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). According to the International Council of Nurses, an NP/Advanced Practice Nurse is "a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which would be determined by the context in which s/he is credentialed to practice."[1]
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.[2] 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.
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The advanced practice nursing role began to take shape in the mid-20th century United States. Nurse anesthetists and nurse midwives were established in the 1940s, followed by psychiatric nursing in 1954. The present day concept of the APN as a primary care provider was created in the mid-1960s, spurred on by a shortage of doctors. The first official training program for NPs in the United States was created in 1965, with a vision to help balance rising health care costs, increase the number of health care providers, and correct the inefficient distribution of health resources. There was some confusion about the varying titles and abilities of advanced practice nurses as the role was developed, which has persisted as the authority and responsibilities of the NP have evolved over time.
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.[3][4] 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.[5][6][7] practice.[8][9][10][11]
The scope of practice for NPs globally varies even more widely than the state-by-state discrepancies in the United States. The International Council of Nurses outlines the following general characteristics of advanced practice nursing: · Integrates research, education, practice and management · High degree of professional autonomy and independent practice · Case Management/own case load · Advanced health assessment skills, decision-making skills and diagnostic reasoning skills · Recognized advanced clinical competencies · Provision of consultant services to other health providers · Plans, implements and evaluates programs · Recognized first point of contact for clients
The "Pearson Report" provides a current state-by-state breakdown of the specific duties a nurse practitioner may perform in the state.[12] A nurse practitioner's role may include the following:
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:
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.[13] 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.[14] The Australian professional organisation is the Australian College of Nurse Practitioners. (ACNP) [15]
The role of Nurse Practitioners is very diverse.[16][17][18][19] 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.[20] 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.[21][22][23]
Post-nominal initials NPs may use are regulated by the state in which they are licensed and include: