How to Become a Nurse Practitioner
Overview: The NP Is In
Nurse practitioners (NPs) are health care providers who practice in a variety of settings such as acute care, outpatient care and specialty clinics. Sometimes they serve in leadership, management, research or teaching roles within healthcare organizations or universities. They are registered nurses who have undergone advanced academic and clinical training to provide medical care for a wide variety of patients. Their daily practice closely resembles that of a doctor.
A nurse practitioner has an advanced degree – either a master’s or doctorate (DNP or PhD). In most states, they practice with independent licensure, but in some states they have collaborative agreements with physicians. Nurse practitioners are known as advanced practice nurses (APRNs) and, if they have a Doctorate in Nursing Practice, can be referred to as DNPs. With their many years of training, they are qualified and licensed to provide a wide array of health services to their patients, such as:
- Performing thorough examinations and evaluations
- Diagnosing diseases and conditions
- Initiating and managing treatments
- Ordering and interpreting tests
- Performing minor surgical procedures or assisting in major surgical procedures
- Prescribing medications (where permitted by law)
- Providing counseling and education
Many NPs serve as primary care providers to adults, children and families. Others specialize in a particular area of medicine, such as psychiatry, dermatology or midwifery. Nurse practitioners are trained in the nursing model, while medical doctors or physician assistants are trained in the medical model. The nursing model focuses on an evidence-based approach to addressing a patient’s mental, social, and physical needs to bring about long-term wellness. This is also referred to as the bio-psycho-social model. The medical model focuses on the eradication of disease and treatment of diagnoses. This helps explain why nurse practitioners often take the time to listen to their patients' concerns and enact holistic approaches to their care. They also take time to educate and provide lifestyle modifications to help with their patients’ symptoms.
When it comes to achieving positive outcomes for patients, research shows that nurse practitioners are every bit as successful as physicians. What’s more, patients of nurse practitioners report high levels of satisfaction with their care. For compassionate people who value responsibility and intellectual stimulation, a career as a nurse practitioner is extremely rewarding. Through a combination of counseling, education and medical intervention, they help patients live longer, healthier and more productive lives.
Nurse practitioners work in a variety of environments, including:
- Hospitals, acute care or ambulatory care settings
- Outpatient settings
- Long-term care facilities and nursing homes
- Private homes providing health care services
- Hospice and palliative care services
- Government and community health agencies
- Universities and research agencies
- Healthcare or health industry businesses
- Private practice
The work schedules of NPs vary by their job. Most often they work standard business hours, but may have extended hours some days of the week. Some inpatient roles work standard hours while others have rotating shifts that cover evening, night and weekend hours as well as holidays. In community agencies and private practice, NPs may offer some evening and weekend appointments for the convenience of working patients. Nurse practitioners sometimes take call nights and weekends, depending on their job. NPs can often find full-time, part-time, or PRN (as needed) positions, depending on their experience.
Nurse practitioners spend most of the workday interacting with patients, families, colleagues and administrators. They generally work in clean, well-lit settings, though some travel to patients’ homes. When working in hospital settings, NPs spend a lot of time on their feet and must be comfortable lifting, bending and stooping. With the evolving role of technology in the healthcare field, NPs often use electronic medical records to help manage their patients’ care.
Education and Training
Nurse practitioners must first earn a bachelor’s degree in nursing (BSN) from an accredited training program. This takes about four years of full-time study and requires both classroom and clinical learning. Some RNs that hold an associate degree (ASN) may pursue a bridge BSN program to obtain this degree while working as a nurse. Students who have earned a four-year degree in a non-nursing field should look into an accelerated BSN program, which can allow them to become a nurse in 12-16 months of study. Once students graduate with their BSN degree, they must successfully pass the national nursing exam (NCLEX) and obtain licensure as an RN in their state.
Nurse practitioner students then must complete an additional two to three full-time years of study to earn a master’s degree in nursing (MSN) or Doctorate of Nursing Practice (DNP). Typically, part-time programs are possible but may take longer to complete. Graduate programs include in-depth courses in pathophysiology, pharmacology, medical ethics, and medical diagnosis and management, as well as extensive clinical training. Many graduate and doctoral programs offer some or all of their didactic courses online. During this phase, students begin to focus on a specialty, such as:
- Family care
- Acute care or primary care
- Psychiatric-mental health
- Adult-focused care
Many graduate schools require NP candidates to have a year of experience as a registered nurse (RN). Others offer bridge programs so that a student can do an RN to DNP during the same course of study. The Accreditation Commission for Education in Nursing (ACEN) and American Association of Colleges of Nursing list accredited programs on their websites.
All NP/DNP education programs include extensive clinical experience; most require 500-1000 hours of clinical rotations.. To enter some specialties and sub-specialties (child and adolescent psychiatry, for example), nurse practitioners must complete additional supervised clinical experience.
How are NPs unique from midwives, CRNAs, or PAs?
NPs, nurse midwives, nurse anesthetists and physician assistants all pursue high-quality graduate education to obtain their level of practice. Nurse midwives (CNMs) and nurse anesthetists (CRNAs) also become BSN nurses at the outset, but they pursue different tracks of graduate study than nurse practitioners. They obtain similar high-quality advanced clinical practice. Meanwhile, physician assistants (PAs) are trained in 2-year graduate programs and can have similar roles as NPs, but cannot work independently of a physician.
Licensing and Certification
Nurse practitioners must be licensed by the state in which they practice. This requires graduation from accredited training programs, successful RN licensure, and board certification in the advanced practice specialty. The board certification typically requires passing a national exam and most certifications have to be renewed every 3-5 years. In some states, nurse practitioners must meet mandatory training requirements (for example, courses in medication safety) prior to licensure.
Healthcare professionals are held to high ethical standards. They undergo background checks, fingerprinting, and validation of all reported credentials in order to obtain licenses, certification, education, and employment. A criminal record may prevent an applicant from succession or stop a current NP from practicing.
The following organizations award board certification in nursing. Candidates must hold an RN license and meet educational and training requirements:
- National Board for Certification of Hospice and Palliative Nurses
- American Association of Nurse Practitioners
- National Certification Corporation
- American Nurses Credentialing Center
- Pediatric Nursing Certification Board
- Oncology Nursing Certification Corporation
Necessary Skills and Qualities
To provide high-quality care, nurse practitioners must be compassionate, empathetic, patient and nonjudgmental. Excellent interpersonal skills are needed to communicate effectively with patients, families and other professionals.
In order to diagnose and treat patients effectively, nurse practitioners rely on excellent analytical and observational skills. They must be especially attentive to detail when performing surgery or prescribing medications.
Opportunities for Advancement
Experienced nurse practitioners often specialize in one or more clinical area of interest. Others serve as managers or administrators of healthcare facilities and community agencies. Some leave the clinical setting to start a private practice or teach at the university level. Many NPs serve as consultants within the healthcare, pharmaceutical or insurance industries.
Opportunities for advancement increase with education, experience and certification in multiple specialty areas.
If you would like to gain the necessary education to become a nurse practitioner, we highly recommend that you check out our free School Finder Tool located HERE.
The average annual salary of a nurse practitioner is $97,990 according to the U.S. Bureau of Labor Statistics as of May 2014. Most earn between $82,720 and $113,470, though the top 10% of wage earners made around $131,050. In many specialties, the average salary is between $95,000 and $120,000.
The demand for nurse practitioners will grow greatly in coming years; the Bureau of Labor Statistics projects job growth of 34% for NPs from 2012 to 2022. Reasons for this high growth include the increasing insured rate of patients, growing elderly population, shortage of doctors, and the current emphasis on preventative care. Hospitals, health departments and home health care agencies are hiring a growing number of NPs to handle some of the workload formerly handled by doctors, and this trend is expected to continue.
Job prospects will be especially good for nurse practitioners who specialize in geriatrics and are willing to work in nursing homes and long-term care facilities. Candidates may increase their job prospects by relocating to rural or urban areas, both of which are experiencing health care worker shortages.