Nurse practitioner

Overview
A nurse practitioner is a registered nurse who has completed specific advanced nursing education (generally a master's degree) and training in the diagnosis and management of common medical conditions. Nurse practitioners provide a broad range of health care services.

Nurse Practitioners (NPs) provide much of the same care provided by physicians generally of the type seen in their specific practice areas like family practice offices, urgent care centers, and rural health clinics, and maintain collaborative working relationships with physicians. NPs are licensed by the state in which they practice, and have a board certification (often through ANCC - American Nurses Credentialing Center or for specialty practice such as the NCC: National Certification Corporation) in their area of practice. Rather than a generic focus of education, Nurse Practitioners specialize in such areas as pediatrics, geriatrics, family, psychiatry and acute care.

Nurse practitioners treat both acute and chronic conditions through prescribing medications, physical therapy, ordering tests and therapies for patients. Many NPs have a DEA registration number that allows them to write for federally defined "controlled" medications. Nurse practitioners may also bill Medicare, Medicaid and private insurance for services performed. An NP can serve as a patient’s "point of entry" health care provider and see patients of all ages depending on their designated scope of practice. 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. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NPs.

In eight states, including Oregon, Washington DC, Washington state, New Hampshire, and many Mountain/Pacific Time Zone states NPs work totally autonomously, and many choose to open their own clinical practices. American NPs, according to the American College of Nurse Practitioners, are required in 28 states to practice in collaboration with and under the supervision of a physician though they may prescribe medications in all U.S. states, commonwealths, districts, and territories; and carry a DEA number in most states.

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


 * Diagnosing, treating, evaluating and managing non-life-threatening acute and chronic illness and disease (e.g. diabetes, high blood pressure)
 * Obtaining medical histories and conducting physical examinations
 * Ordering, performing, and interpreting basic diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs)
 * Prescribing medications (limited)
 * 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
 * Providing care for patients in acute and critical care settings
 * Performing minor surgeries and procedures (with additional training and usually under supervision) (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
 * Some NPs are formally trained for surgical First Assistants in the OR.

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


 * Community clinics and nurse-managed health centers
 * Health departments
 * Health maintenance organizations (HMOs)
 * Home health care agencies
 * Hospitals and hospital clinics including ER, Urgent Care, wards, and intensive care units
 * 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 board certification
NPs are specialize in a particular field of medical care.

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 (RN) include either 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 years. BSN programs are offered by colleges and universities and take 4 years.

In most states a master's degree is required. To become NPs, nurses with an ADN or diploma must first complete a bachelor's degree or enter in various programs offering an ADN to master's degree via a "bridge program," most of which award the bachelor's degree while completing the requirements for the master's.

Once registered nurse status is attained, the candidate must complete a state-approved advanced nursing education program that usually specializes in a field such as family practice, adult health, acute care or women's health. The degree can be granted by:


 * A university, which grants a master's of science in nursing (MSN) degree which is now 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. The certifying organizations, states, and employers require a minimum of a master's degree for new NPs (already established NPs with lesser education were grandfathered in).

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 master's degree in nursing and certification by an accrediting body (AANC, AANP). 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 organizations 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)
 * ACNP-C (Acute Care Nurse Practitioner, Certified)
 * CPNP (pediatric NP when certified by the pediatric nursing certification board (PNCB)
 * CRNA (Certified Registered Nurse Anesthetist)
 * CRNP (certified registered nurse practitioner) used primarily in Pennsylvania
 * MSN (master of science in nursing)
 * MN (master 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)
 * APN (Advance Practice Nurse)
 * AHN (holistic NP)
 * ANP (adult NP)
 * ENP (emergency NP )
 * FNP (family NP)
 * GNP (geriatric NP)
 * NNP (neonatal NP)
 * PMHNP (Psychiatric and mental health Nurse Practitioner)
 * NPP (Nurse Practitioner in Psychiatry)
 * PNP (pediatric NP)
 * WHNP (women's health NP)
 * CNM (certified nurse midwife)
 * BC, PCM (board certified, palliative care management)
 * RN(EP) - RN (Extended Practice), Manitoba, Canada