Nurse practitioner

A Nurse Practitioner (NP) is a registered nurse who has completed specific advanced nursing education (generally a master's degree) and training in the diagnosis and management of common as well as complex medical conditions. Nurse Practitioners provide a broad range of health care services.

In some states, NPs admit and follow their patients in hospitals. Some NPs work in emergency rooms evaluating, diagnosing and treating patients with lacerations and fractures. In a few states NPs are allowed to open their own clinics and offices. Nurse Practitioners are considered "Mid-level Providers/Practitioners" or "Physician Extenders," along with Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists and Physician Assistants.

In the US, NPs are licensed by the state in which they practice, and have a national board certification (usually through the American Nurses Credentialing Center or American Academy of Nurse Practitioners). Nurse Practitioners can be trained and nationally board certified in areas of Family & Community Medicine (FNP), Pediatrics, including Pediatric Acute/Chronic Care, Pediatric Critical Care, Pediatric Oncology and general Pediatrics (PNP), Neonatology (NNP), Gerontology (GNP), Women's Health (emphasis on reproductive & gynecological health) (WHNP), Psychiatry & Mental Health (PMHNP), Acute Care (ACNP), Adult Health (ANP), Oncology (ONP), Emergency Medicine (as FNP or ACNP), Occupational Health (as ANP), etc. These programs, offered by many universities with a School of Nursing, are graduate-level programs; upon successful completion, students are awarded a Master of Science in Nursing degree (M.S.N.).

Nurse Practitioners treat both acute and chronic conditions through comprehensive history taking, physical exams, physical therapy, ordering tests and therapies for patients, within their scope of practice. An NP can serve as a patient's "point of entry" health care provider, and see patients of all ages depending on their designated scope of practice. The core philosophy of the field is individualized care. Nurse Practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families.

Scope of practice

Because the profession is state regulated, care provided by NPs varies. A nurse practitioner's job may include the following:

Diagnosing, treating, evaluating and managing non-life-threatening acute and chronic illness and disease (e.g. diabetes, high blood pressure)
Obtaining medical histories and conducting physical examinations
Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs)
Prescribing physical therapy and other rehabilitation treatments
Prescribing pharmacologic treatments and therapies for acute and chronic illness (extent of prescriptive authority varies by state regulations)
Providing prenatal care and family planning services
Providing well-child care, including screening and immunizations
Providing primary and specialty care services, health-maintenance care for adults, including annual physicals
Providing care for patients in acute and critical care settings
Performing minor surgeries and procedures (with additional training and usually under supervision) (e.g., dermatological biopsies, suturing, casting)
Counseling and educating patients on health behaviors, self-care skills, and treatment options
Not formally trained for surgical assisting

Practice settings

NPs practice in all U.S. states. The institutions in which they work may include, but are not limited to, the following:

Community clinics and nurse-managed health centers
Health departments
Health maintenance organizations (HMOs)
Home health care agencies
Hospitals and hospital clinics including ER, urgent care, wards, and intensive care units
Hospice centers
Nurse Practitioner offices
Nursing homes
Nursing schools
Physician/Private medical practices
Public health departments
School/college clinics
Veterans Administration facilities
Walk-In Clinics

Education, licensing, and board certification

To be licensed as a nurse practitioner, the candidate must first complete the education and training necessary to be a registered nurse (RN).

Requirements for a registered nurse (RN) include either an associate degree in nursing (ASN), a Bachelor of Science degree in nursing (BSN), or completion of a diploma program, as well as direct patient care for acutely or chronically ill patients. Associate degree in nursing programs, which are offered by community and junior colleges, usually take 2 years plus prerequisites. BSN programs are offered by colleges and universities and take 4 years plus necessary prerequisites before acceptance into the program.

While not every state includes specific language requiring a masters degree for NPs, the majority of states do require a masters degree, post-master's certificate or doctoral degree. Further, the current Nurse Practitioner programs offered by all universities and colleges are at the masters or post-master's certification level. Lastly, all states require national board certification for Nurse Practitioners before they are permitted to practice and the two biggest certifying bodies, the American Nurses Credentialing Center and the American Academy of Nurse Practitioners, do require applicants to hold a masters degree or post-master's certificate to be eligible to test for certification. To become NPs, nurses with an associates degree or diploma must first complete a Bachelor of Science in Nursing degree or enter various programs offering an ADN-to-MSN "bridge program," some of which award the bachelors degree while completing the requirements for the masters; others, upon completion, only award the MSN with only the BSN coursework being completed instead of an actual degree awarded.

Once state licensure as a Registered Nurse is attained by successful completion of the NCLEX-RN, the candidate must complete a state-approved advanced nursing education program that usually specializes in a field such as family health, adult health, acute care, women's health, etc. The degree can be granted by:

A university, which grants a master's of science in nursing (MSN) degree which is now the minimum degree required
A university, which grants a doctorate in nursing

The variety of educational paths for NPs is a result of the history of the field. In 1965, the profession of nurse practitioner was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. The certifying organizations, states, and employers require a minimum of a master's degree for new NPs (already established NPs with lesser education were grandfathered in).

After completing the education program, the candidate must be licensed by the state in which he or she plans to practice. The State Boards of Nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a master's degree in nursing and certification by an accrediting body (ANCC, AANP). The license period varies by state; some require biennial relicensing, others require triennial.

Before or after receiving state licensing, a nurse practitioner can apply for national certification from one of several professional nursing organizations such as the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). The American Nurses Association (ANA) does not offer certification directly, but through its credentialing center, the ANCC. Some NPs pursue certification in a specialty. Several organizations oversee certification, including the following:

Post-nominal initials

Post-nominal initials NPs may use are regulated by the state in which they are licensed and include:

NP-C (Nurse Practitioner - Certified; if certified by the AANP)
APRN, BC (Advanced Practice Registered Nurse, Board Certified; if certified by the ANCC)
CNP (Certified Nurse Practitioner)
ACNP-C (Acute Care Nurse Practitioner, Certified)([1])
CPNP (Pediatric NP when certified by the Pediatric Nursing Certification Board (PNCB)
CRNP (Certified Registered Nurse Practitioner) used primarily in Pennsylvania ([2])
MSN (Master of Science in Nursing)
MN (Master of Nursing)
RN (Registered Nurse)
FAAN (Fellow of the American Academy of Nursing (AAN)
FAANP (Fellow of the American Academy of Nurse Practitioners (AANP)
DNP/DrNP (Doctor of Nursing Practice)
D.N.Sc. (Doctor of Nursing Science)
Ph.D. (Doctor of Philosophy)
Post-nominal Specialty Abbreviations
- ACNP (Acute care NP)
- ANP (Adult NP)
- ENP (Emergency NP)
- FNP (Family NP)
- GNP (Geriatric NP)
- NNP (Neonatal NP)
- PMHNP (Psychiatric & Mental Health NP)
- PNP, BC (Pediatric NP)
- WHNP, BC (Women's Health NP)
- BC, PCM (Board Certified, Palliative Care Management)
- BC, ADM (Board Certified, Advanced Diabetes Management)
- RN(EP) RN(Extended Practice) or NP, Manitoba, Canada
- RN(NP) Registered Nurse-Nurse Practitioner, Saskatchewan, Canada

References

External links