How Do I Become a Nurse Practitioner?

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Nurse practitioners are registered nurses (RNs) with advanced degrees and training, enabling them to work with a specialized population of patients (e.g., children, adults, elderly) or in a niche field (e.g., acute care, family, mental health). To help these nurses get the specialized training they need, there are a variety of nurse practitioner (NP) degree programs, including master’s of science in nursing (MSN) and doctor of nursing practice (DNP) programs, as well as post-master’s NP certificates.

According to the U.S. Bureau of Labor Statistics (BLS Dec. 2015), nurse practitioners are both well-compensated and in-demand. By illustration, the BLS (May 2015) reports that NPs earn an average annual salary of $101,260, substantially more than the annual average for all occupations ($48,320). Furthermore, openings for NPs are expected to swell 35 percent between 2014 and 2024, demonstrating five times the average job growth projected for all occupations during that time period (7 percent). So how does a person join this lucrative career on the rise?

Read on below to discover how to become an NP, including the required education, experience, and credentials to join the array of NP subfields.

 

Steps to Becoming a Nurse Practitioner

In order to become a nurse practitioner in any field, the initial steps are typically the same:

1. Graduate from high school. Aspiring NPs typically excel in courses such as anatomy, psychology, chemistry, biology, and statistics. Additionally, some people choose to volunteer in hospitals to get experience and letters of recommendation for the college application process.

2. Pursue a bachelor of science in nursing (BSN) or a similar degree (4 years). There are varied educational paths to becoming an NP, but for prospective advanced practice nurses, pursuing a BSN typically fulfills many of the prerequisites of a graduate nursing program (e.g., MSN or DNP). BSN programs feature hands-on clinical instruction and coursework in areas such as pathophysiology, pharmacology, and nursing care of various populations. Students are advised to ensure that their undergraduate program is accredited by a recognized body such as the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing, Inc. (ACEN). Accreditation is important not only to ensure that a program is top-notch, but also to qualify students to sit for the RN licensure examination.

3. Become a registered nurse (RN) and garner experience (1 – 2 years). As part of an associate’s or bachelor’s program in nursing, students typically earn their RN license. Requirements may vary by state, but generally involve showing proof of having completed an approved training program and passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). After that, RNs typically get nursing experience in the field prior to applying to a graduate program.

4. Pursue a graduate degree in nursing (1.5 – 4 years). According to AANP (2016), 96.2 percent of NPs hold graduate degrees. A majority of graduate nursing programs require their applicants to have at least a BSN—particularly the online program offerings—although there are exceptions. For example, there are “bridge programs” (i.e., RN-to-MSN) such as those listed through the American Association of Community Colleges (AACC), as well as “accelerated BSN programs” (i.e., for applicants with a non-BSN bachelor’s degree) such as the one at Duke University. There are a variety of graduate degrees in nursing, although the two most common are the master of science in nursing (MSN) and the doctor of nursing practice (DNP). The MSN takes roughly two years to complete and can either be a generalist nursing degree or is completed in a chosen specialty (e.g., mental health, family, pediatrics). The DNP—a terminal degree that the American Association of Colleges of Nursing (AACN) has hailed as “the future of specialty nursing education”—takes about four years to complete. For graduate programs in nursing, the admissions requirements vary, but generally include the following:

  • Resume or curriculum vitae (CV)
  • Official university transcripts
  • A 1-2 page personal statement about the student’s professional goals
  • Letters of recommendation from supervisors, professors, and other relevant mentors
  • Interview (in-person or online)
  • Proof of registered nurse (RN) licensure in the U.S.
  • Graduate Record Examination (GRE) or Miller Analogies Test (MAT) scores (especially for MSN program applicants)
  • Application fee
  • Test of English as a Foreign Language (TOEFL) or International English Language Testing System (IELTS) scores for non-native speakers of English

5. Get certified by specialty nursing board (timeline varies). In addition to local licensure—a breakdown of which is provided by the American Association of Nurse Practitioners (AANP)—NPs typically achieve national certification through an established entity such as the American Nurses Credentialing Center (ANCC). While prerequisites for certification vary, they typically include:

Read on to discover what to expect from graduate programs and certification processes among the NP subspecialties. Each of these fields generally requires a minimum of an MSN degree. Finally, please note that the graduate NP program timelines below assume the applicant has completed a BSN program.

How to Become an Adult-Gerontology Nurse Practitioner (AGNP)

Pursue an MSN with an adult-gerontology NP specialization (1.25 – 2 years). There are generalized adult gerontology (AG) programs, as well as two subspecialties: primary care (PC) and acute care (AC). In AG-PCNP programs, students take courses such as nursing leadership, population health, and human development throughout the lifespan. In AG-ACNP programs, there is coursework in advanced physiology, healthcare ethics, and advanced health assessment.

Obtain certification (timeline varies). There are three main organizations which provide national certification for AGNPs. First, the American Nurses Credentialing Center (ANCC) recently retired three certifications—acute care NP, adult nurse NP, and gerontological NP—and stopped accepting new applications after December 2015. The remaining ANCC certifications in this field are AG-ACNP and AG-PCNP. Second, the American Association of Critical-Care Nurses (AACN) offers the adult-gerontology acute care NP certification (ACNPC-AG). Third, the American Academy of Nurse Practitioners (AANP) provides the following certifications: adult nurse practitioner (to be retired December 2016) and AG-PCNP. Please note that there are also several subspecialties (profiled below), which AGNPs may consider: occupational health, aesthetics, flight nursing, hospice care, orthopedics, and nephrology.

Maintain certification AGNP (every 5 years). The ANCC certifications (AG-ACNP and AG-PCNP), the AACN certifications (adult nurse practitioner and AG-PCNP), and the AANP certifications (ANP and AG-PCNP) are all valid for five years.

First, in order to maintain ANCC credentials, candidates must complete 75 hours of AGNP continuing education (CE)—including 25 hours in pharmacotherapeutics—as well as fulfilling one or more of the other renewal categories (e.g., academic credits, presentations, publications, preceptor hours, professional service, practice hours [1,000 in specialty], or passing an exam). Since renewal requirements change, check out the ANCC Renewal Requirements Handbook for the latest standards.

Second, in order to maintain AACN credential, candidates have three renewal options: option 1 (minimum 1,000 practice hours and 150 CE renewal points), option 2 (minimum 1,000 practice hours, 25 hours of pharmacology CE, and passing an exam), or option 3 (minimum 150 CE renewal points and passing an exam). To learn in-depth about renewing these credentials, check out the AACN Renewal Handbooks.

Finally, in order to maintain the AANP credentials expiring on or before December 31, 2016, candidates have two options: option 1 (minimum 1,000 practice hours, minimum 75 hours of CE, and maintain active RN licensure) or option 2 (pass an exam and maintain active RN licensure). In order to maintain AANP credentials expiring on or after January 1, 2017, option 1 will be updated to include 100 CE hours, 25 of which must be completed in advanced practice pharmacology. Please check out the AANP Recertification Standards for the latest requirements.

 

How to Become a Family Nurse Practitioner (FNP)

Pursue an MSN with a family NP specialization (2 – 3 years). FNP programs offer courses such as healthcare perspectives, primary care of the family, and the practitioner-patient relationship.

Obtain certification (timeline varies). The American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP) each offer a family NP certification. Please note that there are several subspecialties (profiled below), which FNPs may consider: travel nursing, oncology, cardiology, surgery, dermatology, orthopedics, public health, and emergency care.

Maintain certification (every 5 years). In order to maintain the ANCC credential, candidates must complete 75 hours of FNP continuing education (CE)—including 25 hours in pharmacotherapeutics—as well as fulfilling one or more of the other renewal categories (e.g., academic credits, presentations, publications, preceptor hours, professional service, practice hours [1,000 in specialty], or passing an exam). Since renewal requirements evolve, check out the ANCC Renewal Requirements Handbook for the latest standards.

Lastly, in order to maintain an AANP FNP credential expiring on or before December 31, 2016, candidates have two options: option 1 (minimum 1,000 practice hours, minimum 75 hours of CE, and maintain active RN licensure) or option 2 (pass an exam and maintain active RN licensure). In order to maintain AANP FNP credentials expiring on or after January 1, 2017, option 1 will be updated to include 100 CE hours, 25 of which must be completed in advanced practice pharmacology. Please check out the AANP Recertification Standards for the latest requirements.

How to Become a Neonatal Nurse Practitioner (NNP)

Pursue an MSN with a neonatal NP specialization (1 – 3 years). NNP programs feature courses such as advanced practice nursing in neonatal patients, neonatal assessment, and population health in a global survey.

Obtain certification (timeline varies).The National Certification Corporation (NCC) offers a three-year neonatal NP certification. Prerequisites for this certification include having a graduate NP degree from an approved program; being an RN; and passing an exam within eight years of graduation from a program.

Maintain certification (every 3 years). This three-year certification must be maintained following a “continuing competency assessment,” which determines the number of continuing education (CE) hours required (between 10 and 45). To learn more, please check out the NCC Continuing Competency Initiative Guide.

How to Become a Pediatric Nurse Practitioner (PNP)

Pursue an MSN with a pediatric NP specialization (2 years). In addition to generalized PNP programs, there are two specializations: primary care (PC) and acute care (AC). PNP-PC programs feature courses in care of the child & the adolescent, pediatric pharmatherapeutics, and theory of advanced pediatric nursing practice. PNP-AC programs have classes such as chronic, acute, and complex illnesses among children.

Obtain certification (timeline varies). The American Nurses Credentialing Center (ANCC) offers a five-year PNP-PC certification, and the Pediatric Nursing Certification Board (PNCB) provides PNP-PC and PNP-AC certifications which must be renewed annually. Please note that PNPs may also consider a subspecialty in pediatric oncology or orthopedics (profiled below).

Maintain certification (every 1 – 5 years, depending on credential). In order to maintain the five-year ANCC PNP-PC credential, candidates must complete 75 hours of PNP continuing education (CE)—including 25 hours in pharmacotherapeutics—as well as fulfilling one or more of the other renewal categories (e.g., academic credits, presentations, publications, preceptor hours, professional service, practice hours [1,000 in specialty], and passing an exam). Since renewal requirements change, check out the ANCC Renewal Requirements Handbook for the latest standards.

In order to maintain the one-year PNCB credentials, candidates must fulfill at least four of the required “pediatric update modules” and complete 15 hours of pediatric pharmacology education. The recertification tracking cycle lasts for seven years, although a renewal application must be submitted annually. For the most recent requirements, candidates are urged to check out the PNCB CPNP-AC Recertification Guide or the PNCB CPNP-PC Recertification Guide.

How to Become a Psychiatric Mental Health Nurse Practitioner (PMHNP)

Pursue an MSN with a psychiatric mental health NP specialization (2 – 3 years). PMHNP programs offer courses such as statistical analysis in evidence-based practice, principles of epidemiology, and adult psychiatric mental health.

Obtain certification (timeline varies). The American Nurses Credentialing Center (ANCC) offers two five-year certifications: adult PMHNP and psychiatric mental health NP (across the lifespan). Please note that this specialty was historically referred to as a family psychiatric-mental health nurse practitioner (ANCC).

Maintain certification (every 5 years). In order to maintain the five-year ANCC credentials, candidates must complete 75 hours of PMHNP continuing education (CE)—including 25 hours in pharmacotherapeutics—as well as fulfilling one or more of the renewal categories (e.g., academic credits, presentations, publications, preceptor hours, professional service, practice hours [1,000 in specialty], and passing an exam). Since renewal requirements evolve, check out the ANCC Renewal Requirements Handbook for the latest standards.

How to Become a Women’s Health Nurse Practitioner (WHNP)

Pursue an MSN with a women’s health NP specialization (2 – 3 years). WHNP programs provide courses such as reproductive healthcare of women, care of the family, and lifespan care through menopause.

Obtain certification (timeline varies). The National Certification Corporation (NCC) offers a three-year WHNP certification. Prerequisites for this certification include having a graduate NP degree from an approved program; being an RN; and passing an exam within eight years of graduation from a program. Please note that this specialty has historically been referred to as an OB/GYN NP (i.e., OGNP).

Maintain certification (every 3 years). This three-year certification must be maintained following a “continuing competency assessment,” which determines the number of continuing education (CE) hours required (between 10 and 45). To learn more, please check out the NCC Continuing Competency Initiative Guide or the how to become a WHNP page.

 

NP Subspecialties with National Certification

In addition to the main nurse practitioner specialties above, there is a variety of credentialed subspecialties available. Pursuing further specialization may enhance an NP’s employment prospects or salary, depending on the demand for services in one’s geographic region and the availability of employers with adequate equipment. Here are a few of the credentialed subspecialties to consider.

Cardiac NP

The American Association of Critical Care Nurses (AACN) offers two certifications: cardiac medicine (CMC) and cardiac surgery (CSC). To qualify, candidates must have unencumbered RN licensure; active specialty certification (e.g., ACNPC-AG); and acceptable clinical practice hours. One option is to have completed 875 of 1,750 total practice hours treating acutely ill cardiac patients over two years. The other option is to have completed 1,000 of 2,000 total practice hours treating acutely ill cardiac patients over five years. Candidates are also expected to shadow a professional in this area of expertise and pass an exam.

In order to maintain these three-year credentials, candidates must submit at least 25 continuing education recognition points (CERPs) or pass an exam. Check out the CMC Renewal Handbook and CSC Renewal Handbook for details.

Additionally, the American Board of Cardiovascular Medicine, Inc. offers the CVNP certification. Open to candidates with master’s degrees and at least two years of practice in cardiology or cardiovascular medicine, CVNP certificants must pass a comprehensive examination with a score of at least 70 percent. To maintain this three-year credential, certificants must pay a $125 renewal fee and show proof of 50 hours of qualifying CE.

Dermatology NP

The Dermatology Nursing Certification Board (DNCB) offers a three-year certification: the dermatology certified nurse practitioner (DCNP) credential. To qualify, candidates must have a master’s degree in nursing; national NP certification; and at least 3,000 hours working in dermatology. To maintain the DCNP certification, candidates must either complete an examination or CE hours. Please contact the DNCB for details.

Emergency NP

To become an emergency NP, candidates typically pursue an MSN in emergency/trauma care. These programs feature classes such as management of acute & chronic illness, palliative care across the spectrum, and genetics. Following graduation, emergency NPs may pursue national certification through the American Nurses Credentialing Center (ANCC), which provides a five-year emergency NP credential.  Prerequisites include having a graduate NP degree (MSN or higher); having two years of experience in the field (minimum 2,000 hours within the past three years); completing 30 hours of continuing education (CE); being an RN; fulfilling at least two “professional development” categories (e.g., academic credits, presentations); and passing a portfolio evaluation. Please note that in January 2017, the American Association of Nurse Practitioners (AANP) will also be adding an emergency NP specialty for FNPs. Check back with AANP for details.

In order to maintain the five-year ANCC emergency NP credential, candidates must complete 75 hours of relevant continuing education (CE)—including 25 hours in pharmacotherapeutics—as well as fulfilling one or more of the other renewal categories (e.g., academic credits, presentations, publications, preceptor hours, professional service, practice hours [1,000 in specialty], and passing an exam). Since renewal requirements change, check out the ANCC Renewal Requirements Handbook for the latest standards.

Hospice NP

The Hospice & Palliative Nurses Association (HPNA) provides the advanced certified hospice and palliative nurse (ACHPN®) credential. To qualify, candidates must have at least a master’s degree from an advanced practice nursing program; unrestricted RN licensure; and at least 500 hours in palliative care over the previous year (or 1,000 hours over the previous two years). Contact HPNA for information about recertification and check out what to expect from working in this subspecialty from NPS’s featured piece: A Day in the Life of a Hospice NP.

Nephrology NP

The Nephrology Nursing Certification Commission (NNCC) offers the five-year certified nephrology nurse-nurse practitioner (CNN-NP) credential. This subspecialty certification is open to candidates who hold active RN licensure; at least a master’s degree in nursing; a minimum of 2,000 practice hours in nephrology; 60 contact hours of approved CE in nephrology; and a passing score on an examination. In order to recertify every five years, candidates must either pass an exam or have completed 150 hours of qualifying CE, 100 of which must be in nephrology.

Occupational Health NP

The American Board For Occupational Health Nurses, Inc. (ABOHN) provides two national certifications: the certified occupational health nurse (COHN) or the certified occupational health nurse-specialist (COHN-S). The COHN credential is open to RNs with at least 3,000 practice hours in occupational health nursing or the completion of a qualifying certificate program. The COHN-S credential is open to bachelor’s degree holders with at least 3,000 practice hours in this field or the completion of a certificate (or graduate) program. All applicants must pass a certification exam, and the credentials are valid for five years. To maintain active certification, candidates must complete between 50-60 hours of CE. For the most recent requirements, check out ABOHN’s Recertification page.

Orthopedic NP

The Orthopaedic Nurses Certification Board (ONCB) provides the orthopaedic nurse practitioner-certified (ONP-C®) credential. To qualify, first-time candidates must have three years of RN experience; at least a master’s degree from an NP program; and a minimum of 2,500 hours of advanced practice work over the previous three years as an NP in orthopaedic nursing. These five-year certifications can be renewed by either passing an examination or showing proof of at least 1,000 practice hours and 100 contact hours of education (at least 70 in clinical orthopaedics).

Oncology NP

The Oncology Nursing Certification Corporation (ONCC) provides the certified pediatric hematology oncology nurse (CPHON®) credential. This certification is open to candidates with unencumbered RN licensure; at least 1,000 clinical hours in pediatric hematology oncology nursing practice; 10 hours of relevant CE; and a passing score on an exam. To learn more about this career, check out the NPS piece on A Day in the Life of a Pediatric Oncology NP.

Additionally, ONCC offers the advanced oncology certified nurse practitioner (AOCNP®) credential to candidates with unencumbered RN licensure; at least a graduate degree from an accredited NP program with a concentration in oncology; one graduate level oncology course (or 30 hours of oncology CE); and 500 hours of clinical practice as an adult oncology NP. For candidates with graduate degrees without an oncology specialty, they may qualify for this certification with 1,000 hours of clinical practice (instead of 500).

All ONCC certifications are valid for four years, and can be renewed following one of three options: option 1 (practice hours + professional development [ILNA Points]); option 2 (practice hours + passing an exam); or option 3 (ILNA Points + passing an exam).

Public Health NP

The American Nurses Credentialing Center (ANCC) provides a five-year certification in this subspecialty: the advanced public health nursing (APHN-BC) credential. To qualify, candidates must have a graduate degree; at least 2,000 practice hours in advanced public health nursing; at least 30 hours of qualifying CE; and the fulfillment of two additional professional development categories (e.g., presentations, publications, professional service). This certification can be achieved through a portfolio review and does not require an exam. The review takes into consideration four domains: professional development, professional & ethical nursing practice, teamwork & collaboration, and quality & safety. For the complete details, check out the ANCC Certification Through Portfolio Application Requirements guide.

Surgical NP

The Medical-Surgical Nursing Certification Board (MSNCB) offers the five-year certified medical-surgical registered nurse (CMSRN®) credential. To qualify, candidates must have at least two years of RN experience in a medical-surgical setting; a minimum of 2,000 hours of practice; and a passing score on an exam. To maintain this certification, candidates must show proof of active RN licensure; have at least 1,000 practice hours in a medical-surgical setting; and complete at least 90 hours of CE. To learn more about this profession, check out the NPS blog piece A Day in the Life of a Surgical NP.

Additional NP Subspecialties

These final three NP subspecialties do not yet have specific national certifications, although that may change in coming years. Professionals in this subfields are often credentialed in other NP specialties such as adult-gerontology, women’s health, or family care.

Aesthetic NP

According to the Advance Healthcare Network, there’s been an increase in NP practices which focus on aesthetic procedures (e.g., laser hair removal, cellulite reduction, body sculpting, spider vein reduction, etc). The regulations for the provision of aesthetic procedures vary widely among US states, but there is advanced training available at places including the Aesthetic Enhancement Institute, Esthetic Skin Institute, or Aesthetic Medical Educators Training.

Flight NP

While there’s no national certification for flight NPs, there are specialized training schools in this profession including Case Western Reserve’s Dorothy Ebersbach Academic Center for Flight Nursing. Not surprisingly, the US Airforce is a major employer in this field, and flight NPs provide people with lifesaving treatments and stabilization services. Please note that NPs in this field are typically trained in adult-gerontology, acute care, or emergency care.

Travel NP

The phrase “locum tenens”—temporarily taking the place of another—applies to the role of a travel NP. These healthcare professionals take their services on the road to provide treatment to a range of patients, depending on local needs. They may be formally trained in various NP specialties such as adult-gerontology, women’s health, family care, or pediatrics. To learn in-depth about what to expect from this NP subspecialty, check out the NPS blog piece A Day in the Life of a Travel NP.

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