||The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (February 2012)|
A nurse practitioner (NP) is an advanced practice registered nurse (APRN) who has completed additional training beyond that of a registered nurse (RN).
Nurse practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, and ordering tests for interpretation. NPs can provide a diagnosis and recommendations for a wide range of acute and chronic diseases (within their scope of practice) and provide appropriate treatment for patients, including prescribing medications in some states. NPs can serve as a patient's primary health care provider, and see patients of all ages depending on their specialty (family, pediatrics, geriatrics, etc.). Similar to all medical professions, the core philosophy of the field is individualized care that focuses on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. In addition to health care services, NPs conduct research and are often active in patient advocacy activities. To become licensed/certified to practice, Nurse Practitioners hold board certification in an area (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed through the state nursing boards. NPs must practice within the scope of their certification.
According to the International Council of Nurses, an NP/advanced practice nurse is "a registered nurse who has acquired the knowledge base, decision-making skills and clinical competencies for expanded practice beyond that of an RN, the characteristics of which would be determined by the context in which s/he is credentialed to practice."
Nurse practitioners can be educated and certified in areas of family health (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 (FNP, ACNP, ANP, PNP or ANP) emergency (as FNP or ACNP), occupational health (as ANP or FNP), etc. In Canada, NPs are licensed by the province or territory in which they practice.
The advanced practice nursing role began to take shape in the mid-20th century United States. Nurse anesthetists and nurse midwives were established in the 1940s, followed by psychiatric nursing in 1954. The present day concept of the APN as a primary care provider was created in the mid-1960s, spurred on by a shortage of medical doctors. The first official training for nurse practitioners was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965, with a vision to help balance rising health care costs, increase the number of health care providers, and correct the inefficient distribution of health resources. There was some confusion about the varying titles and abilities of advanced practice nurses as the role was developed, which has persisted as the authority and responsibilities of the NP have evolved over time.
Scope of practice 
In the United States, because the profession is state-regulated, care provided by NPs varies widely and is limited to their education and knowledge content. Some nurse practitioners seek to work independently 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, responsibilities, nursing treatments, pharmacologic recommendations, etc. again varies widely amongst states of licensure/certification. practice.
The scope of practice for NPs is limited outside the United States and varies even more widely than the state-by-state discrepancies. The International Council of Nurses outlines the following general characteristics of advanced practice nursing: · Integrates research, education, practice and management · Politically seeks a high level of professional autonomy and even independent practice · Case Management/personal case load · Advanced health assessment skills, decision-making skills and nursing diagnostic reasoning skills · Recognized advanced nursing clinical competencies · Provision to aquire consulting services from other more highly trained medical providers · Plans, implements and evaluates programs · Recognized first point of contact for clients
The "Pearson Report" provides a current state-by-state breakdown of the specific duties a nurse practitioner may perform in the state. A nurse practitioner's role may include the following:
- Nursing diagnoses, treatment, evaluation and management of acute and and uncomplicated chronic illness and disease (e.g.high blood pressure)
- Obtaining nursing histories and conducting physical examinations
- Ordering, performing diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs)
- Requesting physical therapy, Occupational Therapy, and other rehabilitation treatments
- Recommending drugs for acute and chronic illness (extent of prescriptive authority varies by state regulations)
- Recommending 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 or assisting in minor surgeries and procedures (with additional training and/or under physician supervision in states where mandated; e.g. dermatological biopsies, suturing, casting)
- Counseling and educating patients on health behaviors, self-care skills, and treatment options in coordination with occupational therapists and other healthcare providers.
Practice settings 
- Community clinics, health centers, urgent care centers
- Health maintenance organizations (HMOs)
- Home health care agencies
- Hospital clinics
- Hospice care
- Physician offices
- Nursing homes
- Private & public schools, universities and colleges
- Veteran's administration facilities
- Retail-based clinics
- Bedside nursing in hospitals
- Walk-in clinics
Education, licensing, and board certification in the United States 
Education to become a nurse practitioner (NP) is rigorous and requires advanced coursework and clinical rotations beyond that required of the RN. Curriculum includes, but is not limited to, courses in epidemiology; health promotion; pathophysiology; physical assessment; pharmacology; differential diagnosis and laboratory/radiography diagnostics; statistics and research methods; health policy; role development and leadership; acute and chronic disease management (e.g., adults, children, women's health, geriatrics, etc.); and, clinical rotations, which varies depending on the program. MSN programs also require a thesis or clinical research project. There are a variety of paths to becoming a licensed nurse practitioner in the United States. Typically, the process begins with obtaining a Bachelor of Science in Nursing (BSN, usually 4 years), followed by a Masters of Science in Nursing (MSN, usually 3 years). DNP programs usually require an additional 2 years of study beyond the MSN. Doctor of Nursing Practice (DNP) programs require advanced coursework in biostatistics; research methods; quality improvement and outcome measures; evidence based practice; informatics; organizational management; and, a project/dissertation and practicum. Admission to a MSN program is competitive and requires an undergraduate degree (usually the BSN), completion of the NCLEX-RN, and completion of the Graduate Record Exam (GRE).
Registered nurses initially trained at the associate degree or diploma level must first complete a Bachelor of Science in Nursing (BSN) or enter a program offering an ADN-to-MN/MSN bridge program. Some of these bridge programs may award a Bachelor's degree while the candidate continues to complete the elements of their Master's or Doctorate degree.
United States 
In the United States, nursing is largely degree based. While not every state includes specific language requiring a master's degree for NPs, the majority of states now require a master's degree for practice. Further, the current nurse practitioner programs offered by all universities and colleges are at the master's degree level. Although controversial in academic circles, the nursing profession defends that masters degrees in nursing are rigorious and represents a masters level knowledge in the nursing profession. Many Universities and colleges contend that their academic institutions are at the mercy of accrediting bodies and nursing degrees are inflated and politically motivated and lack the rigor of more traditional graduate programs. The current proposal is that all advanced practice registered 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. However, all state Nursing Boards will be required to revise their current Practice Acts in order for this to become mandatory. Also heavily scrutinized, there are numerious certifying bodies for nurse practitioners. All U.S. states require national board certification for nurse practitioners before they are permitted to practice. The two biggest certifying bodies are the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP).
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.
In Australia, Nurse Practitioners are required to be registered by the Australian Health Practitioner Regulation Agency. The Australian professional organisation is the Australian College of Nurse Practitioners. (ACNP) 
Global expansion 
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Role in healthcare 
The role of Nurse Practitioners is very diverse. Nurse Practitioners are educated under the nursing model which is designed to provide holistic and preventive 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. NPs are advanced practice nurses who provide high-quality healthcare services in primary care settings and are able to diagnose and treat a range of health problems.
- Acute care nurse practitioner
- Adult nurse practitioner
- Family practice nurse practitioner
- Psychiatric nurse practitioner
- Geriatric nurse practitioner
- Pediatric nurse practitioner
- Obstetric nurse practitioner
- Neonatal nurse practitioner
- Emergency nurse practitioner
- Hepatology nurse practitioner
- "-C" and "-BC" indicate "certified" and "board certified" by a national certifying organization such as the American Nurses Credentialing Center, American Academy of Nurse Practitioners, or the National Certification Corporation (e.g., FNP-BC, NNP-BC, ANP-C, NP-C, WHNP-BC, etc.).
Post-nominal credentials and initials 
Post-nominal initials NPs may use are regulated by the state in which they are licensed and include:
- ACNP-BC (Acute Care Nurse Practitioner - Board Certified; if certified by the ANCC)
- ACNPC (Acute Care Nurse Practitioner Certified)
- APRN-BC (Advanced Practice Registered Nurse - Board Certified; no longer awarded, replaced with specialty-specific credentials by the ANCC )
- ARNP (Advanced Registered Nurse Practitioner)
- CAS (Certificate of Advanced Study)
- CNP (Certified Nurse Practitioner)
- CPNP (Certified Pediatric Nurse Practitioner; if certified by the Pediatric Nursing Certification Board PNCB)
- CPNP-AC (Certified Pediatric Nurse Practitioner - Acute Care; if certified by the PNCB )
- CPNP-PC (Certified Pediatric Nurse Practitioner - Primary Care; if certified by the PNCB )
- CRNP (Certified Registered Nurse Practitioner; used primarily in Pennsylvania  and Alabama )
- DNP (Doctor of Nursing Practice; the terminal practice degree for NPs)
- DNSc (Doctor of Nursing Science; equivalent to Ph.D., most D.N.Sc. programs now converted to PhD programs)
- FAAN (Fellow of the American Academy of Nursing AAN)
- FAANP (Fellow of the American Academy of Nurse Practitioners AANP)
- MA (Master of Arts in Nursing)
- MN (Master of Nursing)
- MSN (Master of Science in Nursing)
- NP-C (Nurse Practitioner - Certified; if certified by the AANP)
- PMC (Post-Master's Certificate)
- RN (Registered Nurse)
- RN(EP) or NP (Registered Nurse - Extended Practice; Manitoba, Canada)
- RN(NP) (Registered Nurse - Nurse Practitioner; Saskatchewan, Canada)
See also 
- International Council of Nurses. "Nurse Practitioner/Advanced Practice Nurse: Definition and Characteristics". Nursing Matters Fact Sheets. Retrieved 11 December 2011.
- "Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services". ISPUB. 2001-06-09. Retrieved 2011-08-31.
- Hancock, Jay (2010-04-14). "Jay Hancock's blog: Md. should make nurse practitioners independent". Weblogs.baltimoresun.com. Retrieved 2011-08-31.
- Lyndia Flanagan (1997-02-07). "Nurse Practitioners: Growing Competition for Family Physicians? - Oct 1998 - Family Practice Management". Aafp.org. Retrieved 2011-08-31.
- "Prescriptive Authority and Barriers to NP Practice | Nurse Practitioner | Find Articles at BNET". Findarticles.com. Retrieved 2011-08-31.
- "Nurse Practitioner Legislation would have reduced barriers to care | Maryland Nurse | Find Articles at BNET". Findarticles.com. Retrieved 2011-08-31.
- "MN2020". MN2020. Retrieved 2011-09-29.
- "John Crisp: Nurse practitioners' role should be expanded » Abilene Reporter-News". Reporternews.com. Retrieved 2011-08-31.
- "Pearson Report" www.pearsonreport.com
- Martin, Greg. "Education and Training: Family Physicians and Nurse Practitioners". American Academy of Family Physicians. Retrieved 29 November 2012.
- "Access". Medscape. Retrieved 2011-08-31.
- Website - Australian Health Practitioner Regulation Agency
- Website - Australian College of Nurse Practitioners
- [dead link]
- "Expanding the Role of the Nurse Practitioner in the Deployed Setting | Military Medicine | Find Articles at BNET". Findarticles.com. 2003-03-24. Retrieved 2011-08-31.
- "Access". Medscape. Retrieved 2011-08-31.
- "What Is a Nurse Practitioner? - What Is a Nurse Practitioner? - HealthCommunities". Womenshealthchannel.com. Retrieved 2011-08-31.
- Lenz, E.R., Mundinger, M.O., Kane, R.L., Hopkins, S.C., & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research Review, 61, 332-351.
- Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.-Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283, 59-68.
- Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823.
- "Acute Care Exam Products". Pncb.org. Retrieved 2011-08-31.
- "Primary Care Exam Products". Pncb.org. Retrieved 2011-08-31.
- "Licensing". Dos.state.pa.us. 2011-01-14. Retrieved 2011-08-31.
- [dead link]
|Look up nurse practitioner in Wiktionary, the free dictionary.|
|Wikimedia Commons has media related to: Nurse practitioners|
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