How to Become a Nurse Practitioner

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. NPs 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; 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.

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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

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.

How Are NPs Different from Physician Assistants, Nurse Midwives and Nurse Anesthetists?

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.

Workplace Details

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.

Hover over any state to explore local income and job growth data.

The average annual salary of a nurse practitioner is $101,260 according to the U.S. Bureau of Labor Statistics. The top 10% of wage earners make a median of $135,830, while the bottom 10% make a median of $70,540.

The demand for nurse practitioners will grow greatly in coming years; the Bureau of Labor Statistics projects job growth of 31% for NPs from 2014 to 2024. 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.

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.

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Once students graduate with their BSN degree, they must successfully pass the National Council Licensure Examination (NCLEX).

Students must obtain licensure as an RN in their state. 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.

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

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
• Oncology
• Geriatrics
• Pediatrics
• Psychiatric-mental health
• Adult-focused care
• Neonatology

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.

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.

Because you need to earn a bachelor’s degree and become an RN in order to apply for graduate nursing training, the BSN-RN offers the quickest route toward qualification as a nurse practitioner. If a BSN program is not immediately feasible for you, there are other routes you can take toward your goal. Many nursing schools offer “bridge” programs that allow working nurses with a CNA to earn a PN degree; those with a PN to earn an associate degree, or a BSN; and those with an associate degree to earn a BSN. You might, for instance, earn an associate degree in nursing, qualify as an RN, and find a job you like – then go back to school part-time to complete your BSN while working. Remember that there is no disadvantage in gaining a deeper practical experience of nursing before you make decisions about graduate school. You may have a better idea of where your professional interests lie after you’ve had time to develop as a nurse. Graduate schools sometimes prefer applicants who have practiced longer, and some advanced practice specialties require a number of years of work in acute-care settings.

Wherever you study as an undergraduate, make sure to choose degree program(s) with accreditation from either the CCNE (Collegiate Council of Nursing Education) or ACEN (Accreditation Commission for Education in Nursing; formerly NLNAC), since this will affect your ability to continue your studies and find employment. Again, your state’s Nursing Commission/Nursing Board can help find out about the accreditation status of programs you’re considering. It’s not a bad idea to visit webpages administered by a few of the graduate programs that interest you, and find out what their admission requirements are with respect to accreditation of BSN programs.

A bachelor’s (baccalaureate) degree in nursing is both a liberal arts and professional degree, meaning that the science and nursing courses that make up the core of your major are part of a broader plan of study that also includes classes in history, social science, and writing. Because a BSN is prerequisite for graduate education in nursing, this degree is your gateway to specialty practice, research and teaching.

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BSN students usually begin taking nursing courses in their second year. Your major coursework will likely include:

You may not need to complete a traditional BSN program if you have already earned a baccalaureate or graduate degree in a different field. If you meet the admission prerequisites, an ABSN (accelerated BSN) option would allow you to earn your professional degree more quickly; this is an option you will tend to find at top universities.

Bachelor’s-prepared nurses (BSN-RNs) who want to qualify as a nurse practitioner can earn a master’s degree (MSN) or a doctorate in nursing practice (DNP) in an advanced practice specialty area. There are doctoral degree program options for BSN-RNs, and options for nurses who already have a master’s degree. Many graduate programs also offer part-time study options.

How should you go about deciding between a master’s program and a doctoral program? Your first consideration may be purely practical – how much time you can afford. If you do have time for a doctoral program, think critically about your employment and personal goals for the next five years or so; also consider where you want to take your degree in the long term. Master’s programs focus on advanced practice in your chosen specialty. No matter your population focus, there will be a great deal of coursework and clinical ground to cover in two years. Doctoral programs cover the same areas, but place greater emphasis on leadership and decision-making. A DNP program typically boosts students’ scientific preparation with courses in statistics and experimental design. Both types programs may provide you with an opportunity to specialize within your population focus – for instance, adult endocrinology or pediatric HIV. Doctoral students complete research projects; this is less frequently true for master’s students. If you plan to pursue executive leadership in healthcare, or if you are interested in medical research or teaching in a university, then you will probably need to earn a DNP or Ph.D. at some point.

How to choose the program that’s ideal for your specialty? Like physicians who specialize in internal medicine, nurse practitioners can act as primary caregivers for patients across most of the lifespan – this is probably the role that most people imagine when they think of NPs. But there are various population specialties under the NP “umbrella,” and each of these is recognized with its own credential. For instance, a family nurse practitioner (FNP) sees patients of all ages, including children, while an adult-gerontologic nurse practitioner (AGNP) does not usually treat minors younger than adolescents. A family nurse practitioner may also be qualified as an ENP, or emergency nurse practitioner, meaning that she or he has additional specialty in critical care. There are NPs who work primarily in pediatrics, neonatal care, acute care (i.e., hospital settings as opposed to primary care settings), women’s health, and psychiatry/mental health. Some graduate programs train students in subspecialities within their NP specialty – for instance, in cardiology, oncology, or orthopedics.

Whichever areas of specialty you’re interested in, you should be able to locate many graduate programs that prepare students for licensing. Or if you’re a master’s-prepared nurse wanting to broaden your scope of practice or pursue a new career opportunity, you can look for post-graduate certification or a doctoral program.

When you’re ready to start comparing graduate schools, you’ll discover that advanced practice training programs at different universities have their own areas of emphasis and excellence. Some programs offer “tracks” within a population specialty, so that the trainee can develop a focus – healthcare leadership, or epidemiology, or oncology – while still mastering the core knowledge needed to qualify as a nurse practitioner. Some programs send their students to work abroad. Many have faculty widely recognized for their work in particular specialty areas. Nursing graduate programs are not interchangeable, and the more you research them, the more ideas you’ll develop about the kind of nurse you want to become.

All nursing graduate programs incorporate coursework and clinical work that have general relevance to advanced nursing practice, as well as courses that are specific to your chosen population specialty. Your studies will very likely include foundational courses like:

There are two separate licensing (credentialing) organizations for family nurse practitioners, adult-gerontologic NPs, and emergency NPs. One of these is the Certification Board of the American Academy of Nurse Practitioners (AANPCB); the other is the American Nurses Credentialing Center (ANCC). These two organizations administer their exams independently and award distinct credentials. A credential awarded by either organization will qualify you to work as a nurse practitioner, and any graduate degree program you enroll in should prepare you to sit for either/both of these licensing exams. You should make sure that this is the case before you enroll. The ANCC also licenses a variety of other NP specialties, including psychiatry. Neonatal NPs are licensed by the National Certification Corporation (NCC). Pediatric NPs are credentialed by the Pediatric Nursing Certification Board (PNCB).

Make sure that the state in which you plan to look for your first job as a nurse practitioner recognizes the credentials awarded by a particular licensing body before you register for a certification exam. Every U.S. state has its own Nursing Board/Nursing Commission, so check the rules that apply to you.

• All family, adult-gero and emergency nurse practitioners must renew their certification on a 5-year basis. Renewal conditions can be met with a combination of continuing education (CE) and clinical practice hours, or by taking an exam. The exact requirements vary by credential and by credentialing organization.
• Pediatric NPs credentialed by PNCB must recertify on an annual basis
• If you’re already a nurse practitioner, you may find that you want to earn a post-graduate certificate in a related specialty to broaden your scope of practice; or perhaps you want to earn a doctoral degree to open career opportunities in hospital leadership or medical research. For instance, a primary care specialist might want to qualify for credentialing in acute care; an adult-gerontology NP may have reason to add advanced pediatric expertise. Post-graduate certification can take 1-2 semesters of full-time study, depending on the preparation afforded by your previous training, while a DNP usually requires three semesters of full-time study for a master’s-prepared nurse.

Continuing education opportunities help nurse practitioners stay current with new concepts in their field and prepare for recertification. CE opportunities may be offered as live classes, seminars, or online courses. Professional organizations and credentialing bodies for every nursing specialty will, in general, make an calendar of CE opportunities available online, so start by investigating pages operated by the American Association of Nurse Practitioners (AANP); the National Association of Nurse Practitioners in Women’s Health (NPWH); the Pediatric Nursing Certification Board (PNCB); and other organizations that serve the community of advanced practice nurses.