Nurse Practitioner -Definition
A Nurse Practitioner (NP) is an advanced practice nurse who has completed graduate-level education (either a Master's or a Doctorate degree) and training in the diagnosis and management of common as well as complex medical conditions. To become licensed to practice, Nurse Practitioners hold national certification in an area of specialty (family practice, pediatrics, adult care, acute care, etc), and are licensed through nursing boards rather than medical boards. Nurse Practitioners provide a broad range of health care services, and appear to be gaining broad acceptance by the public.
Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, physical therapy, and 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, American Academy of Nurse Practitioners or the National Certification Corporation). Nurse Practitioners can be trained and nationally board certified in areas of FNP (Family Nurse Practitioner), 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.
Scope of practice
In the United States, because the profession is state-regulated, care provided by NPs varies widely. In many states, nurse practitioners work 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, etc. it affords an NP to perform and prescribe again varies widely amongst states of licensure. In the states where a collaborative agreement is required, there is no evidence that such legislation either promotes patient safety or positive health outcomes; for this reason there is increasing momentum to remove these types of barriers to autonomous NP practice.
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
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
- Retail-based clinics
To be licensed as a Nurse Practitioner, the candidate must first complete the education and training necessary to be a registered nurse, then go on to complete a graduate-level nurse practitioner program (some of which also require an additional residency), and then the candidate must pass a national board certification in their area of specialty. Registered nurses initially 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-MN/MSN bridge program, some of which award the bachelor's degree while completing the requirements for the master's.
While not every state includes specific language requiring a master's degree for NPs, the majority of states do require a master's degree, post-master's certificate or a doctoral degree. Further, the current nurse practitioner programs offered by all universities and colleges are at the master's, post-master's, or doctoral level. The current plan is that all advanced practice nurse programs will require a Doctor of Nursing Practice (DNP) degree by 2015 thus effectively eliminating the MN or the MSN as an entry to practice degree. 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 (ANCC) and the American Academy of Nurse Practitioners (AANP), do require applicants to hold a master's degree, post-master's certificate, or doctoral degree to be eligible to test for certification.
The variety of educational paths for NPs is a result of the history of the field. The first Nurse Practitioner program was created by a nurse educator, Loretta Ford, EdD, RN, PNP and a physician, Henry Silver, MD, in 1965 at the University of Colorado as a non-degree certificate program. This program trained experienced Registered Nurses for their new advanced nursing roles as Pediatric Nurse Practitioners. In the late 1960s into the 1970s, continued predictions of a primary-care physician shortage increased funding and attendance in various certificate-based nurse practitioner programs. Then, during the 1980s Nurse Practitioner educational requirements were transitioned into graduate-level master's degree programs. Subsequently the national certifying organizations and state licencing boards began to require a master's degree for NP practice. However, already established NPs with certificate-based education were grandfathered in. Once again there are changes presently in the field, and by 2015 all new NPs will need to be trained at the doctorate level as a Doctor of Nursing Practice. Once again already established NPs with lesser education will be 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 graduate degree in nursing and board certification by an accrediting body (ANCC, AANP). The license period varies by state; some require biennial relicensing, others require triennial.
NPs can pursue additional specialty certification through several organizations, including the following:
- American Association of Critical-Care Nurses
- American Psychiatric Nursing Association
- Board of Certification for Emergency Nursing
- Pediatric Nursing Certification Board
- National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
- Oncology Nursing Certification Corporation
The role of Nurse Practitioners is very diverse. Nurse Practitioners are educated under the nursing model which seeks to provide holistic and preventative care engaging the individual as the primary leader in their own care and well-being. Nurse Practitioners bring the nursing history of patient advocacy to partner with the individual for mutually agreed upon treatments and optimal health outcomes. Nurse Practitioners often view the health and wellness of individuals within the family or community system and attempt to incorporate cultural relativism within their treatments and recommendations. Nurse practitioners often work very independently in rural areas and nurse-managed health centers as primary care providers to provide critical health care to vulnerable communities in both rural and underserved urban environments. Conversely, in more affluent and urban settings, Nurse Practitioners may either set up an independent practice, or may work collaboratively within a health care team as a critical health care provider in a wide variety of clinical specialties.
Post-nominal credentials and initials
Post-nominal initials NPs may use are regulated by the state in which they are licensed and include:
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 Practice Registered Nurse - Board Certified; no longer awarded, replaced with specialty-specific credentials by the ANCC)
- ARNP (Advanced Registered Nurse Practitioner)
- ACNPC (Acute Care Nurse Practitioner Certified)
- 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 )
- CPNP-AC (Certified Pediatric Nurse Practitioner - Acute Care; if certified by the PNCB)
- CRNP (Certified Registered Nurse Practitioner; used primarily in Pennsylvania and Alabama)
- 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 (Doctor of Nursing Practice; the terminal professional degree for NPs)
- FAAN (Fellow of the American Academy of Nursing AAN)
- FAANP (Fellow of the American Academy of Nurse Practitioners AANP)
- RN(EP) or NP (Registered Nurse - Extended Practice; Manitoba, Canada)
- RN(NP) (Registered Nurse - Nurse Practitioner; Saskatchewan, Canada)
- [edit]Specialties
- ACNP (Acute Care NP)
- ANP (Adult NP)
- (Specialty Programs: Adult Cardiovascular Care NP, Adult Primary Care NP, Adult Critical Care NP, Adult Acute Care NP)
- 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)
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