Millions of Americans have better access to high-quality preventive care and disease management thanks to the expanding presence of nurse practitioners (NPs), particularly in underserved areas.1,2 This emergence of NPs in recent decades has helped change the landscape of American healthcare.1,3
Typically, NPs are advanced practice nurses who had started their careers as registered nurses (RNs) and then completed a master’s or doctoral education with national NP board certification.3 Many responsibilities of NPs are similar to those of physicians and physician assistants including diagnosing patients and initiating and managing treatment plans.1,2,4 However, NPs are trained differently regarding patient care.5 While all providers deliver high-quality care, the unique training and clinical experience of the NP puts a particular emphasis on holistic care that addresses the emotional and physical aspects of the patient.4,5
There are many reasons a nurse may choose to pursue a career as an NP. NPs are often primary care providers who find it satisfying to develop relationships with and care for patients from many backgrounds, including several generations in the same family.6 NPs can also choose to specialize, giving them the opportunity to work with certain patient populations.5 They might choose to focus on psychiatry and mental health, women’s health, adult care, pediatrics, or newborn care, among other options.5 Many nurses also want to “do more,” take on more responsibilities, and work to the full extent of their capabilities to improve patient care.7,8 The NP role allows for more autonomy in making patient care decisions, and this helps drives many nurses to seek certification as an NP.7,9
Potential Nurse Practitioner Career Paths ‒ How Does One Get There?
There are several possible ways to become an NP (see the career path flow chart). Regardless of educational path, all NP programs require nurses to complete a Bachelor of Science in Nursing (BSN) and pass the national RN certification examination prior to getting NP training.3 There are many programs available to gain the appropriate educational training needed to become an NP. If a BSN has not yet been acquired10:
- RN to BSN post-licensure programs help RNs with a diploma or associate degree in nursing earn a BSN degree in 1 to 2 years.
- Accelerated BSN prelicensure programs help qualified students with a bachelor’s degree in a non-nursing field become an RN through programs that take 12 to 18 months to complete.
After RN training, nurses can earn an MSN degree that focuses on NP training. Several program styles are specific to the type of certification being sought (see below for more on the types of NP certifications). Most programs fall into one of the following categories3:
- RN to MSN programs are designed for RNs with an associate degree or diploma in nursing. Students in these “bridge” programs will complete BSN and MSN requirements.
- BSN to MSN programs are for RNs who already have a BSN degree.
- Entry-level/direct-entry master’s degree programs are designed to help qualified students with a bachelor’s degree in a non-nursing field gain RN licensure and complete BSN and MSN degrees through an accelerated program.
Other programs that offer NP training include3
- Post-master’s certificate programs allow nurses with an MSN degree in another area of nursing to change course during their nursing careers to become NPs.
- Doctoral programs in nursing also provide a path into the NP profession.
Although not a requirement, the American Association of Colleges of Nursing recommends the Doctorate of Nursing Practice (DNP) as the entry-level degree for NPs.3,11
After NP training, students must pass the national NP certification examination relevant to the patient population for which they plan to work (see the NP certification table). National certification is required for state licensure.3
Different NP certifications allow for specialization with distinct patient populations and care settings. All certifications require completion of an accredited graduate NP program in the indicated patient population and care setting.12 Curriculum requirements for program accreditation include separate comprehensive courses to address the Advanced Practice Registered Nurse (APRN) Core, defined as12:
- Advanced physiology/pathophysiolog
- Advanced health assessment
- Advanced pharmacology
All accredited nursing schools prepare future NPs for responsibilities related to accountability for health promotion and maintenance; assessment, diagnosis, and management of patient problems; and prescribing pharmacological and nonpharmacological interventions.12
There are five certification boards in the United States offering NP certifications13:
- The American Nurses Credentialing Center (ANCC)
- The American Academy of Nurse Practitioners Certification Board (AANPCB)
- The American Association of Critical-Care Nurses (AACN)
- The Pediatric Nursing Certification Board (PNCB)
- The National Certification Corporation (NCC)
- Psychiatric Mental Health12
- Family/Across Lifespan12
- Women’s Health16
Pediatric NPs are trained to meet the specialized needs of children from birth through young adulthood. Certifications for working in a pediatric population are available for both primary and acute care settings.
Nurse Practitioner Practice Environments
NP practice environments vary between states. These environments can affect how an NP can practice.20
Full-Practice States: Laws in full-practice states permit NPs to perform evaluations, diagnosis, and treatment, which includes prescribing medications and controlled substances, under the licensure authority of the state nursing board. This is the model recommended by the National Council of State Boards of Nursing and the National Academy of Medicine.
Reduced-Practice States: Laws in reduced-practice states constrain various aspects of NP practice and vary by state. Typically, these laws require NPs to enter into a practice partnership with another type of healthcare provider (eg, a physician) or limit the setting of one or more parts of NP practice.
Restricted-Practice States: Laws in restricted-practice states reduce the ability of NPs to perform at least one part of NP practice and require supervision, delegation, or team management by another healthcare provider (eg, a physician) to allow NPs to provide patient care.
For more information on the practice environment in your state, visit the American Association of Nurse Practitioners website.
All About NPs. American Association of Nurse Practitioners. 2020. https://www.aanp.org/about/all-about-nps. Accessed March 16, 2020.
Traczynski, J & Udalova, V. J Health Econ. 2014;58:90-109.
Advanced Practice Registered Nursing. GraduateNursingEdu.org. 2020. https://www.graduatenursingedu.org/. Accessed March 16, 2020.
Stanik-Hutt, J et al. The Journal for Nurse Practitioners. 2013;9(8):492-500.e413.
Schneider, R. Nurse Practitioner vs. Physician Assistant. Nurse Journal.org. 2020. https://nursejournal.org/nurse-practitioner/np-vs-physician-assistants/. Accessed April 9, 2020.
Family Nurse Practioner (FNP). GraduateNursingEDU.org. 2020. https://www.graduatenursingedu.org/family-nurse-practitioner/. Accessed April 8, 2020.
Brown, M & Draye, M. J Nursing Scholarship. 2003;35(4):391-397.
Spinks, K. J Neonatal Nursing. 2009;15:8-13.
De Milt, D et al. J Am Acad Nurse Pract. 2011;23:42-50.
What is a Registered Nurse? GraduateNursingEdu.org. 2020. https://www.graduatenursingedu.org/what-is-a-registered-nurse/. Accessed March 16, 2020.
Nurse Practitioner Roundtable. Nurse Practitioner DNP Education, Certification and Titling: A Unified Statement. (Nurse Practitioner Roundtable, 2008).
APRN Consensus Workgroup. Consensus model for APRN regulation: Licensure, accreditation, certification, and education. . 2008. https://www.ncsbn.org/. Accessed May 29, 2020.
Nurse Practitioner (NP) Certification. AANP.org. 2020. https://www.aanp.org/student-resources/np-certification. Accessed June 3, 2020.
American Nurses Credentialing Center. Consensus Model for APRN Regulation FAQs. Nursingworld.org. 2020. https://www.nursingworld.org/certification/aprn-consensus-model/faq-consensus-model-for-aprn-regulation/. Accessed June 3, 2020.
American Association of Critical-Care Nurses Certification Corporation. Adult-Gerontology Acute Care Nurse Practitioner Certification Exam Handbook. 2020. https://www.aacn.org/. Accessed May 29, 2020.
National Certification Corporation. Candidate Guide: Women's Health Care Practitioner. 2020. https://www.nccwebsite.org/. Accessed May 29, 2020.
National Certification Corporation. Candidate Guide: Neonatal Nurse Practitioner. 2020. https://www.nccwebsite.org/. Accessed May 29, 2020.
Pediatric Nursing Certification Board. The Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC): Role, competencies, settings & ethics. 2020. https://www.pncb.org/cpnp-ac-role. Accessed June 10, 2020.
Pediatric Nursing Certification Board. The Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC): Role, competencies, settings & ethics. 2020. https://www.pncb.org/cpnp-pc-role. Accessed June 10, 2020.
State Practice Environment. AANP.org. 2020. https://www.aanp.org/advocacy/state/state-practice-environment. Accessed April 8, 2020.
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