What is a Nurse Practitioner?
During the week of the 8th to the 14th of November, the American Association of Nurse Practitioners celebrated National Nurse Practitioner Week. This celebration is held annually and has two core purposes.
First, to celebrate Nurse Practitioners and the outstanding work they do in taking care of their patients and their contributions every day to the healthcare community. Secondly, the event exists to remind lawmakers of the importance of the profession. The AANP hopes that highlighting their importance will help reform legal policies that put barriers between Nurse Practitioners and practicing in a manner that makes full use of their advanced education and experience.
So what exactly is a Nurse Practitioner?
The Difference Between a Nurse and a Nurse Practitioner
Both Registered Nurses and Nurse Practitioners take a ‘patient-centric’ approach to care. They will work closely with their patients, monitoring their health, and providing care to help treat both acute and chronic illnesses.
Nurse Practitioners need to have undertaken a more lengthy education than Registered Nurses. They must hold either a Masters Degree or a DNP (Doctor of Nursing Practice). Registered Nurses will hold either an ADN (Associates Degree In Nursing) or a Bachelor’s Degree.
Because of their level of education, Nurse Practitioners have a higher level of authority when it comes to patient care than Registered Nurses. Their Master’s or DNP means that they have the advanced knowledge required to allow them to make treatment decisions, and dependent on the state; they can do this without the supervision of a Physician.
Nurse Practitioners also often work in private practice or in community clinics where their DNP allows them to work with autonomy in a smaller team. RN’s are more often employed in hospitals and surgical settings and will always work under a physician’s supervision.
Barriers to Practice
In March 2020, the AANP reported that NP’s were allowed to provide direct care to patients in 22 states, the District of Columbia, two U.S. territories, the Veterans Health Administration, and the Indian Health Service. In the remaining jurisdictions, it is illegal for NP’s to provide care unless it is under the supervision of a Physician, even if they are DNP qualified.
The AANP argued that this outdated legislation was causing unnecessary barriers to care, especially while the COVID-19 pandemic was ongoing. By requiring them to work under the supervision of a Physician, this meant that providing care took much longer than it needed to.
According to the AANP’s ‘proclamation map,’ which was released as part of National Nurse Practitioner Week, proclamations in support of the removal of barriers to practice for Nurse Practitioners have been received from 39 States, The District of Columbia, and the U.S. Pacific Territories.
The History of the Profession
The first Master’s level Nursing Practitioner program was established at Boston College in 1967 by the nurse Loretta Ford and pediatrician Henry Silver.
The movement towards advanced nursing practice began around 1965. The Vietnam draft was in full effect, and Lyndon Johnson had just signed the Medicare Act into law. This meant that more people were encouraged to access healthcare, which created a strain on the existing model, which was entirely Physician-led.
This, combined with a growing focus on the advanced technical education of Nurses at a baccalaureate level, saw Ford and Silver partnering to bring to life their shared vision of an expansion of the role of the Nurse.
As more Nurse Practitioner programs were established, and the profession began to gain traction, the value of a patient-centric model backed by technical ability became apparent. The first DNP programs began to surface in the latter part of the twentieth century. Although Nurse Practitioners gain the same level of education as Physicians, their approach is quite different. Rather than adopting a model of leading others, Loretta Ford herself frequently tells audiences that she dislikes the term ‘independent practitioner,’ as she believes all practice requires teamwork and collaboration.
Nurse Practitioner Specializations
One of the great things about getting your Masters or DNP and becoming a Nurse Practitioner is that it allows you to specialize in a branch of medicine. This means that you can focus your career on working in an area that you are truly passionate about.
Generally, you will choose a specialization when you undertake your DNP or Masters. Some of the specializations you can choose are:
- Family – Family Nurse Practitioners focus on health promotion and education, and they work with patients of all ages. One of the most rewarding things about the Family specialization is that it allows you to work with individuals throughout their lives, meaning that you can form relationships and see the impact of the care that you provide.
- Acute Care – Nurse Practitioners specializing in acute care generally work in a hospital setting, specializing in working with patients over thirteen years of age who are acutely ill, are recovering from a surgical procedure, or have suffered a trauma.
- Pediatrics – Pediatric Nurse Practitioners work with children from birth until they are considered adults. They may use their DNP training to treat acute conditions, but they also carry out more routine care such as immunizations, check-ups, and health education.
- Emergency – Emergency Nurse Practitioners specialize in the diagnosis and treatment of urgent health conditions. They are trained to work with the young, the old, the chronically ill, and those who are generally healthy, so it’s a specialism that requires a wide-ranging skillset.
- Adult-Gerontology – Gerontology is the study of aging and the impact it has on people. Adult-Gerontology Nurse Practitioners work with adults throughout their lives, and depending on their specialism, they can provide either routine care such as check-ups, immunizations and education, or care for more acute and chronic conditions.
- Psychiatric – Psychiatric Nurse Practitioners work with their patients to improve their mental health, and provide treatment for mental illnesses. Because they are DNP qualified, they are able to prescribe medications, as well as diagnose conditions, and recommend treatment options. They also work with the families of Psychiatric patients to help them manage their loved ones’ condition.
- Neonatal – Neonatal Nurse Practitioners are concerned with the care of babies born preterm or infants who have a health condition such as a genetic disorder, drug addiction, or surgical birth defect. In some settings, they may also be involved with the delivery.
Typical Day for a Nurse Practitioner
Having achieved a Doctor of Nursing Practice (DNP) or a Master’s degree, Nurse Practitioners are highly qualified and therefore suited to work in a variety of different settings, as we have discussed.
This means that it’s difficult to describe a ‘typical’ day for a Nurse Practitioner. A Nurse Practitioner working in the Emergency department of a hospital in Nashville, Tennessee, describes their day in a blog post as busy and varied and flexible hours.
This particular Nurse Practitioner’s hours were 10am until 6pm, although other Nurse Practitioners working in Emergency Departments have described working shifts that span anywhere within 24 hours. Generally, a Nurse Practitioner will work a 40 hour week, with the option of overtime. This is entirely dependent on where you work, however. If you are working in a quiet clinic, then you are less likely to be needed to work the graveyard shift; however, a busy hospital may not be able to be so flexible.
Our Emergency Nurse Practitioner described how they were called on to carry out examinations of patients, order tests, diagnose their condition, and decide on the best treatment option for them.
They saw a mixture of patients throughout the day, eighteen in total. They describe two that were reasonably straightforward and easy to diagnose and treat and were less straightforward and a little more difficult to treat because the symptoms were not typical for the patient’s age and were complicated by intravenous drug use. They also describe a situation where they were called upon to take care of an extremely unstable patient. The Nurse Practitioner essentially took the lead on the treatment plan, which they are qualified to due to their extensive experience and DNP training, but still had to OK their decisions with their supervising Physician.
Salary and Career Outlook
Although obtaining your DNP or Masters is an expensive undertaking, it can be worthwhile if you consider it an investment. The BLS (Bureau of Labor Statistics) reported that the median salary for Nurse Practitioners in 2019 was $115,800, or $55.67 per hour. This is a great deal higher than the average salary across all occupations, which was $39,810.
The actual salary that Nurse Practitioners get paid varies depending on the area of the country, the type of institution they are working in, and the area of specialization that they choose, so it’s worth doing some research on this when you are planning whether to undertake a DNP.
The expectation is that the requirement for Nurse Practitioners will grow by 45% between 2019 and 2029, with an additional 117,700 Nurse Practitioners being needed.
This is due to the aging population, combined with the growing number of people suffering from chronic health conditions such as obesity and diabetes. There is also a growing emphasis on health education, empowering people to make healthy decisions, and avoid developing these conditions. Nurse Practitioners will be involved in much of this work.
The growing requirement for Nurse Practitioners means that it should be a stable career choice. It also means that Nurse Practitioners will have the freedom to change jobs for reasons like relocation more easily than in other professions. The downside to this is that the demand could see the pressure on Nurse Practitioners increasing, so you must bear this in mind when choosing where to practice. For example, stress levels in city hospitals are likely to be much higher than in rural community clinics.
How Do You Become a Nurse Practitioner?
To become a Nurse Practitioner, you first need to be a Registered Nurse. It’s possible to qualify as a Registered Nurse by completing either an Associate Degree In Nursing (ADN) or a Bachelor’s Degree in Nursing (BSN). There is a drive towards Registered Nurses having BSN’s, so this is the better choice if you aren’t a qualified RN already.
If you hold an ADN, you can enroll in an accelerated RN-BSN program to get your Bachelor’s degree. However, you may be able to train as a Nurse Practitioner without this depending on which program you choose.
Once you are a Registered Nurse, it’s advisable to gain some experience on the job before going on to do further training. This is because working in nursing will help you to choose your specialism when you enroll in your Masters or DNP, and many programs require you to have a certain amount of experience before allowing you to enroll.
Once you have the experience that you need, you can enroll in your graduate program to qualify as a Nurse Practitioner. You can choose either to undertake a Masters’s or a DNP. Some DNP programs are accelerated and will allow you to qualify for both your Doctorate and your Masters in only two semesters longer than a masters does. Pursuing your DNP and getting a higher level of qualification and the perks it brings is certainly worth consideration.
Once you have completed your DNP or Masters you will need to be licensed as a Nurse Practitioner. The license criteria are currently set by each individual state, although there is talk of bringing nationwide licensing criteria. At the moment, you will need to check the criteria with your individual state. It’s a good idea to do this before embarking on any training program, as you’ll need to make sure that your DNP or Masters qualification is recognized by your state.
Why Train as a Nurse Practitioner?
When considering whether to get your Masters or DNP and train as a Nurse Practitioner, there are a few things to consider.
Any educational undertaking is expensive; however, if you are a person who wants to be able to work with autonomy in the healthcare sector while enjoying a great salary and good job security, then a Nurse Practitioner career could be the one for you.
Nurse Practitioners also have the advantage of being able to specialize so that their career is one that is truly meaningful to them, and their days run in a way that works for them. Another advantage of becoming a Nurse Practitioner is that dependent on what state you are registered in; you may even be able to start your own medical practice! If you have an entrepreneurial streak, then this could definitely be a good choice for you.