Nurse practitioners standing around a large nurse practitioner textbook

Article

Student’s Guide to 7 Types of Nurse Practitioner Specialties

Nursing: Adult Gerontology Acute Care Nurse Practitioner

by Norwich University Online

September 1st, 2020

Someone needing health care, whether for a wellness visit or to address a specific medical issue, is increasingly likely to see a nurse practitioner (NP). The American Association of Nurse Practitioners (AANP) reports that millions of patients each year choose NPs for their health care needs, totaling more than 1 billion visits annually.

Registered nurses and nursing students who are interested in pursuing a career as a nurse practitioner will find that the prospects are bright for many types of nurse practitioner specialties serving the acute care and primary care needs of their patients. Demand for NPs specializing in family care, adult gerontology acute care, women’s health, and many other areas is forecast to be well above average for years to come.

This guide provides prospective NPs with a snapshot of the duties, job outlook, and typical salaries of the following specialties.

Psychiatric Mental Health Nurse Practitioner
Family Nurse Practitioner
Adult Gerontology Acute Care Nurse Practitioner
Emergency Nurse Practitioner
Pediatric Nurse Practitioner
Women’s Health Nurse Practitioner
Neonatal Nurse Practitioner

What Do Nurse Practitioners Do?

Nurse practitioners are also referred to as advanced practice registered nurses (APRNs). They’ve earned a graduate degree in their advanced practice nursing specialty. They must pass a national certification exam, be licensed as an RN in their state, and have an APRN license in their state, as the U.S. Bureau of Labor Statistics (BLS) explains.

Typical Activities of Nurse Practitioners

What do nurse practitioners do? The U.S. National Library of Medicine’s MedlinePlus describes the services typically provided by NPs:

Taking a patient’s history, conducting physical exams, and ordering diagnostic tests and procedures
Diagnosing and treating diseases
Prescribing medications and coordinating referrals to medical specialists
Educating patients on disease prevention and healthy living
Performing medical procedures, such as bone marrow biopsies and lumbar punctures

Here’s a closer look at several common NP activities.

Perform Physical Assessments

NPs provide primary care and specialty care that combines scientific process, current evidence, and recognized standards in a holistic, professional manner, as AANP explains. There are several steps in the process of care:

Collect a comprehensive, relevant history of the patient’s health, social, and medical history.
Conduct a complete physical examination based on the patient’s age and medical history.
Perform diagnostic and preventive procedures based on the patient’s age and medical history.
Determine the patient’s risk factors.
Identify social aspects that may affect the patient’s health and medical treatment plan.

Order and Interpret Diagnostic Tests for Acute and Chronic Diseases

NPs apply diagnostic reasoning to make diagnoses, including analysis of the data collected during the patient’s examination and health history. The diagnostic test results are combined with the history and physical examination to devise a differential diagnosis, which distinguishes between two or more conditions that share similar symptoms. The NP’s diagnosis serves as the basis for the patient’s comprehensive care plan.

Create Treatment Plans

A patient’s treatment plan is designed and implemented in conjunction with the person’s family. This plan should be evidence-based, acceptable to all parties, cost conscious, and designed to promote health or to facilitate end-of-life decisions. To create a treatment plan, an NP will do the following:

Determine whether further diagnostic tests will be required.
Set priorities that are in line with the health care needs of the patient, family, and community.
Educate the patient about the plan in a way that considers the patient’s ability to comprehend and learn the plan’s treatments.

Provide Patients with Referrals

A component of the patient treatment plan is to arrange for any necessary consultations and referrals based on the health record, diagnostic results, and standards of professional care. The referrals made in conjunction with the patient and family are a key part of the treatment plan’s implementation.

The interventions included in the plan must consider the patient as an individual, including the person’s preferences and abilities. They must be evidence-based and take advantage of the NP’s theoretical expertise and clinical skills. The NP must also take advantage of every opportunity to educate the patient about healthy living practices.

Prescribe Medicine and Nonpharmacological Treatments

Another component of the patient’s treatment plan is to prescribe pharmacological and nonpharmacological treatments. NPs are now certified to prescribe medications in all 50 states and the District of Columbia, according to AANP. However, some states restrict NPs’ authority to write prescriptions by requiring that they collaborate with a physician.

In a position statement on the prescriptive authority of NPs, AANP contends that allowing NPs to prescribe “legend and controlled medications, devices, health care services, durable medical equipment, and other equipment and supplies is essential to providing timely, cost-effective, quality health care.”

State Limits on Treatments and Services That NPs May Provide

AANP describes three types of practice environments for NPs in U.S. states and territories:

Full practice is recognized in 22 states and two territories. NPs may “evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances.” The National Academy of Medicine recommends this model of practice for NPs.
Reduced practice reduces the ability of NPs in at least one area of practice. The 16 states in this category may require that NPs enter into a “career-long regulated collaborative agreement with another health provider” before they can provide patient care.
Restricted practice prohibits NPs from taking part in at least one area of practice. The 12 states in this category require that NPs have “career-long supervision, delegation, or team management by another health provider” before they can provide patient care.

NPs Practicing in the U.S.: By the Numbers

The BLS estimates that as of May 2019, there were 200,600 NPs working in the U.S., earning a mean annual wage of $111,840 and a median annual wage of $109,820. The following are some facts and figures about NPs compiled by AANP:

57.4% of NPs see three or more patients per hour
87% of NPs accept private insurance
83% of NPs accept Medicare
80% of NPs accept Medicaid
77% of NPs accept uninsured patients
2 out of 3 patients support legislation that would expand access to NP services

NPs Certified in Primary Care and Working in Primary Care

AANP notes that NPs are more likely than physicians or physician assistants to practice in primary care areas. While nearly 90% of NPs were prepared in primary care in 2019, only 8% of physicians entered a primary care residency. Currently, 69% of NPs provide primary care services to their patients, according to AANP’s NP Fact Sheet.

NPs Who Prescribe Medication

The American Medical Association’s Advocacy Resource Center lists the prescription authority of NPs in each state, including whether physician involvement is required, whether they’re authorized to prescribe schedules II and III–V controlled substances, and whether the state makes additional education requirements.

Many states require that NPs complete a specified number of hours studying pharmacology, advanced pharmacology, and/or clinical management of drug therapy. Several also have continuing education requirements in pharmacology, often if the NP hasn’t practiced for a set number of years.

NPs Certified in Various Specialties

According to the 2019 AANP National NP Sample Survey, NPs have an average of 10 years of practice. (Note that the study results are available for purchase by non-AANP members.) The highest percentage of NPs are certified in one or more primary care specialties:

Family practice: 65.4%
Adult practice: 12.6%
Adult gerontology practice: 7.8%
Pediatrics practice: 3.7%
Women’s health practice: 2.8%
Psychiatric and mental health practice: 1.8%
Gerontology: 1.7%

Acute care NPs practice in the following areas:

General acute care: 5.5%
Adult gerontology acute care: 3.4%
Hospice and palliative care: 1.5%

graphic of nurse practitioner salaries by specialty

Psychiatric Mental Health Nurse Practitioner

The American Psychiatric Nurses Association (APNA) explains that the need for mental health professionals has never been greater: a study conducted by the U.S. Department of Health and Human Services found that only 44% of adults in the U.S. who have a diagnosable mental illness receive treatment, and only 20% of children and adolescents receive the mental health treatment they need.

A 2019 report issued by the U.S. Substance Abuse and Mental Health Services Administration estimates that 47.6 million people in the U.S. over the age of 18 experienced a mental illness in 2018, which is 19.1% of all adults in the country. Psychiatric mental health nurse practitioners (PMHNPs) play a key role in addressing the critical need for mental health services.

AANP describes the role of PMHNPs as assessing, diagnosing, and treating their patients’ mental health needs.

They offer therapy and prescribe medication to patients who have mental health or substance abuse problems
They provide physical and psychosocial assessments, often in emergency situations
They work with children, adolescents, adults, and the elderly, often on a daily basis
They work in a variety of settings, including private practices and hospitals; the most common practice setting is a psychiatric mental health facility
The diagnoses and health issues PMHNPs treat most often are depression, anxiety, sleep disorders, and dementia

Psychiatric Mental Health NP Career Outlook and Salary

The APNA reports that 75% of all counties in the U.S. have a shortage of mental health workers, and 96% have an unmet need for mental health prescribers. The shortage of mental health professionals is most acute in rural areas and among racial, cultural, and ethnic minorities. The need is exacerbated by the stigma that many minority populations attach to seeking mental health care, according to the APNA.

The most popular skills for PMHNPs include prescription administration, psychiatric care, and pediatric care.

Data gathered by PayScale indicates that more than half of PMHNPs are just starting out or are in the early part of their careers:

Entry level: 13%
Early career: 43.5%
Midcareer: 18.9%
Experienced: 15.1%
Late career: 9.5%

PayScale lists average annual salary information for PMHNPs as of May 2020:

Overall: about $107,000
Entry level: about $99,000
Midcareer: about $110,000
Late career: about $114,000

Family Nurse Practitioner

Family nurse practitioners treat patients of all ages and offer primary care as well as treatment of acute and chronic illnesses. Much of their work entails educating their patients about healthy lifestyles to prevent serious diseases such as diabetes, hypertension, and heart disease, according to AANP.

Family NPs are employed in a range of health care settings, including private practice, community clinics, hospitals, and universities. A recent AANP survey of family NPs found that in a full workday, they see an average of 18 patients, primarily in three clinical areas: primary care, urgent care, and internal medicine.

Family NP Career Outlook and Salary

Demand for family NPs is expected to grow in large part due to the shortage of primary care physicians, a shortfall that the Association of American Medical Colleges (AAMC) predicts will reach 122,000 physicians by 2032. A study conducted by Health Affairs found that as the percentage of primary care physicians dropped to 8% in 2018, the number of NPs who focus on family medicine, internal medicine, and other primary care categories increased to 84%.

The most popular skills for family NPs, according to PayScale, are family practice, family practice/pediatrics, and internal medicine.

More than half of all family NPs currently fill entry-level or early career positions:

Entry level: 20.7%
Early career: 43.6%
Midcareer: 16.4%
Experienced: 12.8%
Late career: 6.4%

PayScale lists average annual salary information for family NPs as of May 2020:

Overall: about $94,000
Entry level: about $90,000
Midcareer: about $99,000
Late career: about $102,000

Adult Gerontology Acute Care Nurse Practitioner

Adult gerontology acute care nurse practitioners (AGACNPs) focus primarily on treating complex, acute conditions in older adults and geriatric patients, as AANP explains.

They create multifaceted treatment plans for their patients
They often consult with other medical professionals or perform treatments requiring special equipment that is not usually available in a primary or secondary health care setting. AGACNPs are also frequently employed by specialty clinics and long-term care centers.
They emphasize preventing future complications while the patient’s health improves
Their work extends beyond clinical practice to include administrative, teaching, and research roles
The most common practice setting for AGACNPs is hospital inpatient units; the top clinical focus for AGACNPs is critical care.

Adult Gerontology Acute Care NP Career Outlook and Salary

An aging population increases the demand for the services offered by adult gerontology acute care NPs. However, as the Gypsy Nurse points out, AGACNPs treat adolescents and young and middle-aged adults as well as the elderly.

The two most sought-after skills for adult gerontology NPs are geriatrics and diagnosis and treatment planning, according to PayScale. Other popular skills include internal medicine, wound care, and eldercare.

Two out of three AGNPs currently fill entry-level or early career positions:

Entry level: 29.4%
Early career: 36.5%
Midcareer: 15.3%
Experienced: 12.9%
Late career: 5.9%

PayScale lists average annual salary information for AGNPs as of May 2020:

Overall: about $96,000
Entry level: about $88,000
Midcareer: about $102,000
Late career: about $82,000

Emergency Nurse Practitioner

Health care professionals who work best in fast-paced environments are well suited to a career as an emergency nurse practitioner. The work of emergency NPs entails treating trauma, injuries, and advanced illnesses in patients of all ages, as AANP explains.

They typically work in emergency departments of hospitals, trauma centers, and urgent care centers
They’re often on call, and they tend to work long hours, including evening and overnight shifts, holidays, and weekends
While most patients seen in emergency departments are discharged after minor treatment, emergency NPs provide a range of primary care services, treating chronic diseases, obstetric and gynecological illnesses, and illnesses in infants and children
Their primary role is to initiate care for patients with acute, urgent conditions, including traumas and injuries, often entailing resuscitation and stabilization in life-threatening situations

Emergency NP Career Outlook and Salary

The shortage of physicians in rural areas has increased demand for emergency NPs to address the critical care needs of residents located far from medical centers clustered in metropolitan areas. The quality of care provided by emergency NPs is comparable to that offered by emergency physicians. For example, BMC Health Services Research reports that the care provided by emergency NPs to patients presenting with undifferentiated chest pain was as effective as the “standard care model” in terms of service indicators and patient-reported outcomes.

The most in-demand skills for emergency NPs are acute care and geriatrics, according to PayScale. Other popular skills include internal medicine and cardiology.

Just over half of emergency NPs currently fill entry-level or early career positions:

Entry level: 13.4%
Early career: 41.1%
Midcareer: 17.7%
Experienced: 18.2%
Late career: 9.6%

PayScale lists average annual salary information for emergency NPs as of May 2020:

Overall: about $97,000
Entry level: about $93,000
Midcareer: about $104,000
Late career: about $96,000

Pediatric Nurse Practitioner

Pediatric nurse practitioners specialize in treating newborns, infants, children, adolescents, and young adults for a range of acute pediatric illnesses and chronic conditions. AANP states that pediatric NPs emphasize well-child care and the treatment and prevention of chronic illnesses.

They work in a variety of health care settings, including pediatric offices, hospitals, health centers affiliated with schools, and specialty clinics.
The two primary care conditions pediatric NPs treat most frequently are abdominal pain and gastrointestinal reflux, according to an AANP survey.
Separate pediatric NP certifications are available for primary care, primary care mental health, and acute care.

Pediatric NP Career Outlook and Salary

The National Association of Pediatric Nurse Practitioners reports that there’s a dire need for pediatric NPs to address the critical shortage of pediatric primary care providers, which affects underserved and rural areas in particular. The number of children in the U.S. is forecast to increase from 74 million in 2016 to 76.3 million in 2030, yet fewer than 8% of nurse practitioners choose to specialize in pediatrics.

While pediatrics is by far the most popular skill for pediatric NPs, they’re also in demand for patient education, acute care, family practice, and intensive care.

More than 60% of pediatric NPs are in their early career or midcareer:

Entry level: 18.5%
Early career: 40.6%
Midcareer: 21.8%
Experienced: 19.2%

PayScale lists average annual salary information for pediatric NPs as of May 2020:

Overall: about $90,000
Entry level: about $85,000
Midcareer: about $91,000
Late career: about $97,000

Women’s Health Nurse Practitioner

The professional organization Nurse Practitioners in Women’s Health (NPWH) describes the role of a women’s health nurse practitioner as offering holistic, comprehensive health care for women, from adolescents to the elderly. These NPs provide a range of ambulatory health services for women with many different chronic and acute conditions. They also offer wellness care and health education to prevent illnesses.

They conduct well-woman exams that may include breast cancer screening, Pap smears, and HPV screening
They offer contraceptive care, screening for sexually transmitted diseases, and pregnancy testing
They help women manage their health through childbearing years to optimize preconception health; they offer prenatal visits and after-pregnancy care
They address problems relating to menstruation
They treat incontinence, infections, and other urinary tract conditions
They screen for common health problems, such as heart disease, hypertension, and diabetes

Women’s Health NP Career Outlook and Salary

The increasing shortage of primary care providers will drive the growing demand for women’s health NPs, according to AANP. Currently, only 9.1% of NPs focus on women’s health, yet the Association of American Medical Colleges cites a study that predicts the shortage of OB-GYN physicians will grow from 8,000 in 2020 to 22,000 by 2050. The shortage is especially acute in rural areas: half of all counties in the U.S. lack an OB-GYN, according to the study.

OB-GYN is the most popular skill for women’s health NPs, according to PayScale, along with gynecology, reproductive health, obstetrics, and colposcopy.

More than 40% of women’s health NPs are in the midcareer or experienced categories:

Entry level: 10.6%
Early career: 30.4%
Midcareer: 21.1%
Experienced: 20.5%
Late career: 17.4%

PayScale lists average annual salary information for women’s health NPs as of May 2020:

Overall: about $91,000
Entry level: about $83,000
Midcareer: about $93,000
Late career: about $98,000

Neonatal Nurse Practitioner

The neonatal nurse practitioner specialty is best suited to people who have a “passion” for caring for newborns and their families and who thrive in pressure environments, according to AANP. Neonatal NPs provide advanced care to premature newborns and those suffering from illnesses, typically working in neonatal intensive care units (ICUs).

They treat high-risk infants, such as those with low birth weights, heart abnormalities, infections, or complications due to being born prematurely.
In addition to working in neonatal ICUs, they may work in emergency rooms, delivery rooms, or outpatient clinics that provide infants and their families with follow-up care.
Neonatal NPs see an average of 13 patients in a full workday, according to an AANP survey.
The most common illnesses treated by neonatal NPs are acute lower respiratory illness, heart failure, acute upper respiratory illness, arrhythmias, and anemia.

Neonatal NP Career Outlook and Salary

A report from the National Association of Neonatal Nurses (NANN) states that the ongoing shortage of neonatal NPs will worsen through 2028. A recent survey found that 75% of clinical neonatal NPs and 73% of neonatal NP administrators are unable to meet their coverage needs. In addition, 88% of the administrators stated that there are too few neonatal NP faculty to lead education programs.

The most popular skill for neonatal NPs, according to PayScale, is neonatal ICU, followed by neonatology, labor and delivery (birthing), nursery, and critical care.

More than half of all neonatal NPs are in the midcareer, experienced, and late career categories:

Entry level: 15.2%
Early career: 29.9%
Midcareer: 20.9%
Experienced: 23.1%
Late career: 10.9%

PayScale lists average annual salary information for neonatal NPs as of May 2020:

Overall: about $101,000
Entry level: about $94,000
Midcareer: about $103,000
Late career: about $125,000

graphic of increasing demand for nurse practitioners

How to Become a Nurse Practitioner: Education, Certificates, Salaries, Career Outlook

The health care industry’s increasing reliance on NPs is the result of the ability of NPs to combine clinical experience in diagnosing and treating illnesses with their comprehensive approach to the health care needs of their patients. AANP notes that NPs take a “whole person” approach that emphasizes health promotion and education, disease prevention, and smart lifestyle choices.

Students wondering how to become an NP will find the process begins with an education that combines knowledge acquisition and clinical experience. They also have to understand the NP certification process, career paths and prospects, and typical NP salaries.

Education and Certificate Requirements for NPs

NPs must hold an advanced master’s or doctorate degree in nursing. The APNA explains how the three most common advanced nursing degrees differ:

The Master of Science in Nursing (MSN) degree emphasizes nurse leadership, education, and administration.
The Doctor of Nursing Practice (DNP) degree focuses on promoting and enhancing nursing practice.
The PhD in Nursing is centered on research in various nursing-related fields.

There are five primary accredited certifying bodies for nurse practitioners:

The American Academy of Nurse Practitioners Certification Board offers three NP certifications: Family NP, Adult-Gerontology Primary Care NP, and Emergency NP.
The American Nurses Credentialing Center Certification Program covers several specialty and practice areas for NPs, including family NP, psychiatric-mental health NP, adult-gerontology acute care NP, adult-gerontology primary care NP, pediatric primary care NP, and adult NP.
The American Association of Critical-Care Nurses provides accreditation in acute care adult and acute care adult-gerontology.
The Pediatric Nursing Certification Board’s certifications include Primary Care Certified Pediatric NP and Acute Care Certified Pediatric NP.
The National Certification Corporation’s two certification programs for NPs are Neonatal NP and Women’s Health Care NP.

Reaching the Pinnacle of Your Chosen Nursing Specialty

The health of our communities, families, and country will rely increasingly on the services provided by NP specialists with the training and experience to treat acute and chronic health conditions and to promote healthy lifestyles.

Students considering a career as a nurse practitioner need to understand the duties, responsibilities, and other characteristics of various NP specialties, so they can make an informed decision about the career path that best fits their goals. Nurse practitioners in any specialty can have a tremendous, long-lasting impact on the health and well-being of communities from coast to coast.

Sources

All About NPs: NPs Bring a Comprehensive, Whole-Patient Perspective to Health Care, American Association of Nurse Practitioners

Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, U.S. Bureau of Labor Statistics

Nurse Practitioner (NP), MedlinePlus

Standards of Practice for Nurse Practitioners, American Association of Nurse Practitioners

Nurse Practitioners, American Association of Nurse Practitioners

Nurse Practitioner Prescriptive Authority, American Association of Nurse Practitioners

State Law Chart: Nurse Practitioner Prescriptive Authority, American Medical Association

NP Fact Sheet, American Association of Nurse Practitioners

Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses, American Psychiatric Nurses Association

Mental Health Myths and Facts, MentalHealth.gov

2018 NSDUH Annual National Report, U.S. Substance Abuse and Mental Health Services Administration