- Nurse practitioner
A Nurse Practitioner (NP) 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, CNMs, and CNSs. All Nurse Practitioners are Registered Nurses 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.
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 therapy 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
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 clinics, health centers, urgent care centers
- Health maintenance organizations (HMOs)
- Home health care agencies
- Hospitals and hospital clinics
- Hospice care
- Nurse practitioner practices/offices
- Nurse-led clinics
- Nursing homes
- Nursing schools
- Private & public schools, universities and colleges
- Physician/private medical practices
- Physician offices
- Veteran's administration facilities
- Retail-based clinics
- Public health departments
- School/college clinics
- Walk-in clinics
Education, licensing, and board certification
To be licensed 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.
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 Center (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.
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 model 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.
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 Nursing)
- 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)
- ACHPN (Advanced Certified Hospice & Palliative Nurse)
- ACNP (Acute Care 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 (Geriatric 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 Center, American Academy of Nurse Practitioners, or the National Certification Corporation
(e.g., FNP-BC, NNP-BC, ANP-C, NP-C, WHNP-BC, etc.)
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- The Nurse Practitioner: The American Journal of Primary Health Care
- AANP Standards for NP practice in retail based clinics
- CNS and NP Practice in Canada
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