After 15 years as a nurse practitioner (NP), I still sometimes get annoyed when people ask, “What is that?”, and follow-up with “It’s like being a doctor, right?”, or “You should have become a doctor; it’s taken you just as long” and so on and so on. A patient once asked me if NP stood for nurse police. My annoyance aside, times like these are opportunities to teach others about the education and the role of the nurse practitioner .
Here is a basic explanation for those interested in understanding what is a nurse practitioner and how one obtains that designation.
Becoming an NP-The Old Way
What I describe here is the way, until recently, most nurses furthered their education and became NPs. This process is changing, but this is the way most NPs received their degree and certification.
To become a nurse practitioner an individual had to:
1. Become a registered nurse (RN) with a baccalaureate degree (BSN) in nursing.
NPs of a certain age (Ahem!), obtained their BSN, worked a number of years, and then decided to pursue additional graduate nursing education.
2. The next step was obtain a masters degree in nursing (MSN) from a nurse practitioner program by specializing in a specific area of study. Some of those specialties are listed below:
- women’s health
- primary care
- acute or critical care
Nurse practitioner programs ran approximately 3 years during which students combined classroom (didactic) work, and clinical work with experienced NP or physician preceptors. Each state requires a certain number clinical hours that students must complete in an accredited NP program.
3. The next step was to take and pass a national certification exam in the specialty program of study (see list above) after graduating from the NP program.
After the NP student met the academic and clinical requirements of their school’s NP program and the requirements of their licensing state, he or she graduated with a masters degree in nursing. However, an individual can only be designated a nurse practitioner after taking and passing a national certification exam in the specialty studied in the NP program (California, New York, Kansas, and Indiana provide alternatives to national certification). After passing the examination, the individual applied to their state organization that oversees NPs, usually a state board of nursing (BON), to obtain a license as a nurse practitioner, an advance practice nurse.
This is the most basic example of how, until recently, an individual pursued becoming a nurse practitioner.
Becoming an NP-The New Way
Recent changes among professional nursing organizations that guide and oversee nurse practitioner education have determined that the minimal level of education for NPs is a Doctor of Nursing Practice (DNP) degree, and no longer a masters degree (MSN). Nurse practitioners who already have a masters degree may pursue obtaining their DNP with an additional 2-3 years of study.
However, nurses with baccalaureate degrees (BSN) who now enter NP programs enter 3- to 4- year DNP programs depending on full-time or part time status .
Step 3 above remains the same.
The overarching goal is that eventually all NP programs will conform to this standard, but there are still many MSN NP programs across the country.
In many institutions, advanced practice registered nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse-Midwives, and Certified Nurse Anesthetists, are prepared in master’s-degree programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN’s position statement calls for educating APRNs and nurses seeking top systems/organizational roles in DNP programs.
DNP curricula build on traditional master’s programs by providing education in evidence-based practice, quality improvement, and systems leadership, among other key areas.
The DNP is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs. DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNSc, and other research-focused nursing doctorates.
Extensive clinical experience, once considered an essential requirement for advance practice nurses, is not always a necessary requirement in applying to nurse practitioner programs. Agree or disagree, nurses can begin NP programs with very little clinical experience; however, most nurses work in certain specialties to gain clinical experience before deciding to pursue an advanced nursing degree, and it is often their desire to do more in the clinical setting that provides the impetus for pursuing graduate level clinical education.
The Practicing NP
Depending on the state, an NP can have an independent practice, or may be mandated by the state in which he or she practices to have a collaborating physician. Initiatives for new NPs to have a collaborating physician and then move toward independent practice is a practice model in early discussions in some states.
The term “collaboration” takes on many meanings. In some cases the collaborating physician may be well-acquainted with the NP and the NP’s standard of work and may “collaborate” to the extent that once a month he or she reviews patients’ charts in the NPs practice. In some cases the NP and physician (s) share an office and each provider sees his or her patients, or in some cases the NP sees patients who are established in the practice after patients have been seen and established by the physician. There are several other scenarios including those related to NPs who work in hospitals in medical or surgical services, OB/GYN, and other services. That is another lengthy discussion that requires its own post at a later date.
Nurse practitioners are not physicians and describing these advance practice nurses as “physician extenders” is equally inaccurate. Collaborative care provides patients with the benefit of two well-educated experts. The NP works under his or her license and is solely responsible and accountable for his or her actions.
Responsibility and Accountability
To appreciate the role of the NP, one must first dispense with the belief that nurses follow doctors orders: nurses carry out physicians orders while caring for patients. If a physician orders something incorrectly and the nurse follows that order, the nurse is responsible for his or her actions because professional nursing requires a level of education and practice that assures an understanding of what and why an order is prescribed, and that the order is appropriate to the patient’s care, and above all, the order does not compromise patient safety. Nurses are responsible for patient safety, and that means knowing why an action is done and ensuring it is done safely.
On a more advanced level, NPs are responsible for their actions including prescribing medications and treatments, ordering appropriate tests, and diagnosing illnesses. Nurse practitioners carry the associated responsibility and accountability for these actions.
Patients often state that an NP is like a doctor. Although one can understand why some members of the lay population may say this, nothing can be further from the truth. Physicians are educated differently to nurses and nurse practitioners. Medicine is a different field, not a better field, and not a superior field. Without question, the two, medicine and nursing, are deeply intertwined in managing healthcare conditions and diseases, helping patients maintain wellness, and promoting patients’ health and well-being. A nurse practitioner is a well-educated, qualified, certified and licensed healthcare provider who provides quality management of diseases and provides care to patients in the practitioner’s specialty area and, when necessary, works in collaboration with other healthcare providers.
A patient in the care of a nurse practitioner is positioned to receive the best of medical and advanced nursing care.