Nurse practitioners play an important role in the U.S. health care system — as of 2017, Americans logged more than 870 million annual visits to nurse practitioners, looking for cures to a whole host of issues and illnesses. According to the U.S. Bureau of Labor Statistics, there were more than 166,200 licensed nurse practitioners working in the U.S. in 2017 in a variety of settings, including hospitals, private practices, mental health facilities and long-term care centers.
Career Outlook for Nurse Practitioners
| Nurse Practitioner (NP) | National Average | |
|---|---|---|
| Average Salary | $111,840 | $53,490 |
| Projected Job Growth | 28.2% | 5.2% |
Best States for Nurse Practitioners
| Salary | |
|---|---|
| California | $138,660 |
| Washington | $126,920 |
| Hawaii | $124,000 |
| New Jersey | $123,810 |
| Minnesota | $122,850 |
| Job Growth | |
|---|---|
| Arizona | 57.9% |
| Utah | 51.2% |
| Colorado | 45.8% |
| Florida | 44.8% |
| Texas | 43.8% |
What is a Nurse Practitioner?
Nurse practitioners (also known as NPs) are much more than just highly skilled registered nurses. They are nurses who have undergone rigorous graduate education, eked out years of on-the-job experience and earned specialized licensure in the field of nursing. A registered nurse who has earned at least a master’s degree in nursing is known as an “advanced practice registered nurse,” or “APRN”; nurse practitioners are a further specialization of APRN.
Nurse practitioners routinely perform the same duties as registered nurses. RNs, however, are NOT licensed to perform the same scope of duties as nurse practitioners. Nurse practitioners can examine patients, provide diagnosis and treatment plans, and prescribe medications — duties usually reserved for doctors. Because nurse practitioners can perform these key responsibilities, they play an important role in helping patients receive the health care they need; any treatment an NP can administer is one fewer task for a busy physician to attend to.
In 20 states, nurse practitioners have “full-practice authority” — they do not have to work under the supervision of a physician. In other states, a doctor must sign off on certain care decisions made by nurse practitioners. Here is the status of nurse practitioner authority for each state, according to the American Association of Nurse Practitioners as of July 2018:
- List of States with Full-Practice Authority for NPs – Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, Wyoming
- List of States with Reduced-Practice Authority for NPs – Alabama, Arkansas, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, New York, Ohio, Pennsylvania, Utah, West Virginia, Wisconsin
- List of States with Restricted-Practice Authority for NPs – California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia
Nurse Practitioner Skills
| Skill Name | Importance | Competence |
|---|---|---|
Step One: Earn Your Education
There are a few paths that aspiring nurses can take to become nurse practitioners, but they all require graduate work in nursing. In contrast, many registered nursing positions do not require candidates to complete graduate-level college coursework — another difference between RNs and NPs.
Perhaps the most direct path to becoming a nurse practitioner is to start by becoming a registered nurse. Typically this is done by earning a Bachelor of Science in nursing from an accredited college or university, then passing the NCLEX-RN examination. This exam is administered by the National Council for the State Boards of Examination and is required in all 50 states and U.S. territories. The purpose is for candidates to demonstrate aptitude in five key areas:
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
It is advisable to earn several years of work experience as an RN before enrolling in an RN-to-Master of Science in nursing program. Entry into nursing master’s degree programs is usually highly competitive, and work experience is often considered when universities are deciding which applicants to admit. These programs can take two or more years of study to complete.
Many MSN programs offer areas of specialization, such as:
- Family nurse practitioner
- Gerontological nurse practitioner
- General nurse practitioner
- Nurse educator/nursing leadership
- Nurse midwife
Nurses who earned bachelor’s or associate degrees in fields outside of nursing may have the option to enroll in bridge programs, such as a direct-entry MSN program, an RN-to-MSN program, or an LPN-to-MSN program. These programs have different educational approaches and requirements, and may alter the trajectory of a nurse’s career path, but in the end, they end at the same place: with the earning of an Master of Nursing degree.
Once registered nurses obtain the required level of educational obtainment, they can sit for a national examination and become licensed to work as advanced practice registered nurses.
Step Two: Earn Your Certification
Advanced practice registered nurses must earn a second license specific to the area in which they wish to practice. Following are some of the most common licenses that can be earned by NPs.
- Family Nurse Practitioner (FNP) — Administered by the American Academy of Nurse Practitioners Certification Board. This exam gauges clinical knowledge across the human life span, from prenatal to pediatric to elder care, and must be renewed with a 5-year time frame. NPs also must have a minimum of 1,000 hours of clinical practice and 100 hours of continuing education for re-certification.
- Adult Gerontology Primary Care Nurse Practitioner (A-GNP) — Administered by the American Academy of Nurse Practitioners Certification Board. This exam tests clinical knowledge of the adult population, from adolescents to the elderly. Must be renewed within a five-year time frame, and the A-GNP must have logged a minimum of 1,000 of clinical hours of practice, as well as 100 hours of continuing education.
- Pediatric Primary Care Nurse Practitioner (PPCNP) — Administered by the American Nurse Credentialing Center. The exam tests for demonstrated knowledge of diagnosis, treatment and management of health issues in children. The credential is valid for five years.
Since there are multiple organizations that offer certification in overlapping fields, nurses should always inquire with their State Board of Nursing about which exam is preferred or recognized in their state of practice.
Step Three: Continuing Education
Continuing education is required for all nursing professions. It’s especially crucial for APRNs because they typically work in specialized fields, such as gerontology, pediatrics or family care, where even small changes and discoveries can create a large impact. This certainly applies to nurse practitioners as well. NPs should regularly inquire with their state board of nursing in order to be aware of what continuing education requirements may be necessary in their state to renew their licenses.
Fortunately, continuing education resources abound for nurse practitioners. A few resources for continuing nursing education include the American Association of Nurse Practitioners or the Nurse Practitioner Associates for Continuing Education, and there are many different private companies that specialize in continuing education for NPs as well.
- What’s an NP?, American Association of Nurse Practitioners, https://www.aanp.org/all-about-nps/what-is-an-np#why-nps-are-important
- What is a nurse practitioner, Nurse.org, https://nurse.org/resources/nurse-practitioner/#-what-is-a-nurse-practitioner-
- NCLEX & Other Exams, National Council of State Boards of Nursing, https://www.ncsbn.org/nclex.htm
- Nursing Bridge Programs, Nurse Journal, https://nursejournal.org/articles/nurse-bridge-programs/
- Nurse anesthetists, nurse midwives and nurse practitioners, U.S. Bureau of Labor Statistics Occupational Outlook Handbook, https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-4
- National Certification Exam Resources, National Board of Certification and Recertification for Nurse Anesthetists, https://www.nbcrna.com/exams/nce-resources
- Family Nurse Practitioner, American Academy of Nurse Practitioners Certification Board, https://www.aanpcert.org/certs/fnp#
- Adult Gerontology Primary Care Nurse Practitioner, American Academy of Nurse Practitioners Certification Board, https://www.aanpcert.org/certs/agnp
- Pediatric Primary Care Nurse Practitioner, American Nurses Credentialing Center, https://www.nursingworld.org/our-certifications/pediatric-primary-care-nurse-practitioner/
- State Practice Environment, American Association of Nurse Practitioners, Accessed July 2018, https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment