Nurse Practitioner Specialization and Sub-Specialization Tree

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All nurse practitioners (NP) specialize in a particular area of medicine. Nurse practitioners make their specialization decision before applying to NP school, which is a critical difference between a physician assistant and an NP; physician assistants graduate with a general medical degree while NPs typically focus on a particular population.

This article discusses the somewhat confusing world of NP specialties, and it clarifies terms including population foci and subspecialization. Understanding these terms will help prospective students choose the right NP school.

Population Foci

Nurse practitioners must choose among six “population foci.” Each foci represents a group of patients who require specialized treatment. The National Council of State Boards of Nursing developed these, which are detailed in their Consensus Model for APRN Regulation. Nurse practitioner population foci include:

Within the adult-gerontology and pediatric populations, NPs can choose to focus on primary care or acute care. Primary care typically refers to day-to-day healthcare, whereas acute care refers to short-term urgent care. Primary care NPs usually work in an outpatient office or clinic, whereas an acute care NP would work in a hospital setting.

Prospective NP students are encouraged to decide which patient population they would like to work with so that they can best determine which NP school to attend. For example, those interested in becoming a neonatal NP would want to attend a school that has a neonatal program. One cannot become a neonatal NP after graduating from a psychiatric-mental health NP program without completing additional education.

NP Sub-specializations

Depending on which population foci students choose, they may be qualified to pursue certain sub-specializations as well. For example, an acute care adult-gerontology (population foci) NP might choose to further specialize in cardiology or emergency medicine.

These sub-specializations do not require specific schooling beyond population foci; however, some require an additional certification exam. As a result, some schools offer specific programs to help prepare students for the certification exam and gain valuable experience in the field.

For example, Duke University offers a unique program for those who wish to become orthopedic NPs. This program adds three courses to the curriculum that focus on the diagnosis and management of musculoskeletal problems. Upon graduation, students will be eligible to take both their population certification exam as well as the orthopedics sub-specialization certification exam.

Remember: students must choose a population focus, but they can pursue any sub-specialty, provided that they have adequate experience and meet the requirements to pass the corresponding certification exam.

Finally, some sub-specialties do not require an additional certification exam. For example, a psychiatric-mental health NP can work in the subspecialty of psychosomatic medicine without any additional certification exams or schooling in the subject.

The table below includes examples of NP sub-specializations, suggested population foci, and resources about each subspecialty. The suggested population foci column lists the recommended population to pursue; however, these are merely suggestions and may not be required.

Sub-Specialty Suggested Population Focus Resources
Orthopedics*
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the Life of an Orthopedic Nurse Practitioner
Emergency Medicine*
  • Acute care adult-gerontology
  • Acute care pediatrics
Day in the Life of an Emergency Medicine Nurse Practitioner
Palliative Care*
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the Life of a Hospice Nurse Practitioner
Oncology*
  • Primary care pediatrics
  • Acute care pediatrics
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the Life of a Pediatric Oncology Nurse Practitioner
Dermatology*
  • Family
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the life of a Dermatology Nurse Practitioner
Nephrology
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the life of a Nephrology Nurse Practitioner
Cardiology
  • Family
  • Primary care adult-gerontology
  • Acute care adult-gerontology
Day in the Life of a Cardiac Nurse Practitioner
Psychosomatic medicine
  • Family
  • Psychiatric-mental health
Day in the Life of a Consultation-Liaison Psychiatric Nurse Practitioner
Surgery
  • Acute care adult-gerontology
  • Acute care pediatric
Day in the Life of a Surgical Nurse Practitioner
Holistic Care
  • Family
  • Primary care pediatric
  • Primary care adult-gerontology
  • Women’s health and gender-related
  • Psychiatric-mental health
Day in the Life of a Holistic Nurse Practitioner
*These sub-specialties offer specialized certification exams. You can learn more about these in our article, “Ask an Expert: Which Additional Certifications Should NPs Pursue?
Dr. Melissa DeCapua, DNP, PMHNP-BC

Dr. Melissa DeCapua, DNP, PMHNP-BC

Author

Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. She has a background in child and adolescent psychiatry as well as psychosomatic medicine. Uniquely, she also possesses a bachelor’s degree in studio arts, which she uses to enhance patient care, promote the nursing profession, and solve complex problems. Melissa currently works as the Healthcare Strategist at a Seattle-based health information technology company where she guides product development by combining her clinical background and creative thinking. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern health care. For more about Melissa, check out her blog www.melissadecapua.com and follow her on Twitter @melissadecapua.