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Quick Facts :
What Is a Nurse Practitioner?
Not only do nurse practitioner administer direct care and treatment, but during appointments with patients, they also provide a more detailed, comprehensive initial examination than do medical doctors. According to the American Association of Nurse Practitioners (AANP), Americans visit a nurse practitioner more than 916 million times per year. If you’re contemplating a career as a nurse practitioner, consider these general statistics, which were provided by the AANP:
- 95 percent of nurse practitioners are licensed to dispense medication.
- 96 percent of nurse practitioners have a graduate degree.
- 83 percent have earned certification in at least one area of primary care, with family practice the most common focus.
- 50 percent of the nation’s 222,000 nurse practitioners have hospital privileges.
Typical Duties and Responsibilities
Working either independently or as a member of a health care team, the nurse practitioner provides a wide range of patient services, some of which include:
- Acting as a primary point of contact for patient care and managing care and treatment.
- Counseling patients with a specific illness or injury in how to best care for themselves, including stressing the importance of eating nutritiously and exercising, reducing stress, and making positive lifestyle choices.
- Diagnosing and treating patients with acute and chronic health conditions, including diabetes, infections, hypertension, and serious injuries.
- Ordering diagnostic tests such as lab work and X-rays, performing the tests, and interpreting the results.
- Prescribing medications and treating patient health based on the patient’s current symptoms.
Half of all nurse practitioners specialize in primary care, but they also concentrate in other areas, including:
- Acute Care
- Adult Care
- Mental Health
- Neonatal Health
- Women’s Health
Additionally, many subspecialties exist within these divisions, including neurology, dermatology, occupational health, sports medicine, and orthopaedics.
The nurse practitioner also fulfills many other roles. He or she acts as an educator, a mentor, researcher, and, sometimes, as an administrator. Additionally, nurse practitioners are often involved in numerous community organizations that impact health care delivery and policy at the local, state, and federal level.
Nurse practitioner programs emphasize a shift in the focus of patient treatment toward education and prevention, which helps lower overall health care costs. The AANP reports that patients who regularly see a nurse practitioner experience fewer emergency room visits, spend less money on medication, and have shorter hospital stays when they are admitted.
Additionally, patients who incorporate visits to a nurse practitioner into their regular health care routine report high satisfaction rates, while malpractice suits remain low. As a result, nurses with this advanced credential have become practical solutions to the country’s nursing shortage.
Steps to Become a Nurse Practitioner
Perhaps no other career has as rich a history or offers as profound a calling or as brilliant an opportunity as nursing. With the ability to put the needs of others before their own and care for strangers, nurses fulfill a special role in the lives of everyone they treat. However, apart from the personal attributes that define an individual as “right” for a career, nursing also requires expert training and no small amount of education.<.p>
To become a nurse, a number of educational avenues are available, and perhaps the most rigorous course of study for a nursing candidate is that required to become a nurse practitioner. The role of a nurse practitioner is more advanced than regular nursing in many ways. Highly trained and educated to provide medical support in much the same capacity as a full-fledged doctor, the nurse practitioner is a valued and respected member of the medical community. The typical pathway to become a nurse practitioner include the following steps:
Step 1: Earn Your Bachelor of Science in Nursing (BSN) Degree
Nurse practitioners provide specialized patient care that exceeds the typical duties of a conventional nurse. Indeed, they perform duties that are most frequently associated with those of a primary care physician, often working side by side with medical doctors in an interdisciplinary team-based model to diagnose, treat, and prevent illness. A career as a nurse practitioner requires the candidate to possess extensive clinical experience along with graduate-level study, which makes earning a bachelor’s degree in nursing (BSN) the first step toward practicing at an advanced level.
Students in a BSN degree program can expect to not only master the fundamentals of nursing, but also to complete coursework in anatomy and physiology, microbiology, nutrition, health assessment, public health, and evidence-based practice. Elective coursework should focus on helping the student acquire an understanding of current trends in nursing and develop the critical thinking and leadership skills necessary for the traditional BSN program.
As students progress through a BSN program, they can expect to complete coursework that expands into both theoretical- and evidence-based nursing practice. Learning opportunities occur both in the classroom and in clinical observation settings, where students receive their first exposure to real-world nursing duties.
Step 2: Pass the National Council Licensure Examination (NCLEX-RN)
The next step for students who have successfully graduated from a BSN program is to successfully sit for and pass the National Council Licensure Examination (NCLEX-RN). Passing this exam is a requirement to begin work as a registered nurse in all 50 states and the United States territories. The computer-generated national exam is developed and scored by the National Council of State Boards of Nursing (NCSBN), an independent, not-for-profit organization that works with nursing boards from all 50 states (and regulatory boards around the world) to promote nursing through regulating standards applicable to public health, education, patient safety, and public welfare.
The exam comprises eight separate sections, with content designed to measure the competencies required to perform effectively and safely as a registered nurse. Questions cover processes fundamental to the practice of nursing that reflect patients’ needs throughout their lifespan as performed in a variety of settings. The framework of the examination is organized into four major “Client Needs” categories and several subcategories, including:
- Health Promotion and Maintenance
- Safe and Effective Care Environment
- Management of Care
- Safety and Infection Control
- Psychosocial and Psychological Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaptation
To learn more about the NCLEX exam, including information about eligibility, registration, payment, scheduling the exam, and competencies tested, you are encouraged to visit the NCSBN website for instructions and detailed test procedures.
Step 3: Earn Your Master of Science in Nursing (MSN) Degree
A master of science in nursing program is designed to prepare students with both theoretical- and evidence-based clinical practice and to acquire the knowledge essential in providing comprehensive primary care and speciality practice in a variety of settings. In addition to advanced studies in how to diagnose and manage acute and long-term illnesses, MSN students learn about illness prevention, health promotion, and interprofessional collaboration.
Program objectives frequently focus on experiential components, designed to help graduates excel in clinical environments in which they will encounter advanced medical issues that require support from multiple health care disciplines.
Upon completion of the master of science in nursing program, students will be able to:
- Integrate knowledge from across medical disciplines to better support and improve nursing practices in a variety of healthcare settings.
- Collaborate, communicate, and consult with interdisciplinary teams to improve medical care.
- Utilize ethical principles in medical practice.
- Employ enhanced critical decision-making skills to better prepare for a leadership position and advocate for improved healthcare systems.
- Design healthcare systems that are better equipped to solve clinical problems and serve patient needs and to address concerns within the healthcare community.
MSN Clinical Coursework
Most MSN programs offer curricula for students interested in careers serving a specific population focus. For example, many programs provide students with an opportunity to gain significant clinical experience and build competency in areas such as gerontology, family care practice, emergency nursing, psychiatric nursing, and pediatric nursing. The most common nurse practitioner specializations include:
- Adult-Gerontology Acute Nurse Practitioner (AGACNP): An advanced practice nurse with clinical knowledge and skills to meet the patient care needs of seniors and advanced-age adults, typically in outpatient, inpatient, nursing home, home care, and palliative care settings.
- Family Nurse Practitioner (FNP): An advanced practice registered nurse who provides specialty health care to patients throughout their lives by diagnosing illness, prescribing medication, educating families about illness prevention, and promoting health.
- Emergency Nurse Practitioner (ENP): A care provider who provides emergency care for patients of all ages with all types of medical issues.
- Psychiatric Mental Health Nurse Practitioner (PMHNP): An advanced practice nurse whose population focus includes patients with mental health issues, especially those with severe mental health disorders who are receiving treatment in a rehabilitation center or hospital setting.
- Pediatric Primary Care Nurse Practitioner (PPCNP-BC): An advanced practice nurse who provides nursing care, health education, and disease prevention to children of all ages in primary care clinics, health departments, and other outpatient settings.
The level of specialization is the primary difference between the bachelor of science and the master of science in nursing programs. A bachelor of science in nursing program trains candidates for entry-level work in the medical field under the supervision of specialized experts; whereas, the Master of Science in Nursing program (MSN) allows candidates to become those specialized experts. The MSN program typically requires an additional two full-time years of coursework following the BSN.
Step 4: Get Board Certified in Your NP Specialty
As students approach the end of their MSN program, they must begin to prepare for national certification in their area of focus. Certification by an accredited certification body indicates that a candidate possesses the professional knowledge to safely practice. It is often used by regulatory bodies as a primary indicator that graduates possess the requirements to practice as a nurse practitioner.
Certification is defined by the Consensus Model, which was developed by APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee, as, “the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession.” The difference between certification and licensure is that licensure grants a nursing professional the authority to practice; whereas, certification is evidence of the qualifications for licensure.
The American Nurses Credentialing Center (ANCC) provides the following nurse practitioner certifications:
- Adult-Gerontology Acute Care NP
- Adult-Gerontology Primary Care NP
- Family Nurse Practitioner
- Pediatric Primary Care NP
- Psychiatric – Mental Health NP
- Emergency NP
The Board Certification Exam and Credentialing
Candidates who wish to sit for the NP certification examination must confirm their eligibility for the exam and receive authorization from the ANCC before taking it. The eligibility criteria for initial certification include:
- All applicants must hold a current, active license to practice as a registered nurse in a state or territory of the United States.
- Candidates from outside the U.S. must hold an equivalent professional license legally recognized in another country.
- Must hold a master’s postgraduate or doctoral degree in the applicant’s area of advanced nursing practice from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN).
- A minimum of 500 faculty-supervised clinical practice hours in the area of population focus.
- Graduate-level coursework and content in the NP area of specialization (research the specific requirements here).
Once candidates for certification meet all the eligibility requirements and pass the examination, they will be awarded the credential for which they tested. Credentials awarded by the American Nurses Credentialing Center (ANCC) are valid for a period of five years. Board-certified nurse practitioners may continue to practice under this credential by maintaining their license and meeting all renewal requirements issued by the Accreditation Board for Specialty Nursing Certification (ABSNC).
Step 5: Find a Job as a Certified Registered Nurse Practitioner (CRNP)
Despite increasing demand for nurses and promising national employment projections for the next 10 years, many nurses across the country discover that finding a job is not always easy – especially newly graduated nurses, who are being affected profoundly by a tightening job market. Some nurses report they are still looking for work in their ideal employment setting a year or more after graduation. Others, including many advanced practice nurses, are returning to work as a registered nurse instead of working in the career they prefer and for which they sought additional education.
With this in mind, recent graduates and nurses who are approaching the end of their MSN program must begin to look for jobs outside of the traditional hospital positions, the jobs for which applicants are typically groomed. Hospital positions aren’t as plentiful, as of spring 2018, especially for recent graduates.
However, these statistics don’t mean it’s impossible to land a job in a hospital setting. It does mean that recent graduates are wise to explore other employment settings and nontraditional specialities rather than to follow the traditional route for employment: submitting online applications to multiple hospitals and sending out resumes. And since patient care is continuously shifting out of the hospital setting into treatment centers, alternate care facilities, and the community, it’s likely that you will find greater success by broadening the parameters of your search rather than limiting yourself to jobs in a hospital.
Where Do Nurse Practitioners Typically Work?
A few months prior to the completion of your nurse practitioner program, you should begin strategizing ways to research specific employers in the occupational settings with the highest demand for nurse practitioners. Knowing the places where NPs are most frequently hired and searching for employers in nontraditional specialities will help you avoid the frustration of sending your application through general employment sites such as CareerBuilder or Indeed.com, sites on which your resume may be lost within dozens, if not hundreds, of other applicants.
According to the U.S. Bureau of Labor Statistics, nurse practitioners are most commonly utilized in team-based models that provide preventative and primary care. The most common employment settings for nurse practitioners are:
- Ambulatory Health Care Services
- Physicians’ Offices
- Hospitals – State, Local, and Private
- Outpatient Mental Health and Substance Abuse Centers
- Chain Drugstore and Supermarket Pharmacies
Once you identify a group of employers to whom you want to apply (within traditional, specialty, community, and alternate care settings), think strategically to help get your foot in the door. Visit employers to deliver your application in person or introduce yourself directly to a nurse manager in a care center that is at the top of your list. By combining a well-researched list of employers with some creative thinking, you may find success landing the job you want in a shorter period of time, while also avoiding the pitfalls and disappointment that many nurses are experiencing.
Nurse Practitioner Salary and Employment Outlook
According to the U.S. Bureau of Labor Statistics (BLS), the median salary for a nurse practitioner in May 2015 was $98,120 per year, which translates to an hourly wage equivalent to $47.21 for full-time nurse practitioners. The BLS report also provides typical earnings for those at various wage levels, including:
- 10th percentile, annual wage of $70,540 and hourly wage of $33.91
- 25th percentile, annual wage of $84,860 and hourly wage of $40.80
- 75th percentile, annual wage of $117,120 and hourly wage of $56.26
- 90th percentile, annual wage of $135,830 and hourly wage of $65.30
The BLS also reports that the projected demand for nurse practitioners is expected to grow by 19 percent over the next decade. This is an above-average rate of growth when compared to the median growth for all occupations and on pace with other careers in the healthcare industry, which are expected to continue growing for the foreseeable future. A few of the key factors accelerating the demand for nurses with advanced knowledge and skills include:
- A shortage of primary care doctors, which has led to the demand for highly experienced, skilled, and educated nurses to assume some of the tasks typically delegated to a medical doctor. Ordering and interpreting diagnostic tests and prescribing medication are just two examples.
- Employers value speciality nurses and have begun to look to them to deliver patient-centered and cost-effective care.
- The demand for staff in outpatient centers continues to climb because of the fast, high turnover rates in hospital patients. Rapid turnover usually occurs as a result of the financial pressure hospitals face from insurance companies to keep admissions low and as brief as possible. Since these patients still need medical care, a critical need exists for professionals who have earned the nurse practitioner credential.
- Patients living in low-income and rural areas require the services of specialty nurses just as do those in big cities with greater access to health care resources. The need is especially acute for nurse midwives, nurse anesthetists, clinical nurse specialists, and nurse practitioners. Those who are willing to practice in a small town or with patients of limited means have numerous opportunities to do so.
- Highly educated nurses who have obtained their Ph.D. or DNP can replace those who are retiring. The American Association of the Colleges of Nursing states that the average age of nurses with either credential is 56. Professors are closer to 61 years of age, while nurses with a graduate degree are 58 years old, on average.
- The continued demand for nurses with specialized knowledge is not expected to end any time soon. An aging population and a high incidence of conditions such as obesity and Type II diabetes require nurses who can manage a patient’s total care. The ability to manage a complex disease at home keeps patients out of the hospital and lowers health care costs, but it also requires skilled care such as that provided by a nurse practitioner.