How Do I Become a Nurse Practitioner?

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With the nation anticipating a substantial physician shortage by 2030, the time may well be right to become a nurse practitioner (NP), a type of advanced practice registered nurse (APRN) who bridges the widening gap between physician and patient for routine procedures related to primary care.

With the ability to examine, diagnose, and provide treatment, NPs have “full practice authority” (FPA) in 22 states, meaning they don’t require the supervision of a physician.

“We can pretty much do anything that a doctor can do with the exception of performing surgical procedures independently,” says NP Sylvia Estrada in a Cedars-Sinai Hospital (CA) blog entry.

The primary difference between a nurse practitioner and a physician lies in their training and approach. Doctors spend more years in school than NPs. Researchers at heart, physicians study illness in order to cure it. NPs are more likely to stress wellness and avoiding disease altogether.

“We have a focus on disease prevention and health education and counseling,” says Estrada. “These are unique assets ingrained in our education that enhance our clinical interaction with patients.”

Another difference: in many instances, clients can book an appointment with one of this country’s 270,000 NPs more quickly than they can with a doctor. As the physician shortage grows, that disparity will likely grow more acute.

In this article, we’ll cover:

• The pros and cons of becoming a nurse practitioner
• Kinds of nurse practitioner jobs
• Educational commitment to become a nurse practitioner
• Licensure and accreditation
• Why NPs matter

Pros of becoming a nurse practitioner

With higher expectations of achieving health goals, Americans will need more access to health counseling in order to manage healthy body weights and control blood pressure, cholesterol, and blood glucose levels. Enter the NP.

Job security

While nursing is considered a stable industry, NPs may have even more job security and may earn higher pay than RNs. With median annual earnings of $107,030, NPs make more than RNs at $71,730 (although less than physicians and surgeons at $208,000).

Overall employment of advanced practice registered nurses (APRN), including nurse midwives, nurse anesthetists, and NPs, is projected to grow 31 percent from 2016 to 2026, much faster than the average for all occupations.

Growing job market

According to a 2019 projection update by the Association of American Medical Colleges (AAMC), the population of those age 65 and greater is projected to grow by 50 percent through 2030. Older adults need more health care than younger populations, obviously. Meanwhile, more than two out of five active doctors will reach retirement age within the next 10 years. As a result,the United States could face a shortage of up to 120,000 physicians by 2030.

The work is important

NPs provide a crucial link in primary care and prevention. According to the Kaiser Family Foundation (KFF), NPs can provide 80 to 90 percent of the care that primary care physicians offer. Without NPs, there may not be enough medical professionals to go around, according to nurse.org.

Low malpractice rates

Despite their larger scope of practice, NPs have low malpractice rates, with only 1.1 percent of NPs named as primary defendants in malpractice lawsuits, according to the American Association of Nurse Practitioners (AANP).

Career advancement

Rather than being limited to clinical settings, NPs may have more career advancement opportunities outside of direct care, including research, corporate consulting, or nursing education.

Cons of becoming a nurse practitioner

Now for the downsides (every career has them).

Limited autonomy

With the predicted shortage of physicians, NPs may have more opportunities but not necessarily more autonomy or respect. There is a debate within the medical community over the need for physician supervision of NPs, and that can translate into friction between NPs and their colleagues, a major point in the 2013 documentary, Nurses: If Florence Could See Us Now.

Restricted practice authority

In California, NPs are under “restricted practice authority,” meaning they must have physician oversight to perform many of their duties, including prescribing medicines. This policy impacts a lot of NPs, given that California is by far our most populous state.

On-the-job dangers

As are many types of nurses, NPs may be exposed to numerous dangers: germs, violent clients, blood-born pathogens, toxic materials, and stress and poor ergonomics leading to chronic backaches and musculoskeletal injuries and disorders (MSD), according to the journal Nursing Health, & Environment.

Shift work may disturb sleep cycles and social schedules with family and friends, according to Patient Safety and Quality: An Evidence-Based Handbook for Nurses. The job can be hard on the body and hard on the nerves.

Risk of burnout

Compassion fatigue, which is related to burnout, can set in with long hours and not enough time for self care, according to this AAMC blog. Instead of being excited about work, career nurses may be more detached than those fresh out of college. When a patient dies, a professional may feel guilt that becomes part of secondary traumatic stress.

“Burnout is an accepted part of the job,” says Dr. Kate Sheppard, assistant professor at the University of Arizona College of Nursing. “What pushes a provider into secondary traumatic stress is the feeling that they can’t take it anymore… That’s when some providers build emotional walls to protect themselves,” she says. Because compassion fatigue has a negative connotation suggesting a lack of sensitivity, Sheppard prefers the term “professional emotional saturation.”

When NPs work long hours with little time for self-care, they can expect to experience this feeling of going through the motions.

Kinds of nurse practitioner careers

In 1965, Loretta Ford teamed with physician Henry Silver to offer the first nurse practitioner training program at the University of Colorado Denver. Its emphasis was on family health, disease prevention, and health promotion, which today all remain part of an NP’s wheelhouse. Ford and Silver became co-founders of this “nurse practitioner movement”, with the goal of empowering patients by providing and promoting basic health care.

“There was great concern, I think, that the kind of direction that we were taking was much more medical than nursing,” Ford told CNN. “It’s not easy when you have to buck some of the old prejudices and some of the demands of faculty that’s set in its ways, so to speak.” Nevertheless, she persisted.

Today, there are over 270,000 nurse practitioners in the United States. Below is a list of six different types of NPs; these nurse practitioners earn between $105,000 and $138,000 a year, according to Glassdoor.com.

Family Nurse Practitioner (FNP)

With 66 percent of NPs becoming family nurse practitioners, family medicine represents the largest field for NPs, according to AANP. Because FNPs specialize in health across lifespans, they have a broad range of skills that include leading clients toward wellness habits, performing diagnostic tests, and counseling. Average salary for FNPs is $104,427, but some may earn as much as $195,442, according to Indeed.com.

Gerontology Nurse Practitioner (GNP)

Trained to work with aging clients, gerontology nurse pratitioners are in particularly high demand in rural settings, where people may have limited access to health care. Specializing in diseases more common in older adults, GNPs may help patients concerned with memory loss and normal physical decline. Two specialties within this field include acute care and primary care.

Pediatric Nurse Practitioner (PNP)

You can always recognize PNPs by the cartoon characters hanging from their stethoscopes. Trained to serve clients ages 0 through 21, they have a toolbox full of skills ranging from conducting home visits and immunizations to prescribing medication.

Neonatal Nurse Practitioner (NNP)

NNPs work with babies ages 0 through 2 who may experience problems soon after birth. With approximately 40,000 low-birthweight babies born in the U.S. each year, these infants need special care.

Oncology Nurse Practitioner (ONP)

ONPs focus on families and individuals living with cancer. Because cancers and their treatments vary, so do the roles of ONPs. They may work in hospices, cancer centers, extended care facilities, and/or hospitals. ONPs may offer prevention strategies, palliative care, and cancer genetic counseling.

Psychiatric Mental Health Nurse Practitioner (PMHNP)

Not only do PMHNPs have the authority to conduct physical and mental health assessments, they may be leaders in creating policy. Areas of focus include substance abuse treatment, counseling, and forensics. Most important of all, they recognize the importance of treating both the mind and the body.

Educational commitment for becoming a nurse practitioner

If you are already an RN in good standing with a bachelor’s degree in nursing (BSN), you’re well on your way to graduating as an NP after about two years of study in an accredited MSN program.

Examples of top online and distance-enhanced options include Duke University, Georgetown University, and Ohio State University. Students complete their clinical hours offline.

For those holding an associate’s degree in nursing, some schools offer options leading to a master’s degree in nursing (MSN) in four years.

While it isn’t necessary to earn a doctor of nursing practice (DNP), some nurses do, in order to stand out and sharpen their clinical focus. Online opportunities can help you study around your work schedule.

After graduation, students should become credentialed through the American Association of Nurse Practitioners Certification Program (AANPCP) or the American Nurses Credentialing Center (ANCC).

Licensure and accreditation for becoming a nurse practitioner

NPs are accredited by the AANPCP and the ANCC, which require members to recertify every five years.

To apply for a certification with AANCPP, you must sit for the Adult-Gero Primary Care NP, Emergency NP, or Family NP exams.

Meanwhile, the ANCC provides board certifications for:

• Family Nurse Practitioner-Board Certified (FNP-BC)
• Pyschiatric Mental Health Nurse Practitioner-Board Certified (PMHNP-BC)
• ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC)
• Adult Gerontology Primary Care Nurse Practitioner-Board Certified (AGPCNP-BC)

Why NPs matter

According to Loretta Ford, the profession’s co-creator, NPs take a holistic approach to health, not just treating disease but educating individuals and families. In collaboration with their physician colleagues, they provide one-on-one care that makes them unique.

“The end result, of course, is to empower the patient or the family or the person to advance to self-care and to be responsible for that,” she once told CNN. That sounds like a pretty good way to make a living.

(Last Updated on February 26, 2024)

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