What is a Nurse Practitioner?

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.

What is a Nurse Practitioner?

Nurse Practitioners (NP) are registered nurses (RN) 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.

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.

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.

Understanding the Practice Doctorate in Nursing

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Resources

The American Association of Nurse Practitioners

Medline Plus article on NPs

National Association for Pediatric Nurse Practitioners

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

ANCC Certifications

AANP

APRN Prescribing Law - State by State (MEDSCAPE 2018)

Bureau of Labor Statistics NP Occupational Employment and Wages (5/2012)

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DidiRN

About DidiRN

I’ve been on allnurses since the beginning (1998). 25 plus year(s) of experience in ICU, step down, dialysis.

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Specializes in Family Nurse Practitioner.

Do all acute care nurse practitioner programs require critical care/ICU experience?

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
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.

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Specializes in Family Nurse Practitioner.
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!

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Specializes in Medical-Surgical, Telemetry/ICU Stepdown.

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...

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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...[/quote']

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..

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Specializes in Adult Internal Medicine.
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...[/quote']

What would "we" need to talk about?

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Specializes in Medical-Surgical, Telemetry/ICU Stepdown.
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...

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Specializes in Pediatric Nursing Certification.

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 http://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.

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Specializes in Anesthesia, Pain, Emergency Medicine.

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 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 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 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.

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Specializes in Anesthesia, Pain, Emergency Medicine.

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?

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...
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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
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.

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