The demand for nurse practitioners keeps increasing against a backdrop of chronic healthcare system staff shortages. According to Fortune Education, it is now the fastest-growing profession in the United States. US Bureau of Labor Statistics has predicted a 46% rise in demand between 2021 and 2031.
American Association of Nurse Practitioners statistics show that 355,000 licensed nurse practitioners hold a current license. The vast majority work in family care, meaning an enormous career potential exists in many other nurse practitioner specialties. If you seek out further education in areas such as mental health, oncology, acute pediatric care, gerontology, or neonatal care, you can be sure of multiple job opportunities and competitive salaries. The average nurse practitioner salary is over $120k, with specialty nurse practitioner salaries exceeding this substantial wage.
This article examines the training paths to firstly qualifying as a nurse practitioner and secondly to specializing in a care area to move up to leadership roles. Nurse practitioners will likely continue to play an expanding role, translating into excellent career opportunities alongside highly competitive remuneration packages. You will also learn about how the roles and responsibilities of a nurse practitioner depend on the location and fall under state regulations.
Nurse practitioner training paths
The nurse practitioner (NP) role is far more diverse and expansive than that of a registered nurse. NPs have far greater responsibilities and much more authority, leading teams and making crucial patient care decisions. The training paths reflect the weight of those life-and-death-heavy powers by containing in-depth education in diagnostics and treatment, medicine and therapy prescription, lab result and X-ray interpretation, teaching and counseling patients, complete patient examinations and assessments, and referral practices.
A Bachelor of Science in Nursing (BSN) is a prerequisite, after which you can choose between two pathways to become a nurse practitioner. You can either earn a Master of Science in Nursing (MSN) involving postgraduate education and a national certification examination. The other option is to pursue a terminal degree, such as a Doctor of Nursing Practice (DNP). Nurse practitioners with a DNP qualification may be in a position to take on educating other nurses, head up nursing departments, deliver executive nurse leadership to medical organizations, contribute to the drafting of health policies, and create and maintain nursing informatics structures.
Nurse practitioners can work in many settings, including hospitals, medical centers, and independent practices. During NP training programs, you choose a specialty in which you then clock up your practice hours. Candidates generally select a specialty in line with the career path they envisage, meaning if you want to work with older people, you choose gerontology. In contrast, if you want to work in mental health, opt for that area of specialty.
Depending on your training path and college, you must earn practice hours. The number varies, with Doctor of Nursing Practice students having to work more than 1,000 hours during the three-year program.
Upon completing the degree and work experience, nurse practitioners proceed to the certification and licensing stage. The requirements again depend on the specialty and location.
The training path from start to finish, including the initial BA, MA, work experience, and licensing process, can take up to eight years.
As the remit of duties and responsibilities is expansive, nurse practitioners are often the leading healthcare authority in small communities. Not only are many roles and opportunities open to NPs, but the profession also enjoys one of the most significant scopes for independence.
But what are the specialties open to nurse practitioners? The following section outlines some of the career paths.
What kind of specialties can nurse practitioners choose to advance their careers?
A vast array of specialties is available to nurse practitioners wishing to advance their careers. While they may choose one area during their training, they can pursue a different path when they step out as professionals through advanced education. NPs select their specialties bearing in mind their preference of location, what kind of patients they would like to work with, and what area of nursing they are most passionate about. The demand is high, so any of the choices below will materialize in excellent job opportunities and competitive salaries.
Here are the foremost specialties open to nurse practitioners:
- Family care nurse practitioners: More than seven out of ten NPs today work with families, taking care of family members, young and old. The role is highly diverse as it allows nurse practitioners to forge long-term relationships and cater to the health needs of different age groups.
- Pediatric nurse practitioners: They specialize in treating children.
- Adult gerontology nurse practitioners: Providing medical care to older adults, gerontology NPs not only help treat ailments but also advise on maintaining good health into old age.
- Psychiatric mental health nurse practitioners: With a focus on mental health, psychiatric mental health NPs assess patients and may prescribe treatments and drugs while also making referrals to other mental health professionals. The scope of the work depends on the state practices.
- Oncology nurse practitioners: They specialize in caring for people with cancer, working with teams, and providing family support.
- Acute care nurse practitioners: Specializing in emergency care, acute care NPs work in emergency rooms, trauma units, and urgent care departments. Beyond providing immediate care, they create long-term recovery programs and healthcare plans.
- Aesthetic nurse practitioners: NPs in this area support cosmetic surgeons, mostly in private clinics. Unlike most NPs, they enjoy regular Monday-Friday work schedules allowing for an improved work-life balance.
- Women’s health nurse practitioners: Working with women of all ages and at varying life stages, women’s health NPs provide care, educate, diagnose, and prescribe treatments.
- Neonatal nurse practitioners: As the name suggests, neonatal NPs work with newborns, especially those who suffer from an illness or disability. They also support parents, educating them on how to best care for their babies.
Other specialties include infectious diseases, dermatology, nephrology (health relating to the kidneys), orthopedics (musculoskeletal system), cardiology, surgery, and palliative care (working with the terminally ill).
As you can imagine, the above roles require intense training. Some experienced NPs opt for advanced training that leads them away from the frontline into administrative roles.
Administrative nurse practitioner advanced career paths
Some NPs move away from patient care further into their career path. They may prefer more regular work hours or wish to apply their skills, knowledge, and first-hand experience in other areas. Again, they can pursue many opportunities, including the following:
- Nurse educator: At a university or medical institution, NP nurse educators teach and train nurses in patient care.
- Nurse informaticist: With a DNP background, NPs can train in creating information technology systems to improve care delivery.
- Nurse policy specialist: Healthcare in any state depends on health policies, which NPs who’ve undergone advanced training can help shape.
- Chief nursing officer: At the highest level of nursing, chief nursing officers manage teams and advocate for them. The role combines leadership, policymaking, patient welfare, and creating healthcare plans and policies.
- Nurse administrator: After gaining experience in administration, nurse administrators manage teams, departments, and nursing units. They can also work as health executives and policymakers.
- Nurse researchers: They survey, analyze, and evaluate healthcare delivery, clinical practice, nurse education, and health systems and outcomes.
To work in an area of specialty, NPs must first gain work experience and then proceed toward certification set out by the relevant governing bodies. Like registered nurses, nurse practitioners must earn continuing education credits set out by the state’s nursing boards to maintain their licensure.
Specialized nurse practitioner job prospects and salary
NP salaries are highly competitive but depend on the specialty, location, and the NP’s years of experience. The salary of a nurse practitioner in Texas, for instance, starts at just over $95k but climbs up to more than $160k for a nurse practitioner with 20 or more years of experience.
The demand for NPs in all settings is growing. According to the BLS, more than 118,000 new roles will emerge between now and 2031 in rural areas, hospitals, and private city and country practices.
Nurse practitioner – a diverse new role that is hard to define
NPs head up teams and take charge of patient groups while taking on many of a physician’s responsibilities. As the role is relatively new, it is vital to understand its remit. The daily workload also comes into play, with specialty and location shaping an NP’s task list.
No nationwide-agreed job remit exists but rather state-specific scopes of practice, meaning your job as an NP will vary significantly depending on where you choose to work. But let’s first look at the workload all nurse practitioners share.
Nurse practitioner’s day-to-day general responsibilities
While patient care lies at the heart of a registered nurse’s and nurse practitioner’s job, NPs have greater autonomy and authority and can even take on some of the physicians’ jobs. They can, for instance, order tests, diagnose patients, and prescribe treatments. Unlike registered nurses, they do not need the consent or supervision of a doctor, at least in some states.
Nurse practitioners hold a multifaceted role within the healthcare system, encompassing both coordination and supervision of medical teams, as well as functioning as primary care providers. Their daily responsibilities span a wide range of tasks applicable to all specialties. These tasks include collecting samples and relevant patient information, conducting comprehensive examinations and assessments, gathering detailed medical histories, and evaluating symptoms. Additionally, nurse practitioners ensure the accuracy and currency of medical records, observe patients closely, and assess test results.
They are authorized to prescribe medications, closely monitor treatment outcomes, and develop comprehensive treatment plans. Moreover, they facilitate referrals to specialists when necessary and proficiently operate medical devices. As integral leaders, nurse practitioners also have the authority to order essential tests and supervise nursing staff while demonstrating strong leadership capabilities in guiding healthcare teams. With their diverse and critical responsibilities, nurse practitioners play a pivotal role in delivering quality healthcare to patients across various medical settings.
Other NP duties depend on the specialty, meaning family nurses have duties to meet family needs, while a cardiology nurse practitioner caters to the requirements of heart patients.
It is important to remember that the nurse practitioner role was created to address the shortage of doctors. The training prepares them to perform some physician duties, including x-ray interpretation, prescribing medication, and educating and supporting patients and families during treatment and recovery.
As the nurse practitioner’s role varies in specialty and scope, you must remember that each state has its rules governing the work. The nurse practitioner’s scope of practice defines the role in detail, establishing precise parameters of the type of care NPs have the authority to provide.
In the following section, you learn a cross-section of the kind of nurse practitioner scopes in various US states.
Nurse practitioner scope of practice by state
The scope of practice defines the “who,” “what,” “where,” “when,” “why,” and “how” of a nurse practitioner’s job, stipulating what duties they have the authority to perform. In some states, NPs are permitted to diagnose autonomously, while in others, they must consult a physician.
Each state has an NP scope of practice, making it difficult for nurse practitioners to work in different locations. They run the risk of performing tasks beyond the scope of practice, thus violating it. A national scope of practice may materialize in the future, but as of now, NPs must carefully examine and honor the state-specific scope of practice. You may also see the training standards and requirements streamlined across the country in the future, thus building consistency in the role at work and during training.
Nine elements comprise the nurse practitioner’s scope of practice, outlining the regulations nurses must follow in a specific state. Nurse practitioner authority, one of the nine components, sets out to what extent an NP can fulfill tasks and establishes three categories:
- Full practice, meaning the NP can work independently
- Reduced practice, meaning the nurse practitioner must work with a physician
- Restricted practice, meaning the NP must be supervised
Each state’s State Board of Nursing establishes the parameters of the nurse practitioner (NP) scope of practice, which necessitates reviewing the state’s specific NP rules and regulations when applying for an NP position. Beyond the categories mentioned above, the state’s NP scope of practice also governs several other aspects of the role, such as autonomous practice, primary care provider status, prescribing Schedule II drugs, ordering physical therapy, signing death certificates, and obtaining full medical memberships.
As a result of the significant discrepancies between state-specific scopes of practice for NPs, discussions have intensified among nursing and medical experts concerning the importance of clarity for patients and medical staff alike. While many acknowledge the value of NPs lightening physicians’ workloads in numerous states, physician assistants and nurse practitioners’ express concerns about potential confusion among patients regarding who is in charge. The following section will delve into the main points of contention surrounding this topic.
Nurse practitioner vs. physician assistant
With states granting nurse practitioners more and more authority and nursing bodies advocating as much, it is hardly surprising that some physician groups object. Many feel NP education does not sufficiently prepare candidates for total autonomy. Groups such as Physicians for Patient Protection campaign to maintain physician-led healthcare rather than allow nurse practitioners to take over many of their responsibilities. In contrast, nursing bodies want all states to provide the broadest scope of practice possible.
The debate will likely continue for years, but with physicians in short supply, NPs are set to enjoy continuing demand, job growth, and plenty of independence.
Of all the healthcare professionals, nurse practitioners are in the highest demand regardless of specialty or advanced training credentials. Nonetheless, embarking on studying a specialty, gaining experience in the field, and earning the relevant specialty license provide a pass to endless job prospects and sizeable salaries.
You must also remember that, without the hard work and expertise of the hundreds of thousands of nurse practitioners across the US, the health system may very well have collapsed under chronic staff shortages.