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Nurse Practitioner Nursing Specialty: Ultimate Guide to NP Jobs

What Is a Nurse Practitioner (NP) or CRNP? Ultimate Guide

The United States is facing a significant primary care shortage. Fortunately, nurses can be part of the solution by joining the more than 355,000 nurse practitioners currently working in this role. Nurse practitioners offer quality, cost-effective, patient-centered care autonomously or under the supervision of a physician. 

Would you like to expand your knowledge and scope of practice by pursuing a career as a nurse practitioner? Read on for everything there is to know about this advanced nursing specialty. 

Table of Contents

What Does NP Stand for, and What Is a CRNP?

Nurse practitioner
Want to know more about becoming a nurse practitioner? You're in the right place.

The abbreviation CRNP stands for certified registered nurse practitioner. CRNPs—or simply NPs—are registered nurses (RNs) who have pursued higher education in a specialized area of healthcare. These clinicians may work with different age groups as well as patients’ families. They practice in all fifty states under the rules and regulations of each state’s Nurse Practice Act. Additionally, most NPs are nationally certified in their specialty area.

What Does Nurse Practitioner (NP) Mean in Medical Terms? 

Nurse practitioners are essential components of the primary care workforce. They focus their graduate education on and become nationally certified to work with one of the following populations: 

  • Family/individual across the lifespan
  • Women’s health
  • Adult-gerontology acute or primary care
  • Neonatology
  • Pediatrics 
  • Psychiatric/mental health

What Is the Role of a Nurse Practitioner?

Nurse practitioners focus on the health and well-being of the entire person, encompassing health promotion, disease prevention, education, and counseling. They help their patients make better health and lifestyle choices, which reduces healthcare costs for patients. In fact, patients whose primary care providers are NPs usually have fewer emergency room visits, lower medication costs, and shorter hospital stays. 

CRNPs provide a full range of acute, primary, and specialty healthcare services, including the following:

  • Managing patients' overall care
  • Ordering, performing, and interpreting diagnostic tests, including x-rays and lab work
  • Diagnosing and treating both chronic and acute conditions such as infections, injuries, diabetes, and high blood pressure
  • Prescribing medications and other treatments
  • Counseling and educating patients on positive health and lifestyle choices and disease prevention

Additionally, nurse practitioners may participate in healthcare forums, conduct research, and use findings to guide evidence-based care. 

Where Can Nurse Practitioners Work?

Nurse practitioners can work in numerous rural, suburban, and urban settings, including the following:

  • Doctors’ offices
  • Hospitals and clinics
  • Emergency rooms
  • Urgent care sites
  • School and college student health clinics
  • Business and industry employee health offices
  • Public health departments
  • Nurse practitioner offices
  • Nursing homes and hospices
  • Home health agencies
  • The armed forces and veterans affairs (VA) facilities

What Do Nurse Practitioners Do in Hospitals?

Nurse practitioner
Nurse practitioners help patients and have rewarding careers.

The responsibilities of a nurse practitioner vary from state to state and from one healthcare setting to another. In the hospital setting, the following are typical duties of a nurse practitioner:

  • Ordering, performing, and interpreting the results of diagnostic tests, such as x-rays, complete blood counts (CBCs), and electrocardiograms (EKGs)
  • Analyzing and interpreting a patient’s history, symptoms, physical findings, or diagnostic information to develop an appropriate diagnosis
  • Developing treatment plans based on standards of care, professional practice guidelines, and scientific rationale
  • Diagnosing and treating acute healthcare problems such as illnesses, infections, and injuries
  • Prescribing medication dosages, routes, and frequencies based on patients’ particular characteristics 
  • Prescribing medications based on efficacy, safety, and cost as legally authorized
  • Counseling patients regarding their medication, including side effects or interactions with other substances, such as over-the-counter medications, food supplements, and herbal remedies
  • Detecting and responding to adverse drug reactions
  • Making recommendations related to behavioral health
  • Educating patients about self-management of acute or chronic illnesses
  • Maintaining electronic health records

How to Become a Nurse Practitioner and How Long Does It Take?

By definition, CRNPs are licensed registered nurses who have continued their education to become certified nurse practitioners. Therefore, the first step to becoming a CRNP is becoming a licensed registered nurse. The two main pathways to becoming an RN are through a two-year associate’s degree in nursing (ADN) or a four-year bachelor’s of science in nursing (BSN). After either type of program, nurses can take the NCLEX-RN to become licensed RNs.

After becoming licensed RNs, aspiring NPs must complete master’s or doctoral degree programs. These post-graduate studies prepare nurses to practice in primary, acute, and long-term care settings. Furthermore, NPs must obtain national certification, undergo periodic peer review and clinical outcome evaluations, and follow a code for ethical practices. Completing a master’s program takes an additional two years on average, and a doctoral degree program usually takes an additional three to six years. Although accelerated programs can help aspiring NPs reduce their years of study, this study time reduction is usually compensated by additional years of work experience.

Additionally, many nurse practitioner jobs require Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS) certifications. 

Finally, although becoming a nurse pr may be done quickly, the following comment by a nurse practitioner on an NP thread on Reddit reflects a common sentiment in the field:

“I worked for 3 years as an RN before i decided to go back to school, then continued to work full-time and attend school part-time through my masters degree. I didn't plan to pursue an MSN when I graduated with my BSN. I'm not saying this is the only way to do things but, to pursue an NP path, you should first have the desire to work as a nurse and understand/embrace that role before you plan to be an NP. I don't believe my assessment/critical thinking skills would be as good without almost 9 years of bedside experience under my belt.” 

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Different Kinds of Nurse Practitioners?

It is important to note that not all nurse practitioners have the same preparation and expertise. NPs can specialize in many different areas, including the following: 

  • Acute Care
  • Adult Health
  • Family Health
  • Gerontology Health
  • Neonatal Health
  • Oncology
  • Pediatric/Child Health
  • Psychiatric/Mental Health
  • Women's Health

In addition, nurse practitioners can pursue the following sub-specialty areas:

  • Allergy and Immunology
  • Cardiovascular
  • Dermatology
  • Emergency
  • Endocrinology
  • Gastroenterology
  • Hematology and Oncology
  • Neurology
  • Occupational Health
  • Orthopedics
  • Pulmonology and Respiratory
  • Sports Medicine
  • Urology

Nurse Practitioner Certification?

Nurse practitioner
Nurse practitioners often run their own practices.

The final step to becoming an NP is obtaining national certification in the desired specialization area. 

The American Academy of Nurse Practitioners Certification Board (AANPCB) offers the following three certification options for nurse practitioners:

  • Family Nurse Practitioner (FNP)
  • Adult-Gerontology Primary Care Nurse Practitioner (A-GNP)
  • Emergency Nurse Practitioner (ENP)

Additionally, the American Nurses Credentialing Center (ANCC) offers nurse practitioners the following certification options:

  • Family Nurse Practitioner Certification (FNP-BC™)
  • Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC®)
  • Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC®)
  • Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC™)

The ANCC also has many other nurse practitioner certifications available only for renewal.

The National Certification Corporation (NCC) provides these two certification options:

  • Neonatal Nurse Practitioner (NNP-BC®)
  • Women's Health Care Nurse Practitioner (WHNP-BC®)

The American Association of Critical Care Nurses (AACN) offers two certification options:

  • Acute Care Nurse Practitioner Certification Adult-Gerontology (ACNPC-AG)
  • Acute Care Nurse Practitioner (ACNPC) (Available only for renewal)

Finally, the Pediatric Nursing Certification Board offers the following two certifications for nurse practitioners:

  • Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC)
  • Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC)

Is Nurse Practitioner School Hard?

Aside from the significant time commitment required to become a nurse practitioner, the consensus among students of nurse practitioner programs is that NP classes are easier than basic nursing school classes.

“I have found NP classes way easier than my core BSN classes (I went to top rated programs for both)...I’ve found my clinicals to be less stressful than my RN clinicals. The accompanying classes are easier than the initial classes is my opinion so far. I’m actually a little disturbed that the program is not more rigorous…I barely passed my LPN program…The NP program I am in is really kind and gentle to the students. LPN school was more like reform school. My BSN was kind of like being in the army. Now I guess I live in the officer’s quarters?” – Comment on Reddit by YearsOfGlitter

“I mean I am ten years older than when I started nursing school, so I guess it makes sense they would be less stressful because for me a lot of it was just nerves and dealing with people/social anxiety. Although for some reason I still get the shakes when I have to do a redemo in front of my instructor like a little girl.” – Comment on Reddit by joshy83

How Much Does a Nurse Practitioner Make?

According to the US Bureau of Labor Statistics (BLS), becoming a nurse practitioner increases a licensed registered nurse’s average salary from $82,750 to $118,040 annually. That said, the average salary of a nurse practitioner varies significantly based on where they work. The following are the average salaries of CRNPs in different settings:

  • Offices of physicians: $114,870
  • Offices of other health practitioners: $108,890
  • General medical and surgical hospitals: $122,960
  • Outpatient care centers: $129,190
  • Psychiatric and substance abuse hospitals: $131,830
  • Home health care services: $133,170
  • Business, professional, labor, political, and similar organizations: $133,800
  • Accounting, tax preparation, bookkeeping, and payroll services: $148,980

What Is It Like to Work as a Nurse Practitioner?

As is the case with most nursing specialties, nurse practitioners must be prepared to be on their feet for about eight hours per day, sit for two to four hours per day, assist patients in changing positions, frequently bend, stoop, push, and pull, work under pressure, and handle challenging patients and family members professionally.

Regarding job security and demand, this nurse practitioner on Reddit helps paint the broad picture:

“It depends on what you want from your career, how flexible you are about your location, and how much money you want to make. If you go into psych there are more jobs for telehealth than there are PMHNPs to fill them. You could literally work from anywhere you can get internet. If you want to be a FNP as long as you don't need to live in a major city there are more jobs out there than there are FNPs to fill them. If you want to be a FNP or Acute in a major city there is stiff competition in the pay is not great. If you want to round in rural nursing homes as a PHMNP there is more work to do than there are hours in the day. If you work fee for service on a 1099 rather than being a normal W-2 employee with benefits you can make as much money as you want…”

Additionally, this new NP helps illustrate the differences between working as an RN and working as an NP:

“...I’ve only recently started working as an NP but I am really enjoying it. I am getting paid what I was getting paid agency work overnights on an inpatient psych unit. I actually work in that same facility now but employed part time as an NP. It’s like night and day, literally, because I only work days now. I also only work 8 hrs. Good by 12 hr shifts. I can work less and make the same. Becoming an NP also opens the door to telemedicine. I’m doing some of that in my post grad psych clinicals and I am loving it. I may finally be able to live the dream of living or traveling anywhere and still being able to find work through telemedicine.”

Why Choose to Be a Nurse Practitioner?

Nurse practitioner
Nurse practitioners work with patients of all ages.

There are certainly many reasons to become an NP, and not all nurse practitioners are guided by the same motivations. That said, the following nurse practitioner testimonials offer valuable insights into the allure of this nursing specialty.

“Being a bedside nurse just wasn't enough. For me, it was the drive for greater clinical knowledge, professional collaboration, and autonomy…No, my clinical knowledge is not equal to that of an MD/DO's. I have not completed a surgical rotation, I can't perform a paracentesis…But, I know primary care internal medicine and I am good at it. And, I think my background as a nurse makes me a more effective provider of primary care. We have a set of skills we can utilize to care for our patients that physicians just do not have.” Redditu/larkface

“You want more autonomy in order to provide better patient care. I say go get your NP and do just that. It isn't all rainbows and butterflies afterwards, and you will still have to deal with management. But you are writing the scripts, providing the education, and putting in the orders in the end.” Redditu/daorkykid

What Makes a Good Nurse Practitioner: Tips for New Nurses?

Aside from completing extensive studies and obtaining both basic and specialized certifications, nurse practitioners should strive to develop the following skills to be exceptional in their chosen career path: 

  • Excellent listening skills (giving people their full attention, asking appropriate questions, not interrupting)
  • Effective communication

Career-focused reading comprehension skills

  • A scientific approach to problem-solving
  • Critical thinking
  • Willingness to incorporate new information 

In addition, here are some words of wisdom from NPs who have already tread this career path:

“My advice…is to really commit to becoming a knowledgable, skilled, highly-competent clinician if you go this route. You have to love the medicine as much as the patient. And you have to have the personality; be confident, be able to make decisions independently, but have enough humility to know when you require collaboration.” Redditu/larkface

“Becoming an NP should not just be a "shortcut" to being a doctor-like provider, it needs careful consideration of the role you want to fill and whether the education meets that need. If you want to work in a hospital and are ok with being a "permaresident", the NP role might be a good fit. It will mean you have less autonomy, especially when you start, and there's always going to be a physician as a backup who is going to be involved in your patient's care too.” Redditu/sapphireminds

What Is a Certified Registered Nurse Practitioner?

Are you a registered nurse wanting to tend to patients by yourself? Is becoming a CRNP the path you want to take? Learn more about becoming a CRNP here: from the expectation of pay to the different types of CRNPs, the difference with an MD (medical doctor), how to become one, and more.

A CRNP (certified registered nurse practitioner) is a registered nurse who continues their medical education to care for patients, sometimes on their own, sometimes with the support of an MD.

What Do Certified Registered Nurse Practitioners Do?

A CRNP has many functions within their scope of practice, for example:

  • Diagnose medical conditions
  • Order and interpret tests
  • Coordinate treatment plans
  • Gather the medical history
  • Perform physical examinations
  • Assess patient health
  • Prescribe medications
  • Review and analyze test results
  • Perform medical procedures

Most of the functions fall between disease prevention, patient education, managing conditions, and coordination of care. Depending on the state, CRNPs might work with a medical team or a physician and acquire sufficient knowledge to handle more complex levels of care after a few years of working with a supervising physician. Depending on the state's legislation, CRNPs can work independently or under the supervision of a physician. Most CRNPs work in primary care (the first point of contact for a patient before specialties, surgery, etc).

CRNP Medical Meaning

In medical terms, a CRNP is a certified registered nurse practitioner who works with patients who need them and provides hands-on care. CRNPs are clinically prepared healthcare providers with high education who work tirelessly for their patients.

Nurse Practitioner vs CRNP

A nurse practitioner (NP) is almost the same as a CRNP. Overall, the only difference is that a CRNP has a "C" in front of their credentials, which stands for "certified," meaning they are showing proof of continuing education.

CRNP vs APRN: Another category is APRNs, which stands for advanced practice nurse practitioners and includes clinical nurse specialists, nurse anesthetists, and nurse midwives. Thus, the name might vary depending on the state, but they are both NPs (nurse practitioners).

Some CRNPs include Certified Pediatric Nurse Practitioners or Certified Family Nurse Practitioners.

To sum it up, your name and functions vary depending on your state and the education and specialty you took as an NP.

Is a CRNP a Doctor? CRNP Vs. MD

If a patient is looking for medical assistance, a CRNP can help, although a CRNP is not the same as a physician. In most matters, CRNPs and MDs can perform with patients similarly (so your patients can feel in excellent hands). Some differences include:

  • Surgery: Given the different training a CRNP has, they cannot perform surgical procedures.
  • Scope of practice: CRNPs work mainly as primary healthcare providers, and, as mentioned above, they can work either independently or under the supervision of a physician.
  • Type of training: A physician, or MD, went through the medical education model, while the CRNP went through a nursing education model. An MD attended medical school and residency, with approximately 16,000 to 20,000 clinical hours before their board certification. A CRNP accumulates about 500 to 1,500 clinical hours before graduating, but as they keep practicing, they might gain a lot of experience with patients.

Remember that there are more similarities between an MD and a CRNP; for example, both can:

  • Diagnose and treat conditions.
  • Manage the overall care of a patient.
  • Order diagnostics tests and interpret them.
  • Provide primary care.
  • Offer specialty treatments like women's health, family practice, pediatric practice, and more.
  • Write prescriptions in most states.

As mentioned before, although most CRNPs work under the supervision of physicians, they can work independently in many states.

Another common question is if CRNPs are the same as PAs (physician assistants), and the answer is no, given that physician assistants also go through the medical model of education, and their scope of practice is different. PAs always work under the supervision of physicians, as they can't work independently.

Can a CRNP Prescribe Meds?

The CRNP prescriptive authority varies significantly from one state to the other. Nevertheless, the American Association of Nurse Practitioners (AANP) recognizes that prescribing is within the scope of practice of any nurse practitioner, as this is essential to providing quality healthcare to all patients. However, each state board of nursing gives different guidelines, as in some states, there are additional applications, training, or supervision from a physician to prescribe medications. You can consult your board of nursing to know whether a CRNP can prescribe meds independently in your state.

How Do You Become a Certified Registered Nurse Practitioner?

To know if you should become an RN or continue the path to being a CRNP, you can balance the following pathways to become a CRNP:

  1. Traditional Pathway: 
  1. Obtain an RN degree through a BSN, ABN, or MSN, and then pass the NCLEX to obtain your RN license.
  2. Once an RN, you can either wait for more experience and a better understanding of the specialties or enter a master's program. You can enter a full-time or part-time program to finish your degree and go as far as you wish (master's or doctorate program).
  1. With a master's program, you will earn your certification faster, and it is recommended for nurses who like the research part of the nursing path.
  2. With a doctorate program, you will earn a certification over time, but the program is directed toward research and teaching.

Both kinds of programs are similar in the licensing exams, have similar pay as professionals, and have almost the exact scope of practice.

  1. Direct Entry:
  1. When applying for direct entry to become a CRNP, you must first have a bachelor's degree in any related field, earn an RN licensure, and apply for a master's or doctorate program. This will typically take you three to five years.

For both entry cases, you must pass a certification exam (the nurse practitioner board exam) and then apply for licensing in your state.

One of the advantages of becoming a CRNP is that the study costs less than other medical degrees, like that of a physician.

What Are the Different Types of CRNPs?

The program you choose will determine your specialization area, so you should select the location you prefer from the beginning.

Some specialization areas include:

Remember that for your specialization, you must choose from the beginning of your CRNP career, as the specialization is focused from the start.

What Is the Average CRNP Salary?

According to the US Bureau of Labor Statistics (BLS), the average salary for a CRNP is $125,900 per year or $60.53 per hour. However, the CRNP salary can significantly vary according to specialty, with women's health specialists earning an average of $98,000 and neonatal CRNPs earning $126,000.

Advantages of CRNP

As a certified registered nurse practitioner, you will have certain advantages:

  • A good work/life balance
  • Autonomy
  • Lots of hours of practical training (2-4 years of training)
  • Less debt
  • No overnight calls (depending on the specialty you have)
  • Less stress of malpractice in case you have a good physician as a mentor
  • Unless you are practicing independently, as an NP, you tend to practice in primary care and make long-term relationships with your patients
  • Predictable hours (for most CRNPs): 40 hours per week

Although some disadvantages include having no surgical training and having a salary that is less than that of a physician, you will have an excellent knowledge of the human body and how to manage most ailments.

Should I Become a CRNP?

If you are a team player, enjoy educating patients, and make decisions as part of your day-to-day job, consider being a CRNP.

Finally, CRNPs have grown in the United States in the last decades from 15,000 in the 1970s to 250,000 in 2020.

Final Thoughts on Working as a Nurse Practitioner

Two people could read this ultimate guide to working as a nurse practitioner and have completely different reactions: One might immediately begin researching graduate nursing programs and nurse practitioner certifications, while the other might move on to exploring other nursing specialties. This discrepancy is perfectly normal because we all have different strengths, interests, and personality traits. Therefore, follow your instincts and strive to stay true to yourself.
That said, there is no better way to know what type of work you love than to experience working in different settings and roles. The best way to obtain this experience is to browse available PRN nursing jobs near you. Request as many as interest you, and begin exploring your nursing career options today!

Sources:

  1. The Path to Becoming a Nurse Practitioner
  2. The American Association of Nurse Practitioners
  3. Application Guide to Becoming a CRNP

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