Highly trained nurse practitioners (NPs) specialize in patient populations and hold advanced nursing degrees. They can focus on acute care, family healthcare, oncology, or mental health. NPs are licensed as advanced practice registered nurses (APRNs) and earn national board certification in their specialty areas.
NPs are primary care providers who perform many of the same services as physicians. They often have greater autonomy compared to registered nurses. Depending on state regulations, some jurisdictions allow full practice authority, while others require a collaborative agreement with a doctor.
Continue reading to learn more about NP careers.
How Long to Become
6-8 years
Job Outlook
40% growth from 2021-2031
Average Annual Salary
$118,040
Source: BLS
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What Does a Nurse Practitioner Do?
msn or dnp required
Certification required
NPs provide clinical care for patients and are authorized to diagnose health conditions, order tests, and prescribe medications. NPs' scope of work varies depending on their specialization area, the population they serve, and the state where they practice. One of their main roles within healthcare is to address the shortage of physicians and bring down healthcare costs.
In some states, they need to work under the supervision of a physician or in collaboration with a physician; in other states, they have full-practice authority, giving them professional autonomy.
NP specializations usually correspond with patient populations. For example, pediatric nurse practitioners work with patients from birth to age 21, and women's healthcare nurse practitioners serve women. Certain states let NPs establish private practices, but regulations vary.
Nurse practitioners may experience challenges like long hours, high levels of stress, and the threat of burnout. COVID-19 has been especially hard for nurses, with some reported rates of burnout quadrupling six months into the pandemic.
Depending on the setting, a NP's key skills and responsibilities could include the tasks below:
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Key Responsibilities
- Ordering medical tests
- Diagnosing medical conditions
- Prescribing treatment, including medication
- Counseling and educating patients
- Leading nursing departments or teams
- Supervising the work of other clinical staff
- Promoting community and populating health
Career Traits
- Clinical knowledge
- Judgment under pressure
- Communication skills
- Integrity
Key Holistic Skills for Nurse Practitioners
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Empathy and Compassion
If you meet a nurse practitioner, they will tell you that you need both of these traits to understand and build relationships with patients and their families. Compassionate and empathetic nurses who see their patients as whole people may offer improved patient care.
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Communication Skills
Because NPs spend so much time explaining medical diagnoses and treatments to patients and their families, they need clear, concise, and empathetic communication skills. Working with other healthcare professionals also requires good communication skills.
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Leadership Skills
Nurse practitioners are often looked upon as leaders. NPs should be prepared to coach and mentor other nurses, lead problem-solving efforts, contribute to team building, and help build a positive culture.
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Critical-Thinking Skills
Critical-thinking skills help NPs provide better care, improve patient safety, and recognize changes in a patient's medical status. It can also lead to innovation and better decision-making.
Key Medical Skills for Nurse Practitioners
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Basic Emergency and Urgent Care Skills
A solid grasp of basic emergency and urgent care skills allows NPs to quickly assess and address medical issues. Examples include dressing, suturing, and stapling wounds, providing intravenous therapy, assessing the respiratory system, and chest tube management.
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Vital Sign Monitoring and Checking
Knowing how to monitor and check vital signs, including pulse rate, body temperature, blood pressure, and respiration rate, helps NPs find and monitor healthcare problems.
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Patient Education
Skilled NPs provide health education and counseling to patients and their families. They help patients understand diagnoses and treatments, make lifestyle changes to improve health conditions, and learn how to provide at-home care.
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Technology Skills
As technology's role in the healthcare system grows, nurse practitioners use technology to help diagnose, monitor, and treat patients. They also need technical skills to accurately complete medical forms, send prescriptions, and order labs or procedures.
History of Nurse Practitioners
The first nurse practitioner program started in 1965 in Colorado. That same year, Medicare and Medicaid expansion increased the number of Americans who qualified for coverage and could seek primary healthcare.
In 2018, an estimated 56,000 NPs practiced in the U.S. The rise of the NP profession came in response to the lack of primary care physicians available to meet this need.
Nurse practitioners serve an important role in helping to address the continuing primary care shortage, lowering healthcare costs, and improving patient satisfaction. Nurse practitioners stand out from other healthcare providers by looking at patient health and well-being from a whole-person perspective.
Throughout the profession's history, NPs have advocated for policy changes to improve healthcare and access, particularly for children, low-income individuals, and other marginalized groups.
Where Do Nurse Practitioners Work?
Physicians' offices employ more than 40% of nurse practitioners, followed by outpatient care centers at 23%, and hospitals and offices of other health practitioners at nearly 10% each. The remainder work in settings like home health care services.
Here are some examples of specific workplaces and job duties:
1. Hospital Outpatient
NPs generally serve as primary care providers or specialists in hospital outpatient settings, assessing and diagnosing patients, prescribing treatment, advising patients on care, and referring patients to physicians for additional care when needed.
2. Hospital Inpatient
In a hospital inpatient setting, NPs also assess and diagnose patients and prescribe treatment as part of a patient's ongoing care. They may also lead nursing teams and oversee the work of other clinical staff.
3. Private Group Practices
In a private group practice, NPs may serve as primary care providers or specialists. They see patients, assess conditions, and prescribe treatments, escalating a patient to seeing a physician or specialist NP as necessary.
Why Become a Nurse Practitioner?
There are pros and cons to any occupation, and NPs are no different. You can compare key qualities of an NP found in the list below.
Benefits of Becoming an NP
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High demand and NP salaries considerably above the national average -
Personal satisfaction from providing patient care -
Potential for career advancement in clinical or administrative roles -
Opportunities to specialize and practice more independently
Challenges of Becoming an NP
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Strenuous education, board exam(s), and licensing requirements -
High potential for burnout due to demanding schedules -
Emotional stress from witnessing patient suffering -
Paperwork and regulatory, administrative burdens
How to Become a Nurse Practitioner
Becoming a nurse practitioner is a multi-step process that starts with an undergraduate nursing degree and registered nurse (RN) license. After gaining experience as an RN, aspiring NPs complete a graduate nursing program, followed by board certification and advanced practice licensing.
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1
Earn an associate degree in nursing (ADN) or a BSN.
Students can earn an ADN in two years or a BSN in four years. Some students prefer to earn the ADN first, allowing them to see if they like the work and environment. Others prefer to start with the BSN and begin work at a higher level of responsibility and pay.
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2
Pass the NCLEX-RN to receive registered nurse (RN) licensure.
Master of science in nursing (MSN)-NP programs require experience in nursing. To practice as an RN, you must pass the National Council Licensure Examination for RNs (NCLEX-RN) examination, which measures a graduate's readiness to begin practice as a registered nurse. It asks questions about safety, health promotion, and patient physical and psychological needs.
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3
Earn an MSN.
Students typically take two years of full-time study to earn an MSN degree. Admission for most MSN programs requires or prefers students with at least two years of RN experience. MSN-NP programs also require a valid, unencumbered state nursing license.
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4
Pass the national nurse practitioner certification board exam.
This examination, like the NCLEX-RN exam, assesses a graduate's readiness to work in the field as an NP. It typically comprises 150 multiple-choice questions. However, there are several certifying bodies with differing exams depending on your MSN-NP specialty track, such as family nurse practitioner, adult-gerontology primary care nurse practitioner, and pediatric nurse practitioner.
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5
Get state licensure as an NP.
Each state has its licensing requirements, but all require NPs to earn an MSN or doctor of nursing practice (DNP) degree and pass the national board exam.
Nurse Practitioner Concentrations and Specializations
Popular nurse practitioner specializations include women's, family, and neonatal health. We explain these and other specialties below. Licensure and national certification requirements vary by state and specialization.
Please note that NP salary and distribution data is from the American Association of Nurse Practitioners' 2020 report unless otherwise stated.
Working in clinics, hospitals, psychiatric facilities, and substance abuse centers, these professionals focus on behavioral and mental health. Often specializing in patient populations, such as military/veterans or pediatrics, psychiatric NPs diagnose conditions, formulate treatment plans, and educate patients and caregivers.
Median Total Salary
$136,000
Distribution of NPs
2.2%
Learn More About Psychiatric Nurse Practitioners
Adult-gerontology NPs (AGNPs) specialize in acute or primary care and see patients in clinics, hospitals, and long-term care facilities. AGNPs perform physical exams and diagnoses for adults of all ages. Acute-care AGNPs treat existing illnesses and are more likely to work in hospitals, while primary-care AGNPs focus on preventative care.
Median Total Salary
Primary care $116,000
Acute care $131,000
Distribution of NPs
Primary care 7%
Acute care 2.9%
Learn More About Adult-Gerontology Nurse Practitioners
Family nurse practitioners (FNPs) comprise the largest percentage of NPs. FNPs care for patients of all ages and life stages, providing preventative care and treatment for illnesses, conditions, and injuries. They work in clinics, hospitals, and private practice.
Median Total Salary
$115,000
Distribution of NPs
69.7%
Learn More About Family Nurse Practitioners
Women's health NPs care for women of all ages, providing healthcare specific to women, including gynecology and obstetrics. They find employment in hospitals, clinics, and fertility centers and often collaborate with physicians and nurse midwives.
Median Total Salary
$112,000
Distribution of NPs
2.2%
Learn More About Women's Health Nurse Practitioners
Employed primarily in hospital neonatal intensive care units, these professionals care for infants born prematurely or with illnesses. They provide acute and critical care to newborns and ongoing treatments like incubation, tube feedings, IV lines, and medications.
Median Total Salary
1%
Distribution of NPs
$132,500
Learn More About Neonatal Nurse Practitioner
ERNPs collaborate with teams of healthcare providers to help patients experiencing medical emergencies. This fast-paced career involves assessing, diagnosing, and treating patients undergoing trauma, severe injuries, and emotional crises. Other responsibilities may include supervising RNs and educating patients.
Average Base Salary
$125,000
Source: Salary.com, October 2022
Distribution of NPs
0.9%
Learn More About Emergency Room Nurse Practitioners
Pediatric nurse practitioners (PNPs) specialize in primary or acute care of infants, children, and teens. PNPs see patients in physicians' offices, hospitals, and outpatient care centers. Acute care specialists work in emergency rooms, intensive care units, and urgent care clinics.
Median Total Salary
Primary care $119,000
Acute care $135,000
Distribution of NPs
Primary care 3.2%
Acute care 0.7%
Learn More About Pediatric Nurse Practitioners
A pain management NP career involves administering and monitoring medication, along with providing non-pharmaceutical options like acupuncture and chiropractic care. Common workplaces include cancer and surgical units in hospitals or rehabilitation facilities.
Average Base Salary
$111,320
Source: Indeed, October 2022
Learn More About Pain Management Nurse Practitioners
How Much Do Nurse Practitioners Make?
As some of the highest-paid nursing professionals, NPs earn an average annual salary of $118,000 or nearly $57 per hour., according to the Bureau of Labor Statistics (BLS). NP salaries can vary by levels of education and experience, specialization area, workplace, and geographic location.
For example, NPs in home health care services make an average salary of $133,170, compared to $129,190 for those employed at outpatient care centers. And NPs in California outearn their counterparts in other states. The top 10 highest-paying metro areas for NPs are also in California.
Job prospects look especially promising for NPs. The BLS projects a 46% rise in employment for NPs during 2021-2031 – the fastest growth rate among occupations nationwide.
The table below lists the top five states for NP salaries and the average annual wages.
| State | Average Annual Salary |
|---|---|
| California | $151,830 |
| New Jersey | $137,010 |
| New York | $133,940 |
| Washington | $130,840 |
| Massachusetts | $129,540 |
Source: BLS OES, 2021
Highest-Paying Workplaces for Nurse Practitioners
NP salaries also vary by workplace settings, but the most common industries that employ NPs, including physicians' offices, hospitals, and higher educational institutions, do not necessarily offer the highest salaries. Job-seekers hoping to earn top dollar may want to explore the workplaces listed in the table below.
| Workplace Setting | Median Total Salary |
|---|---|
| Hospital Inpatient Unit | $125,000 |
| Urgent Care | $120,000 |
| Private NP Practice | $120,000 |
| Employer/Corporate Clinic | $120,000 |
| Hospital Outpatient Clinic | $117,000 |
The NP designation takes at least six years of school to earn, plus time working as an RN. Most full-time students need four years to earn a BSN degree versus two for an ADN and two years to earn a master's degree in nursing. Most schools require or strongly recommend at least two years of work as an RN before applying to an MSN-NP program.
NPs can prescribe medications, including controlled substances. Some states require a certain number of credit hours in pharmacology, while others require NPs or newly credentialed NPs to collaborate with a physician. Others grant NPs full-practice authority, meaning they do not require a physician's collaboration or supervision.
The American Association of Nurse Practitioners reports the distribution of NPs by primary practice area. In 2020, family nurse practitioners topped the list, with nearly 70% of NPs choosing this specialty. The second most popular specialization was adult care at 10.8%, followed by adult-gerontology primary care at 7%.
An RN has a two- or four-year degree in nursing, or a nursing diploma, whereas an NP has at least an MSN and board certification as an NP. While all NPs are RNs, not all RNs are NPs.
