Nurse practitioner
Encyclopedia
A Nurse Practitioner is an Advanced practice registered nurse (APRN) who has completed graduate-level education (either a Master's or a Doctoral degree). Additional APRN roles include the Certified Registered Nurse Anesthetist (CRNA)
s, CNM
s, and CNS
s. All Nurse Practitioners are Registered Nurse
s who have completed extensive additional education, training, and have a dramatically expanded scope of practice over the traditional RN role. To become licensed/certified to practice, Nurse Practitioners hold national board certification in an area of specialty (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed or certified through the state nursing boards rather than medical boards. 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. Another focus is educating patients about their health and encouraging them to make healthy choices. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.
Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, ordering and interpreting diagnostic tests. NPs can then diagnose the disease and then provide appropriate treatment for the patients, including prescribing medications. 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.).
In the United States
, nurse practitioners have a national board certification. Nurse Practitioners can be educated and nationally 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 "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:
as a Nurse Practitioner, the candidate must first complete the education and clinical experiences necessary to be a registered nurse
, then go on to complete a graduate-level nurse practitioner program (either a Master's or Doctorate degree). Next, 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 therefore first complete a Bachelor of Science in Nursing
(BSN) or enter various programs 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.
(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.
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 similar
to those of a physician in primary care and are able to diagnose and treat a wide range of health problems.
Nurse anesthetist
A nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
s, CNM
Nurse midwife
In the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
s, and CNS
Clinical nurse specialist
A clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
s. All Nurse Practitioners are Registered Nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
s who have completed extensive additional education, training, and have a dramatically expanded scope of practice over the traditional RN role. To become licensed/certified to practice, Nurse Practitioners hold national board certification in an area of specialty (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed or certified through the state nursing boards rather than medical boards. 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. Another focus is educating patients about their health and encouraging them to make healthy choices. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.
Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, ordering and interpreting diagnostic tests. NPs can then diagnose the disease and then provide appropriate treatment for the patients, including prescribing medications. 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.).
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, nurse practitioners have a national board certification. Nurse Practitioners can be educated and nationally 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
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, NPs are licensed by the province or territory in which they practice.
Scope of practice
In the United States, because the profession is state-regulated, care provided by NPs varies widely. Some nurse practitioners 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, medical treatments, pharmacologic prescriptions, etc. afford an NP to perform and prescribe again varies widely amongst states of licensure/certification. practice.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:
- 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 therapyPhysical therapyPhysical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
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
- 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
Practice settings
NPs practice in all U.S. states, Canadian provinces and territories and in all Australian states and territories. The institutions in which they work may include:- Community clinicClinicA clinic is a health care facility that is primarily devoted to the care of outpatients...
s, health centers, urgent careUrgent careUrgent care is the delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department, usually on an unscheduled, walk-in basis. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate...
centers - Health maintenance organizations (HMOs)
- Home health care agencies
- HospitalHospitalA hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s and hospital clinics - Hospice care
- Nurse practitioner practices/offices
- Nurse-led clinicNurse-led clinicA nurse-led clinic can be considered an umbrella term which describes any outpatient clinic that is run or managed by Registered nurses, usually nurse practitioners...
s - Nursing homeNursing homeA nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
s - Nursing schoolNursing schoolA nursing school is a type of educational institution, or part thereof, providing education and training to become a fully qualified nurse. The nature of nursing education and nursing qualifications varies considerably across the world.-United Kingdom:...
s - Private & public schools, universities and colleges
- Physician/private medical practices
- Physician offices
- Veteran's administration facilities
- Retail-based clinics
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
departments - School/college clinics
- Walk-in clinics
Education, licensing, and board certification
To be licensedLicensure
Licensure refers to the granting of a license, which gives a "permission to practice." Such licenses are usually issued in order to regulate some activity that is deemed to be dangerous or a threat to the person or the public or which involves a high level of specialized skill...
as a Nurse Practitioner, the candidate must first complete the education and clinical experiences necessary to be a registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
, then go on to complete a graduate-level nurse practitioner program (either a Master's or Doctorate degree). Next, 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 therefore first complete a Bachelor of Science in Nursing
Bachelor of Science in Nursing
The Bachelor of Science in Nursing is an American four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school...
(BSN) or enter various programs 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
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 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. All U.S. states require national board certification for nurse practitioners before they are permitted to practice and the two biggest certifying bodies, the American Nurses Credentialing CenterAmerican Nurses Credentialing Center
The American Nurses Credentialing Center , a subsidiary of the American Nurses Association , is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the United States , currently certifying over 75,000 APRNs...
(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
Grandfather clause
Grandfather clause is a legal term used to describe a situation in which an old rule continues to apply to some existing situations, while a new rule will apply to all future situations. It is often used as a verb: to grandfather means to grant such an exemption...
. 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
Grandfather clause
Grandfather clause is a legal term used to describe a situation in which an old rule continues to apply to some existing situations, while a new rule will apply to all future situations. It is often used as a verb: to grandfather means to grant such an exemption...
.
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.
Australia
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)Role in healthcare
The role of Nurse Practitioners is very diverse. Nurse Practitioners are educated under the nursing modelNursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
which is designed to provide holistic
Holism
Holism is the idea that all the properties of a given system cannot be determined or explained by its component parts alone...
and preventive care
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
engaging the individual as the primary leader in their own care and well-being
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
. Nurse Practitioners bring the nursing history of patient advocacy
Patient advocacy
A Patient Advocate acts as a support structure and if legally contracted to do so may act as a liaison between a patient and their Health Care Provider. Most health care professionals see themselves as advocates for their patients, however their time and scope are limited by their job function...
to partner with the individual for mutually agreed upon treatments and optimal health outcomes
Routine health outcomes measurement
Evidence-based practice describes a healthcare system in which evidence from published studies, often mediated by systematic reviews or processed into medical guidelines is incorporated into clinical practice. The flow of information is one way; from research to practice...
. Nurse Practitioners often view the health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and wellness
Wellness (alternative medicine)
Wellness is generally used to mean a healthy balance of the mind, body and spirit that results in an overall feeling of well-being. It has been used in the context of alternative medicine since Halbert L. Dunn, M.D., began using the phrase high level wellness in the 1950s...
of individuals within the family
Family
In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children...
or community
Community
The term community has two distinct meanings:*a group of interacting people, possibly living in close proximity, and often refers to a group that shares some common values, and is attributed with social cohesion within a shared geographical location, generally in social units larger than a household...
system and attempt to incorporate cultural relativism
Cultural relativism
Cultural relativism is the principle that an individual human's beliefs and activities should be understood by others in terms of that individual's own culture. This principle was established as axiomatic in anthropological research by Franz Boas in the first few decades of the 20th century and...
within their treatments and recommendations. NPs are advanced practice nurses who provide high-quality healthcare services similar
to those of a physician in primary care and are able to diagnose and treat a wide range of health problems.
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 NursingMaster of Science in NursingA Master of Science in Nursing is an advanced-level postgraduate degree for registered nurses and is considered an entry-level degree for nurse educators and managers. The degree also may prepare a nurse to seek a career as a nurse administrator, health policy expert, or clinical nurse leader...
) - NP-C (Nurse Practitioner - Certified; if certified by the AANP)
- PhD (Doctor of Philosophy)
- 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)
Specialties
- ACHPN (Advanced Certified Hospice & Palliative Nurse)
- ACNP (Acute CareAcute careAcute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery...
NP) - ACPNP (Acute Care Pediatric NP)
- ANP (Adult NP)
(Specialty Programs: Adult Cardiovascular Care NP, Adult Primary Care NP, Adult Critical Care NP, Adult Acute Care NP ) - AOCNP or AOCNS (Advanced Oncology Certified Nurse Practitioner or Clinical Nurse Specialist—by ONCC)
- APMHNP (Adult Psychiatric/Mental Health NP)
- BC-ADM (Board Certified - Advanced Diabetes Management)
- BC-PCM (Board Certified - Palliative Care Management, discontinued by ANCC)
- ENP (Emergency NP)
- FNP (Family NP)
- FPMHNP (Family Psychiatric/Mental Health NP)
- GNP (GeriatricGeriatricsGeriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
NP) - HNP (Holistic NP; APN program )
- NNP (Neonatal NP)
- OHNP (Occupational Health NP)
- ONP (Oncology NP)
- PA/CCNP (Pediatric Acute/Chronic Care NP )
- PCCNP (Pediatric Critical Care NP)
- PCNP (Palliative Care NP; APN program )
- PMHNP (Psychiatric/Mental Health NP)
- PNP (Pediatric NP)
- PONP (Pediatric Oncology NP)
- WHNP (Women's Health NP)
- "-C" and "-BC" indicate "Certified" and "Board Certified" by a national certifying organization such as the American Nurses Credentialing CenterAmerican Nurses Credentialing CenterThe American Nurses Credentialing Center , a subsidiary of the American Nurses Association , is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the United States , currently certifying over 75,000 APRNs...
, American Academy of Nurse PractitionersAmerican Academy of Nurse PractitionersThe American Academy of Nurse Practitioners is an organization formed in 1985 to provide nurse practitioners with a unified way to network and advocate their issues. It was the first organization created for nurse practitioners of all specialties in the United States of America and remains the only...
, or the National Certification CorporationNational Certification CorporationThe National Certification Corporation was established for the development, administration, and evaluation of a program for certification in obstetric, gynecologic, and neonatal nursing specialties in the United States...
(e.g., FNP-BC, NNP-BC, ANP-C, NP-C, WHNP-BC, etc.)
See also
- Registered NurseRegistered nurseA registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
- Physician assistantPhysician assistantA physician assistant/associate ' is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.-General description:...
- List of counseling topics