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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.
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.
What do nurse practitioners do? The U.S. National Library of Medicine’s MedlinePlus describes the services typically provided by NPs:
Here’s a closer look at several common NP activities.
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:
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.
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:
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.
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.”
AANP describes three types of practice environments for NPs in U.S. states and territories:
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:
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.
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.
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:
Acute care NPs practice in the following areas:
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.
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:
PayScale lists average annual salary information for PMHNPs as of May 2020:
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.
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:
PayScale lists average annual salary information for family NPs as of May 2020:
Adult gerontology acute care nurse practitioners (AGACNPs) focus primarily on treating complex, acute conditions in older adults and geriatric patients, as AANP explains.
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:
PayScale lists average annual salary information for AGNPs as of May 2020:
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.
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:
PayScale lists average annual salary information for emergency NPs as of May 2020:
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.
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:
PayScale lists average annual salary information for pediatric NPs as of May 2020:
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.
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:
PayScale lists average annual salary information for women’s health NPs as of May 2020:
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).
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:
PayScale lists average annual salary information for neonatal NPs as of May 2020:
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.
NPs must hold an advanced master’s or doctorate degree in nursing. The APNA explains how the three most common advanced nursing degrees differ:
There are five primary accredited certifying bodies for nurse practitioners:
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
Are You Considering a Career as a Psychiatric Mental Health Nurse Practitioner?, American Association of Nurse Practitioners
Are You Considering a Career as a Family Nurse Practitioner?, American Association of Nurse Practitioners
Are You Considering a Career as an Adult-Gerontology Acute Care Nurse Practitioner?, American Association of Nurse Practitioners
Are You Considering a Career as an Emergency Nurse Practitioner?, American Association of Nurse Practitioners
Are You Considering a Career as a Pediatric Nurse Practitioner?, American Association of Nurse Practitioners
Nurse Practitioner & Women’s Health Nurse Practitioner Practice Facts, Nurse Practitioners in Women’s Health
Are You Considering a Career as a Neonatal Nurse Practitioner?, American Association of Nurse Practitioners
What’s a Nurse Practitioner (NP)?, American Association of Nurse Practitioners
Nurse Practitioner (NP) Certification, American Association of Nurse Practitioners
Our Certifications, American Nurses Credentialing Center
APRN Certifications, American Association of Critical-Care Nurses
Certification Exams, National Certification Corporation
About Graduate Degree Programs, American Psychiatric Nurses Association
Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification, American Nurses Credentialing Center
Certification, American Nurses Credentialing Center
Average Psychiatric Nurse Practitioner (NP) Salary, PayScale
New Findings Confirm Predictions on Physician Shortage, Association of American Medical Colleges
“Primary Care Workforce Data and the Need for Nurse Practitioner Full Practice Authority,” Health Affairs
Average Family Nurse Practitioner (NP) Salary, PayScale
What Exactly Does an Adult Gerontology Nurse Practitioner Do?, Gypsy Nurse
Average Adult Gerontology Acute Care Nurse Practitioner Salary, PayScale
“The Effectiveness of Emergency Nurse Practitioner Service in the Management of Patients Presenting to Rural Hospitals with Chest Pain,” National Center for Biotechnology Information
Average Nurse Practitioner (NP) with Emergency Room (ER) Skills Salary, PayScale
Critical Shortage of Pediatric Nurse Practitioners Emerging Over Next Decade, National Association of Pediatric Nurse Practitioners
Average Pediatrics Nurse Practitioner (NP) Salary, PayScale
Nurse Practitioners in Primary Care, American Association of Nurse Practitioners
“Labor Pains: The OB-GYN Shortage,” Association of American Medical Colleges
Average Women’s Health Nurse Practitioner (NP) Salary, PayScale
NNP Workforce: White Paper, National Association of Neonatal Nurses