Nurse practitioner

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A nurse practitioner (NP) is a registered nurse who has completed advanced education (generally a minimum of a master's degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a broad range of health care services.

Countries with Nurse Practitioners

Canada

United Kingdom

United States of America

Overview

Nurse Practitioners (NPs) provide much of the same care provided by physicians and usually maintain collaborative working relationships with physicians. NPs are licensed by the state in which they practice, and have a board certification (often through ANCC - American Nurses Credentialing Center) [1]in their area of practice. Rather than a generic focus of education, Nurse Practitioners are able to specialize in an area of study they desire (i.e. Pediatrics, Family Practice, Adult, Geriatric, etc.,) and provide care within the scope of their expertise. As well, Nurse practitioners in certain states can be "psychiatric clinicians" and perform similar practice as a psychiatrist would.

Nurse practitioners may treat both acute and chronic conditions, as well as prescribe medications and therapies for the patient at hand. Many NPs have a DEA registration number that allows them to write for "controlled" medications in most states. Nurse practitioners may also bill for Medicare and Medicaid and private insurance for services performed. An NP can serve as a patient’s regular 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. NPs make prevention, wellness, and patient education priorities. This can mean fewer prescriptions and less expensive treatments. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

In 14 states, NPs can work autonomously and some are able to open their own clinical practices. American NPs, according to the American College of Nurse Practitioners, are required in 28 states to practice in collaboration with a physician [2] though they may prescribe medications and carry a DEA number in 49 states.

Scope of practice

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

Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g., pneumonia, diabetes, high blood pressure)
Obtaining medical histories and conducting physical examinations
Ordering, performing, and interpreting diagnostic studies (e.g., lab tests, x-rays, EKGs)
Prescribing medications
Prescribing physical therapy and other rehabilitation treatments
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
Performing minor surgeries and procedures (e.g., dermatological biopsies, suturing, casting)
Collaborating with physicians and other health professionals as needed, including providing referrals
Counseling and educating patients on health behaviors, self-care skills, and treatment options

Practice settings

NPs practice in all states. The institutions in which they work include 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 and Urgent Care
Hospice centers
Nurse practitioner offices
Nursing homes
Nursing schools
Physician offices
Public health departments
School/college clinics
Veterans Administration facilities
Walk-In Clinics

Education, licensure, and board certification

Most NPs specialize in a particular field of medical care, and there are as many types of NPs as there are medical specialties.

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 include an associate degree in nursing (ADN), 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 2–3 years. BSN programs are offered by colleges and universities and take 4–5 years and diploma programs are administered in hospitals anually take 2–3 years. Depending on the program attended, the candidate may fulfill some NP requirements while completing the RN degree.

In most states a master's degree is required. To become NPs, nurses with an ADN or diploma must enter a bachelor of science to master's program. They may be able to find a staff nursing position and take advantage of tuition reimbursement programs.

Once registered nurse status is attained, the candidate must complete a state-approved advanced nursing education program that usually specializes in a field such as family practice, adult health, acute care or women's health. 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). Some professional organizations, such as the American Nurses Association (ANA), have recommended that by 2015, all accredited NP programs should be at the doctoral level (DNP, DrNP).

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 (AANC, 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). Contrary to popular belief, the American Nurses Association (ANA) does not offer certification, but is linked with 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 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)([3])
CPNP (pediatric NP when certified by the pediatric nursing certification board (PNCB)
CRNA (Certified Registered Nurse Anesthetist)
CRNP (certified registered nurse practitioner) used primarily in Pennsylvannia ([4])
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)
CDE (certified diabetic educator)
ND (nursing doctorate)
DNP (doctor of nursing practice)
DrNP (clinical doctorate in nursing)
Initials of the NP's specialty may also follow their name:
- ACNP (Acute care NP)
- APN (Advance Practice Nurse)
- AHN (holistic NP)
- ANP (adult NP)
- FNP (family NP)
- GNP (geriatric NP)
- NNP (neonatal NP)
- PMHNP (Psychiatric and mental health Nurse Practitioner)
- NPP (Nurse Practitioner in Psychiatry)
- PNP (pediatric NP)
- WHNP (women's health NP)
- CNM (certified nurse midwife)
- BC, PCM (board certified, palliative care management)
- RN(EP) - RN (Extended Practice), Manitoba, Canada

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