The Nurse Practitioner (NP) profession was ranked #6 in the U.S. News and World Report’s 100 Best Jobs of 2016, and it’s easy to see why: good working conditions, the ability to be a dedicated provider, and increased job satisfaction, just to name a few.
According to the American Association of Nurse Practitioners (AANP), there are more than 205,000 NPs in the United States as of 2014, with an estimated growth to 244,000 by 2025. Nurse practitioners care for patients across the lifespan in a variety of settings and are one of four recognized advanced practice registered nurse (APRN) roles, which also includes Clinical Nurse Specialists, Nurse Anesthetists, and Certified Nurse Midwifes. All NPs must complete a master’s (or doctorate) degree program, and they hold certificates in one of 8 recognized specialties, with Family Nurse Practitioner (FNP) being the most popular at 54.5%.
What Exactly is a Nurse Practitioner?
“I think the public is sometimes confused on what the NP role is and what we have to offer to health care,” says Kaulette Clark, a FNP who works in the ER at Delano Regional Hospital in Delano, California. Many people, the general population and patients alike, agree with Clark and are confused by the function of an NP. With the title including nurse, and the connotations associated with that role, coupled with working in the capacity of a physician, anyone could see the potential dilemma. Simply put, NPs diagnose and treat as physicians do, but they also integrate the compassion of a nurse.
Christene Ingram, MSN, APRN, FNP-C, who works at Clinic 45, a family practice clinic in Houston, Texas, sees the importance of a nurse’s touch as a NP in her practice: “NPs are qualified health care providers that provide care that is safe, effective, and patient-centered. Most [patients] appreciate the warmth that is associated with being a nurse.”
The AANP defines an NP as a registered nurse with advanced education and clinical training. Furthermore, NPs provide patients with high quality, comprehensive, patient-centered primary, acute, and specialty health care services. In addition to diagnosing and managing acute episodic and chronic illnesses, NPs also focus on health promotion, disease prevention, health education and counseling, and guiding patients to make smarter health and lifestyle choices. Services NPs provide include, but are not limited to, ordering, performing, and interpreting diagnostic tests such as lab work and x-rays; diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections, and injuries; prescribing medications and other treatments; and managing a patient’s overall care.
Roles and Specialties
NPs practice within the specific population focus in which they are trained. There are eight recognized NP specialties by certification examination: Family [FNP]; Adult and Gerontology Primary Care [AGPCNP]; Adult and Gerontology Acute Care [AGACNP]; Pediatric Primary Care [PPCNP]; Pediatric Acute Care [PNP-AC]; Women’s Health [WHNP]; Neonatal [NNP]; and Psychiatric and Mental Health [PMHNP]. Further, NPs can branch out in a wide variety of sub-specialties after completion of their NP program through additional education and work experience.
A 2015 AANP survey revealed that more than 80% of NPs are educated in one of the primary care specialties (Family, Adult and Geriatrics, Women’s Health, and Pediatrics). Ingram, for example, felt like taking the FNP route would increase her job prospects the most after school. “I personally didn’t want to limit myself to one particular specialty,” she says. NPs can be found working in hospitals, community health centers, or managing their own clinics. The role and capacity in which a NP can work is ubiquitous.
History of Nurse Practitioners
The NP profession is a fairly new profession with history dating back to the late 1950s. Due to a shortage of primary care physicians in the United States, the need for NPs developed. Physicians began training nurses to identify and treat the primary care needs of children and families. With collaboration from pediatrician Dr. Henry Silver, Loretta Ford, a public health nurse, developed the first training program for NPs at the University of Colorado in 1965.
When Ford conceptualized the NP role she envisioned the NP to assess, diagnose, treat, and evaluate—the same as it is today. The early NP programs granted no degree upon graduation, only a certificate. The first master’s degree NP program was established in 1967 by Boston College and the American Academy of Nurse Practitioners, the first organization for NPs of all specialties, was formed in 1985.
Today’s NP student graduates with either a master’s or doctorate degree and the ability to provide care in a wide range of settings, including inpatient, outpatient, and rural settings. Prospective NP students are RNs who typically have one year or more nursing experience in the area in which they desire to specialize. Current requirements for all NPs to practice include: a bachelor’s degree in nursing, registered nurse licensure, graduate nursing education, national board certification, and state-specific NP licensure and registration.
NP education is divided between didactic and clinical training. The amount of clinical hours required to graduate vary depending on the school. All clinical training is completed in a specific population focus and upon completion of school, graduates must pass a board examination in order to practice. Graduates must also fulfill state nursing board requirements to be recognized within their respective state—including prescriptive authority, in order to practice in that state. Scheduled medication authority for all states is granted through the U.S. Drug Enforcement Agency. NPs hold prescriptive authority in all 50 states and the District of Columbia, including controlled substances in 49. Currently, 21 states and the District of Columbia allow NPs to practice independently, with more states on the horizon.
The timeline for NP education after completion of a BSN and required RN experience varies depending on the educational path chosen. NP education can be completed either part-time or full-time, allowing the most flexibility for nurses wanting to continue their education while working. The doctor of nursing practice (DNP) is considered the terminal clinical degree for the profession, but there is no current requirement for it to be the entry-level education for NPs. Consequently, NP students can choose to complete either a master’s or doctorate degree to practice.
Full-time course studies for a master’s degree can typically be completed in 2 years, with part-time studies in 3-4 years versus a doctorate degree completed in 3-5 years. Additionally, nurses who already have master’s degrees can build upon their education and become an NP through post-master’s programs.
Although the average time it takes to complete NP education from start to finish is 7 years, many nurses spend a considerable amount of time as a nurse before continuing their education. Both Clark and Ingram’s path to the NP profession was a long one; Clark spent 15 years as a nurse before pursuing advanced education and Ingram was a nurse for 21 years before enrolling in NP school.
Why It’s a Good Time to Consider the NP Profession
Once again, the United States is faced with a primary care provider shortage. The implementation of the Affordable Care Act (ACA) in 2010 made way for NPs to be active participants in solving the primary care provider shortage by way of implementing provisions for increased clinical training funding and student loan forgiveness. In addition, grants were provisioned to place NPs in more Federally Qualified Health Centers (FQHCs) and Nurse Managed Health Centers (NMHCs). Many more provisions were made that pertain to increasing funding for APRNs to help alleviate the primary care provider shortage.
Less physicians are going into primary care, whereas over 80% of NPs specialize in a primary care role—which is good news considering NPs can help fill that gap. Almost half of the United States has legislation to allow NPs to practice without physician supervision, allowing NPs more access to those who need it the most. Clark sees how changing legislation in the remaining states would benefit others: “I hope all states will grant full practice authority; there are so many underserved areas that would greatly benefit.” Those who chose to become an NP will have many job prospects in the primary care specialties for years to come because of the shortage. Primary care provided by NPs also results in cost-effective care for those that need it the most since NPs are not reimbursed by insurance companies as much as their physician counterparts.
Both Clark and Ingram would recommend the profession to others, citing both autonomy and the rewards of being an NP in terms of patient relations. “I love the autonomy that an NP has,” states Ingram. “It’s very rewarding to contribute and provide cost-effective primary care. Patients will often request to schedule with me because they feel I spend more time with them.”
Clark knows she is making a difference in her role as an NP when patients comment on her patient-centered approach: “When someone says, ‘No one has taken the time to teach me or explain things to me the way you have,’ I know I am making a difference in my role as an NP.”
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