Nurse practitioner

A Nurse Practitioner (NP) is a registered nurse who has completed advanced education (generally a minimum of a master's degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a broad range of health care services.

Overview
Nurse practitioners provide much of the same care provided by physicians and usually maintain close working relationships with physicians. Demographically, nurse practitioners are mostly female. An NP can serve as a patient’s regular health care provider and see patients of all ages. 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. This can mean fewer prescriptions and less expensive treatments. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

NPs usually work autonomously and are able to open their own clinical practices. American NPs may prescribe medications and carry a DEA number in at least 44 states of the USA.

Scope of practice
Because the profession is state regulated, care provided by NPs varies. A nurse practitioner's duties include the following:


 * Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g., pneumonia, diabetes, high blood pressure)
 * Obtaining medical histories and conducting physical examinations
 * Ordering, performing, and interpreting diagnostic studies (e.g., lab tests, x-rays, EKGs)
 * Prescribing medications
 * Prescribing physical therapy and other rehabilitation treatments
 * 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
 * Performing minor surgeries and procedures (e.g., dermatological biopsies, suturing, casting)
 * Collaborating with physicians and other health professionals as needed, including providing referrals
 * Counseling and educating patients on health behaviors, self-care skills, and treatment options

Practice settings
NPs practice in all states. The institutions in which they work include the following:


 * Community clinics and health centers
 * Health departments
 * Health maintenance organizations (HMOs)
 * Home health care agencies
 * Hospitals and hospital clinics
 * Hospice centers
 * Nurse practitioner offices
 * Nursing homes
 * Nursing schools
 * Physician offices
 * Public health departments
 * School/college clinics
 * Veterans Administration facilities
 * Walk-in clinics

Education, Licensure and certification
Most NPs specialize in a particular field of medical care, and there are as many types of NPs as there are medical specialties.

To be licensed as a nurse practitioner, the candidate must first complete the education and training necessary to be a registered nurse (RN).

Requirements for a registered nurse include an associate degree in nursing (ADN), a bachelor of science degree in nursing (BSN), or completion of a diploma program, as well as direct patient care for acutely or chronically ill patients. Associate degree in nursing programs, which are offered by community and junior colleges, usually take 2–3 years. BSN programs are offered by colleges and universities and take 4–5 years and diploma programs are administered in hospitals and usually take 2–3 years. Depending on the program attended, the candidate may fulfill some NP requirements while completing the RN degree.

In most cases, professionals and employers in the field strongly recommend the MSN as a minimal requirement for NPs, and some states require this. To become NPs, most nurses with an ADN or diploma enter a bachelor of science to master's program. They may be able to find a staff nursing position and take advantage of tuition reimbursement programs.

Once registered nurse status is attained, the candidate must complete a state-approved advanced training program that usually specializes in a field such as family practice, internal medicine, or women's health. The degree can be granted by any of the following:


 * A community college, which grants an associate in arts degree
 * A hospital-based program, which grants a 3-year diploma
 * A university, which grants a bachelor of science in nursing (BSN) degree
 * A university, which grants a master's of science in nursing (MSN) degree which is now usually the minimum degree required
 * A university, which grants a doctorate in nursing

The variety of educational paths for NPs is a result of the history of the field. In 1965, the profession of nurse practitioner was instituted and required a master's degree. In the late 1960s into the 1970s, predictions of a physician shortage increased funding and attendance in nurse practitioner programs. During the 1970s, the NP requirements relaxed to include continuing education programs, which helped accommodate the demand for NPs. Currently, all five educational options to attain NP status are valid, although most certifying bodies, states, and employers require a minimum of a master's degree for new NPs (already established NPs with lesser education were "grandfathered in"). It appears it has been planned that by 2015, all NP programs will be at the doctoral level (DNP, DrNP).

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 nursing program and clinical experience. Because state board requirements differ, nurse practitioners may have to fulfill additional requirements, such as obtaining board certification. The license period varies by state; some require biennial relicensing, others require triennial.

Before or after receiving state licensing, a nurse practitioner can apply for national certification from one of several professional nursing boards such as the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners(AANP). Contrary to popular belief, the American Nurses Association (ANA) does not offer certification, but is linked with the ANCC. Some NPs pursue certification in a specialty. Several organizations oversee certification, including the following:


 * American Association of Critical-Care Nurses
 * American Psychiatric Nursing Association
 * Board of Certification for Emergency Nursing
 * National Certification Board of Pediatric Nurse Practitioners and Nurses
 * National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
 * Oncology Nursing Certification Corporation
 * American Holistic Nurses Association

Post-nominal initials
Post-nominal initials NPs may use include:
 * NP-C (Nurse Practitioner - Certified; if certified by the AANP),
 * APRN, BC (Advanced Practice Registered Nurse, Board Certified; if certified by the ANCC)
 * CNP (Certified Nurse Practitioner)
 * CPNP (Pediatric NP when certified by the Pediatric Nursing Certification Board (PNCB)
 * MSN (Master's of Science in Nursing)
 * MN (Master's of Nursing)
 * RN (Registered Nurse)
 * FAAN (Fellow of The American Academy of Nursing (AAN)
 * FAANP (Fellow of The American Academy of Nurse Practitioners (AANP)
 * CDE (Certified Diabetic Educator)
 * ND (Nursing Doctorate)
 * DNP (Doctor of Nursing Practice)
 * DrNP (Clinical Doctorate in Nursing)
 * Initials of the NP's specialty may also follow their name:
 * ACNP (Acute Care NP)
 * AHN (Holistic NP)
 * ANP (Adult NP)
 * FNP (Family NP)
 * GNP (Geriatric NP)
 * NNP (Neonatal NP)
 * PMHNP (Psychiatric Mental Health NP)
 * PNP (Pediatric NP)
 * WHNP (Women's Health NP)