurse Practitioner
  • Certified Registered Nurse Anesthetist
  • Nurse Midwife

What Does an NP Do?

A nurse practitioner is authorized to establish care with patients, independently examining patients, diagnosing illness, providing treatments, and assessing outcomes. In many states, nurse practitioners have full practice authority, which means they are not required to have a doctor supervising them while providing care. In other states, NPs are still considered advanced providers but may need to make patient care decisions under the supervision of a physician.

NPs have an increasing presence in acute care settings like hospitals, where they oversee patient care along with - or instead of - physicians. Still relying on the nursing model to practice, NPs continue to have close relationship with patients. This gives them a unique perspective, while their advanced education allows them to make sound, informed decisions about patient care. According to the Kaiser Family Foundation, nurse practitioners can handle between 80% and 90% of what doctors are authorized to manage in the primary care setting. Furthermore, disease outcomes and quality of life measures for patients of NPs and physicians are comparable.

Where Can an NP work?

Nurse practitioners are capable of providing high-quality care in rural, urban and, suburban communities. A nurse practitioner is qualified to work across many different health settings, including but not limited to:

  • Medical clinics and primary care offices
  • Emergency departments
  • Hospital inpatient units
  • The operating room
  • Urgent care clinics
  • Private practice
  • Colleges, schools, and universities
  • Nursing homes and other extended care facilities
  • Public health

Essentially, nurse practitioners can work anywhere healthcare services are provided. Depending on state legislation and facility-specific needs, their role may vary slightly.

Work Environment

The work environment for NPs can be very fast-paced and demanding. NPs who work in urgent and acute care settings expect emergencies as part of their work, while NPs in medical clinics and other outpatient areas rarely experience patient crises but are prepared to address them if they come up.

Having certain personal attributes can help people thrive in the NP work environment and optimize patient care. These attributes can include, but may not be limited to:

  • Physical stamina
  • Being detail-oriented and organized
  • Strong time management skills
  • Advanced communicative ability
  • Flexibility and ability to reprioritize
  • Empathy for patients

Career Outlook and Demand

The nursing sector is growing, and NPs in particular have higher than average projected career growth. Demand for the work of NPs is increasing, particularly in primary care settings. The U.S. Bureau of Labor Statistics estimates that jobs for nurse practitioners will increase by 31% between 2016 and 2026, more than four times faster than the average projected job growth of 7%.

Salary

NPs are some of the highest earners among licensed nurses. According to the U.S. Bureau of Labor Statistics, the median annual pay for nurse practitioners was $107,030 in 2018. NPs in the bottom 10th percentile make $78,300 per year or less, while NPs in the 90th percentile make $150,320 or more. Salary for an NP is highly dependent on state where practicing, urban versus rural locations, type of facility, NP level of education, and experience.

Education

To become a nurse practitioner, one must first earn a Bachelor of Science in Nursing (BSN) and become a registered nurse. NP-hopefuls can enroll in a Master of Science in Nursing (MSN) program, which takes about two years to complete, if done full time. Most nurses work while they pursue an MSN, which may increase the amount of time to complete their degree. The normal path to an MSN is to earn a BSN first, but there are also RN-MSN programs for applicants who have an RN license, ADN-MSN programs for applicants who hold an associate degree in nursing, and MSN programs for students who have a bachelor’s degree in a non-nursing field. Many nurse practitioners today receive a Doctor of Nursing Practice (DNP), a terminal degree in clinical nursing. For every nursing degree, students of nursing are required to complete both didactic coursework and clinical training.

Applying to Nursing School

A master of science in nursing (MSN) is the minimum educational requirement to become an NP. To successfully apply for MSN programs, an applicant should meet several prerequisites:

  • Bachelor of Science in Nursing (BSN)
  • Biology, chemistry, and other physical sciences
  • Humanities, statistics, and research
  • Nursing experience
  • State licensure

MSN applicants submit their transcripts, records of nursing experience, volunteer or other practical experience, letters of recommendation, and personal statements with their application. Some schools require GRE or other standardized tests for admission, but applicants should review each program individually to determine if this is the case.

Continuing Education for NPs

Nurse practitioners go through advanced academic and clinical training to get into their roles, and continuing education (CE) helps to ensure NPs stay current with the latest health advancements and clinical evidence. This allows them to treat their patients most effectively throughout their career. CE is offered by some employers, at universities, and by professional organizations. Common CE topics for NPs include:

  • Pediatric care
  • HIV/AIDS populations
  • Avoiding medical errors
  • Resident and patient rights
  • Providing psychosocial support for patients
  • Effective documentation in healthcare settings
  • Elderly patient care
  • Medical breakthroughs and evidence-based practice

Licensure

Licensing requirements vary by state. To work as an NP, most states require a nurse to be licensed as an Advanced Practice Registered Nursing (APRN). At a minimum, prospective NPs must complete these steps:

  • Gain clinical patient experience, which is often a prerequisite for NP school.
  • Earn a graduate degree (MSN or DNP).
  • Choose a specialization. All NP programs are specialization-specific.

Certification is required to work with different patient populations. There are five different NP certification boards in the U.S., with each offering certifications for different patient groups. These include:

  1. The American Nurses Credentialing Center (ANCC)
    • Adult-Gerontology Acute Care
    • Adult-Gerontology Primary Care
    • Family
    • Pediatric Primary Care
    • Psychiatric-Mental Health
  2. The Pediatric Nursing Certification Board (PNCB)
    • Pediatric Primary Care
    • Pediatric Acute Care
  3. The National Certification Corporation (NCC)
    • Neonatal
    • Women’s Health-Gender Related
  4. The American Academy of Nurse Practitioners Certification Program (AANPCP)
    • Family
    • Adult-Gerontology Primary Care
  5. The American Association of Critical-Care Nurses (AACN)
    • Adult-Gerontology Acute Care

In addition to national certification, there may be additional requirements on a state level. Specific requirements for nurse practitioner licensure can vary on a state-by-state basis, but in general, applicants need the following to practice legally in any state:

  • Photo identification
  • Proof of completion for education requirements
  • Proof of legal name change (if applicable)
  • Criminal history and fingerprinting for background checks
  • An application fee

Frequently Asked Questions

What Is the Difference Between a Physician Assistant and a Nurse Practitioner?

Nurse practitioners and physician assistants (PAs) handle many of the same tasks, but there are a few noteworthy differences between them. PAs must work under the supervision of a physician, while about half of the states offer NP full practice autonomy. NPs are trained to work in specific nursing specialties during their schooling, while PAs are not trained to work with general patient populations.

What Is the Difference Between a Nurse Practitioner and a Doctor?

Nurse practitioners and doctors have overlapping responsibilities but are different from one another in training criteria and scope of practice. It takes less time and a more flexible timeline to become an NP than a physician, and the medical model of patient care is different than the nursing model.

How Long Does It Take to Become a Nurse Practitioner?

NPs are among the most highly trained professionals in the nursing sector. As a result, it usually takes at least six years of experience and training to become an NP. Because many nurses choose to get experience as RNs before becoming NPs, it may take much longer. Prior to beginning NP school, prospective nurses have historically needed to spend a few years in healthcare settings getting hands-on patient and health experience, but many programs now also offer direct to NP programs. Additional education and training may be warranted for NPs who work with very specific or complex patient populations.

Can Nurse Practitioners Write Prescriptions?

NPs can have prescriptive authority, including prescriptions for controlled substances, in all 50 states and Washington, D.C. Not every state offers the same level of independence, however. Depending on where an NP practices, he or she may treat and prescribe under the supervision of, or in collaboration with, a physician. In addition to pharmaceuticals, medical devices and certain services may also require physician oversight. It depends on a state’s “practice authority,” which refers to the ability of an NP to practice and work to the extent of their education, training, and highest level of certification. In some states, NPs must also apply for prescriptive authority separately.