Nurse practitioner

Template:Globalize/US 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 a few complex medical conditions. Nurse Practitioners are generally licensed through nursing boards rather than medical boards as they provide advanced nursing services. All nurse practitioners are considered "mid-level" providers similar to physician assistants (PAs). Nurse Practitioners provide a broad range of health care services.

Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, physical therapy, ordering tests and therapies for patients, within their scope of practice. NPs can serve as a patient's primary health care provider, and see patients of all ages depending on their designated scope of practice.

In the United States, 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 FNP, Pediatrics, including Pediatric Acute/Chronic Care, Pediatric Critical Care, Pediatric Oncology and general Pediatrics (PNP), Neonatology (NNP), Gerontology (GNP), Women's 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, graduate-level nursing programs upon completion students may be awarded a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree.

In regard to level and scope of practice, each state certifies nurse practitioners thus their scope of practice can differ depending on the state. Nurse practitioners may practice independent of physician supervision.

Scope of practice

Because the profession is state-regulated, care provided by NPs varies widely. In many states, nurse practitioners work completely independently and autonomously of physicians while, in other states, a collaborative agreement with a physician is required for practice; the extent of this collaborative agreement, and the role, duties, tasks, medical treatments, pharmacologic prescriptions, et al. it affords a Nurse Practitioner to perform and prescribe again varies amongst states of licensure. A nurse practitioner's job may include the following:

Diagnosing, treating, evaluating and managing 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 drugs 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
Assisting in 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

Practice Settings

NPs practice in all U.S. states. The institutions in which they work may include:

Community clinics, health centers, urgent care centers
Health departments
Health maintenance organizations (HMOs)
Home health care agencies
Hospitals
Hospice care
Nurse practitioner practices/offices
Nursing homes
Private & public schools, universities and colleges
Physician/private medical practices
Veteran's administration facilities

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 of Science in Nursing (ASN), a Bachelor of Science in Nursing (BSN), or completion of a diploma program, as well as direct patient care for acutely or chronically ill patients. ASN 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. In the future these organizations mean to require a Doctor of Nursing Practice (DNP) degree for a candidate to be eligible to take the certification examination. The DNP will be the entry level of practice beginning in 2015.

To become a Nurse Practitioner (NP), nurses trained at the associate degree or diploma level must first complete a Bachelor of Science in Nursing (BSN) 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 an MSN or 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:

Role in Medicine

The role of nurse practitioners is diverse. Having generally (but not consistently widespread experience at the patients' bedside, nurse practitioners can serve an important role in patient care. Having somewhat limited training and education on pathophysiology and updated literature, it is often thought that nurse practitioners best serve the community under the supervision of an accredited doctor of medicine (M.D. or D.O.). Nurse Practitioners are educated under the nursing model.

Post-nominal credentials and initials

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

RN (Registered Nurse)
NP-C (Nurse Practitioner - Certified; if certified by the AANP)
APRN-BC (Advanced Pactice Registered Nurse - Board Certified; no longer awarded, replaced with specialty-specific credentials by the ANCC [1])
ARNP (Advanced Registered Nurse Practitioner)
ACNPC (Acute Care Nurse Practitioner Certified)[2]
CNP (Certified Nurse Practitioner)
CPNP (Certified Pediatric Nurse Practitioner; if certified by the Pediatric Nursing Certification Board PNCB)
CPNP-PC (Certified Pediatric Nurse Practitioner - Primary Care; if certified by the PNCB [3])
CPNP-AC (Certified Pediatric Nurse Practitioner - Acute Care; if certified by the PNCB [4])
CRNP (Certified Registered Nurse Practitioner; used primarily in Pennsylvania [5] and Alabama [6])
MSN (Master of Science in Nursing)
MN (Master of Nursing)
MA (Master of Arts in Nursing)
PMC (Post-Master's Certificate)
CAS (Certificate of Advanced Study)
DNSc (Doctor of Nursing Science; equivalent to Ph.D., most D.N.Sc. programs now converted to PhD programs)
PhD (Doctor of Philosophy)
DNP/DrNP (Doctor of Nursing Practice; clinical doctorate, not equivalent to DNSc or PhD)
FAAN (Fellow of the American Academy of Nursing AAN)
FAANP (Fellow of the American Academy of Nurse Practitioners AANP)
RN(EP) (Registered Nurse - Extended Practice; Manitoba, Canada)
RN(NP) (Registered Nurse - Nurse Practitioner; Saskatchewan, Canada)

Specialties

ACNP (Acute Care NP)
ANP (Adult NP)
(Specialty Programs: Adult Cardiovascular Care NP, Adult Primary Care NP, Adult Critical Care NP [7], Adult Acute Care NP [8])
ENP (Emergency NP)
FNP (Family NP)
GNP (Geriatric NP)
HNP (Holistic NP; APN program [9])
NNP (Neonatal NP)
PMHNP (Psychiatric/Mental Health NP)
APMHNP (Adult Psychiatric/Mental Health NP)
FPMHNP (Family Psychiatric/Mental Health NP)
OHNP (Occupational Health NP)
ONP (Oncology NP)
AONP (Adult Oncology NP)
PONP (Pediatric Oncology NP)
PCNP (Palliative Care NP; APN program [10])
PNP (Pediatric NP)
PCCNP (Pediatric Critical Care NP)
ACPNP (Acute Care Pediatric NP)
PA/CCNP (Pediatric Acute/Chronic Care NP [11])
WHNP (Women's Health NP)
BC-PCM (Board Certified - Palliative Care Management, discontinued by ANCC)
BC-ADM (Board Certified - Advanced Diabetes Management)
ACHPN (Advanced Certified Hospice & Palliative Nurse)
"-C" and "-BC" indicate "Certified" and "Board Certified" by a national certifying organization such as the ANCC or AANP
(eg, FNP-BC, NNP-BC, ANP-C, NP-C, etc)

References

External links