Nurse Practitioners

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    Nurse practitioners are experiencing a period of high growth in recent years. Many current RNs and prospective students are interested in more information on this area of nursing. This article is a basic description of this field.

    Nurse practitioners are registered nurses with graduate level degrees and are considered advanced practice nurses. They are able to provide health care services to patients in a variety of different settings. Some responsibilities include: assessing, diagnosing, and managing acute and chronic conditions. They are also responsible for prescribing medications as needed as well as health promotion and disease management.

    Educational Requirements

    The minimum educational requirements for an NP is a masters in science of nursing. Some programs require some RN experience while others do not. Some colleges offer a route for individuals without a nursing degree; they are generally known as direct entry programs. These types of programs usually require a bachelor's degree in another field as a prerequisite for admission. The American Association of Colleges of Nursing (AACN) recommends (not requires) a minimum of a doctor of nursing practice (DNP) by 2015. However many colleges and universities are moving forward with the DNP requirement and no longer offer the MSN approach. These typically take three to four years to complete, while the MSN requires 2 years of study for individuals who already are RNs.

    There are different types of specializations for the NP which include: family nurse practitioner, adult geriatric nurse practitioner, acute care nurse practitioner, pediatric nurse practitioner, psychiatric-mental health nurse practitioner, neonatal nurse practitioner and women's health nurse practitioner. A few programs offer dual degrees such as Vanderbilt University's dual Family Nurse Practitioner/Adult Gerontological Nursing with an Emergency Care focus or Case Western Reserve's Adult-Gerontology Acute Care NP with a focus on Flight Nursing, Cardiovascular Nursing and Oncology/Palliative Care NP focus.

    Certification is required in order for NPs to practice is most states. The American Academy of Nurse Practitioner (AANP) is one organization that offers a certification exam. The American Nurses Credentialing Center (ANCC), which is affiliated with the American Nurses Association, also offers a certification exam. There are only small differences between the two. For example, the ANCC allows NPs to earn CEU's by precepting NP students. The AANP exam can actually be taken prior to graduation. Most NP positions require one certification or the other; a few organizations may prefer to hire NPs with a specific certification.

    It is imperative that each NP know and understand the requirements of their practicing state. Almost all states require certification from either AANP or ANCC before a license is issued. Prescriptive authority are requirements that must be met in order to legally prescribe medications. To prescribe controlled substances, NPs must apply for a DEA (Drug Enforcement Agency) number. This number is also used to track the number of controlled substances the NP may write as well as for identification purposes by the DEA.

    Most states require a NP to have a current collaboration agreement with a physician. These are written agreements in which the physician agrees to oversee a NP's practice. The requirements of these agreements vary from state to state. Some may only require physician agreement in order to prescribe medications only while others may require it for the NP to a diagnose and treat. Some may require the agreement to include written treatment protocols, periodic physician review of the NPs charts, patient referral and consultation, or resolutions of disagreements between the NP and the physician. States where this agreement is not required are considered independent practice states.

    Work Environment

    NP's work in many areas within health care organizations such as hospitals, mental health facilities, community health centers, physician offices, long term care, urgent care, and hospice. New areas are opening up such as telehealth and home health. In independent practice states, NP's can even open their own clinics and treat patients.

    Duties / Responsibilities
    • Diagnosis and manage patient all types of health conditions
    • Detailed physical examinations (history and physicals)
    • Orders diagnostic and/or laboratory tests and interprets results
    • Orders treatments and monitors effectiveness
    • Collaborates with other members of the health care team
    • Performs procedures dependent on area of specialization
    • Patient and family education and counseling on health conditions

    Projected Vacancies

    The Bureau of Labor Statistics (BLS) does not differentiate between projected vacancies for nurse practitioners and registered nurses. Many do foresee an explosion of opportunities in many areas of the US due to the current health care climate and shortage of primary health care providers. There may be areas that have few opportunities while others areas may have a high demand.

    Salary

    Salaries vary quite a bit from state and specialty. NPs who specialize in acute care or work with surgeons can usually command a higher salary than ones who work in a family practice office. The mean salary according to the Bureau of Labor Statistics in May 2012 is $91,450/year.

    It is important for new NPs to understand the negotiating process during the interview and hiring process. Not only is salary negotiable but benefits, loans repayments, vacations and bonuses can be negotiated as well. Knowing how much revenue you bring to the practice can help serve as a point of reference if this is possible to discover this ahead of time. Many websites can give tips on how to negotiate as well as local salary information.

    Resources

    The American Association of Nurse Practitioners

    Medline Plus article on NPs

    Bureau of Labor Statistics Occupational Employment and Wages Report


    National Association for Pediatric Nurse Practitioners

    Nurse Practitioners in Women's Health

    FAQ About Psychiatric Mental Health Nurses from the American Psychiatric Nurses Assoc.

    Certifications:

    ANCC
    AANP

    APN Prescribing Requirements by State

    Bureau of Labor Statistics NP Occupational Employment and Wages (5/2012)
    Last edit by Joe V on Dec 4, '13
    Jules92, ronchelednik, Esme12, and 7 others like this.

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  2. Visit  DidiRN profile page

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    22 Comments so far...

  3. Visit  Lev <3 profile page
    0
    Do all acute care nurse practitioner programs require critical care/ICU experience?
  4. Visit  juan de la cruz profile page
    0
    Quote from Lev <3
    Do all acute care nurse practitioner programs require critical care/ICU experience?
    They don't necessarily require critical care experience like CRNA programs do but I'd say a great majority require acute care experience (which can include ED, Med/Surg, ICU or Step-down). Depending on the competitiveness of the program, applicants with experience that fit well with the ACNP role have a better chance of getting admitted.
  5. Visit  Lev <3 profile page
    0
    Quote from juan de la cruz
    They don't necessarily require critical care experience like CRNA programs do but I'd say a great majority require acute care experience (which can include ED, Med/Surg, ICU or Step-down). Depending on the competitiveness of the program, applicants with experience that fit well with the ACNP role have a better chance of getting admitted.
    Thanks juan de la cruz!
  6. Visit  Concerto_in_C profile page
    0
    I've always had mixed emotions about advanced practice nurses because I'm curious what drives and motivates them...

    Is an APN still #1 a nurse, or is she #2 a doctor wannabe? Because if #2 is true, then we need to talk about it.

    I realize the transition to advanced practice nursing is still work in progress as it is new to many patients and doctors...
    Last edit by Concerto_in_C on Dec 2, '13
  7. Visit  BostonRN13 profile page
    5
    Quote from Concerto_in_C
    I've always had mixed emotions about advanced practice nurses because I'm curious what drives and motivates them... Is an APN still #1 a nurse, or is she #2 a doctor wannabe? Because if #2 is true, then we need to talk about it. I realize the transition to advanced practice nursing is still work in progress as it is new to many patients and doctors...
    Can't say I know anyone who went back to NP school because they are a doctor wannabe ? Lol. I think that's unfortunate that a nurse (I'm assuming that's what you are) would think that of her own peers and lessen the value of APNs. My reason for going back was to have increased autonomy and new challenges..
    ICUman, antania31, Apntrekkie, and 2 others like this.
  8. Visit  BostonFNP profile page
    0
    Quote from Concerto_in_C
    I've always had mixed emotions about advanced practice nurses because I'm curious what drives and motivates them... Is an APN still #1 a nurse, or is she #2 a doctor wannabe? Because if #2 is true, then we need to talk about it. I realize the transition to advanced practice nursing is still work in progress as it is new to many patients and doctors...
    What would "we" need to talk about?
  9. Visit  Concerto_in_C profile page
    0
    Quote from BostonFNP
    What would "we" need to talk about?
    One of the problems at the place I work is on some floors everybody wants to be in command but nobody wants to be with the troops in the trenches. Too may alpha females and controlling personalities, not enough dedicated worker bees to do the work. It seems some of the overachievers I've spoken to want to bolt bedside care as soon as they get their bachelor's...
  10. Visit  lboocks profile page
    2
    Thank you for sharing this information, but your statement, “Almost all states require certification from either AANP or ANCC before a license is issued,” is misleading. There are other NP roles for which ANCC and AANP do not offer an exam, and there are other certification boards whose exams are accepted by any state requiring certification to practice. For example, Pediatric Nursing Certification Board’s PNP certification is accepted by all states, and over 90% of PNPs are certified by PNCB. I hope you can edit your article to reflect this. For more about PNCB exams, visit www.pncb.org. All but 3 states currently require certification for APRN licensure. The Campaign for APRN Consensus offers informative maps exploring this and other topics at https://www.ncsbn.org/2567.htm.
    Last edit by lboocks on Dec 4, '13 : Reason: html error
    DidiRN and juan de la cruz like this.
  11. Visit  nomadcrna profile page
    1
    You statement that "Most" states require a written collaborative agreement may be misleading. It is much more complicated than that. Personally, I would emphasize the independent practice in 22 states.


    1. Which states allow APRNs to independently deliver a broad range of services?
      The scope of practice for APRNs varies widely by state and specialty. For example, in the case ofnurse practitioners (NPs), the most numerous of APRN roles, 22 states and DC allow NPs to diagnoseand treat without physician involvement: (AK, AZ, CO, HI, ID, IA, KY, ME, MI, MT, NH, NJ, NM, ND,OK, OR, TN, UT, WA, WV, and WY. In contrast, 24 states require a formal [FONT= ]relationship, documentedin writing, between an NP and a physician: (AL, AR, CA, DE, FL, GA, IL, KS, LA, MD, MA, MS, MO, NE,NV, NY, NC, OH, SC, SD, TX, VT, VA, and WI.) This [FONT= ]relationship requirement varies from state to stateand could call for supervision, delegation, authorization, or more general direction andcollaboration. The remaining 4 states also require some form of [FONT= ]relationship between NPs andphysicians, but do not require documentation of such relationship: CT, IN, MN, and PA. When itcomes to prescriptive authority, only 13 of the 23 jurisdictions that allow autonomous practice byNPs allow them to prescribe medications for diagnosis and treatment without the involvement of aphysician: AK, AZ, DC, ID, IA, ME, MT, NH, NM, OR, RI, WA, and WY. The remaining 38 states allrequire documented physician involvement for NPs to be able to prescribe medications.
      In the case of certified nurse-midwives, 18 jurisdictions allow CNMs to diagnose and treat withoutrequiring physician supervision or formal collaborative agreements; other states vary as torequirements for physician involvement. All states confer prescriptive authority to CNMs, although11 require physician involvement.
      For certified registered nurse anesthetists (CRNA) the ability to provide anesthesia in hospitals andoutpatient settings without supervision is controlled by both state and federal regulations. Stateregulations have to allow CRNAs to practice in hospitals and outpatient settings without supervisionfrom physicians, and the state must also opt out of federal Medicare requirements for physician



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    supervision (otherwise hospitals will not be reimbursed for CRNAs’ services). Currently, 16 stateshave state laws that do not require CRNAs to be supervised and have opted out of the federalsupervision requirements; other states either do not allow CRNAs to practice without supervision bya physician or have not opted out of the federal Medicare requirement for physician supervision ofCRNAs.
    DidiRN likes this.
  12. Visit  nomadcrna profile page
    2
    It is a totally different profession. NP all need to make the transition from floor nurse to independent practitioner.
    You do realize that we do the exact same job as our physician counterparts?

    Quote from Concerto_in_C
    One of the problems at the place I work is on some floors everybody wants to be in command but nobody wants to be with the troops in the trenches. Too may alpha females and controlling personalities, not enough dedicated worker bees to do the work. It seems some of the overachievers I've spoken to want to bolt bedside care as soon as they get their bachelor's...
    ronchelednik and JRJohnson like this.
  13. Visit  juan de la cruz profile page
    1
    Quote from Concerto_in_C
    One of the problems at the place I work is on some floors everybody wants to be in command but nobody wants to be with the troops in the trenches. Too may alpha females and controlling personalities, not enough dedicated worker bees to do the work. It seems some of the overachievers I've spoken to want to bolt bedside care as soon as they get their bachelor's...
    While I'm not dismissing the legitimacy of your gripe, you and I know that the Nurse Practitioner field has nothing to do with that issue. There are many dissatisfied hospital bedside RN's out there. Much of that is a result of poor nursing management styles and the whole health care organization's culture of disrespect to bedside nursing as easily replaceable by any breathing human being willing to take abuse. I think your gripe is best directed to the appropriate channels - maybe a nurse practice council in your hospital, even a union. If you feel a need to vent, start a separate thread about it.

    As a nurse with years of experience, I once during my career have been in the trenches too with many dissatisfied bedside nurses and yes, many colleagues said they would love to become NP's and leave the grueling work at the bedside. But how many of those colleagues really followed through and are now NP? not a lot in my experience.
    ronchelednik likes this.
  14. Visit  juan de la cruz profile page
    2
    Thanks lboocks for pointing out the other Nurse Practitioner specialties not represented by AANP nor ANCC in terms of certification. I think this forum in general, paints the Nurse Practitioner field in the eyes of FNP's. They are the biggest chunk of NP's in the country in terms of numbers and perhaps that's the reason for the bias.

    I think we should add, for the benefit of fairness, that the Consensus Model slated to be implemented in 2015, have given us 8 Nurse Practitioner educational path templates and these are what we should go by:

    1. Family Nurse Practitioner (FNP) - certification through ANCC or AANP
    2. Adult and Gerontology Nurse Practitioner (AGNP) - certification through ANCC or AANP
    3. Adult and Gerontology Acute Care Nurse Practitioner (AGACNP) - certification through ANCC or AACN
    4. Pediatric Primary Care Nurse Practitioner (PC-PNP) - certification through ANCC or PNCB
    5. Pediatric Acute Care Nurse Practitioner (AC-PNP) - certification through PNCB
    6. Women's Health Nurse Practitioner (WHNP) - certification through NCC
    7. Neonatal Nurse Practitioner (NNP) - certification through NCC
    8. Family Psychiatric and Mental Health Nurse Practitioner (FPMHNP) - certification through ANCC

    Any combination of Nurse Practitioner paths offered in schools (i.e., combined FNP/ENP, combined AGACNP/Critical Care NP, combined AGNP/Oncology NP) must adhere to the core requirements of the corresponding certification boards listed above.


    Links not included in the article:
    Pediatric Nursing Certification Board - PC-PNP and AC-PNP
    American Association of Critical Care Nurses - AGACNP
    National Certification Corporation - WHNP and NNP
    Last edit by juan de la cruz on Dec 4, '13
    ronchelednik and lboocks like this.


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