Nurse Practitioner Career

Nurse practitioners are one of four classifications of advanced practice nurses (APNs). APNs are registered nurses who have advanced training and education. This training enables them to carry out many of the responsibilities traditionally handled by physicians. Some nurse practitioners specialize in a certain field, such as pediatrics, oncology, critical care, or primary care. The most common specialty is a family nurse practitioner who usually serves community-based health clinics. There are approximately 115,000 nurse prac­titioners employed in the United States.

Nurse Practitioner Career History

Nurse practitioners first appeared on the scene following World War II, partially in response to the acute shortage of physicians. In addition, there was an influx of former corpsmen who hoped to utilize their military training and experience to fill the void of medical practitioners.

Even prior to the establishment of the first training program for nurse practitioners at Duke University in 1965, nurses had performed simple but time-consuming tasks formerly regarded as the physician’s responsibility, such as taking blood pressures or administering intrave­nous feedings or medications. Those involved in the first nurse practitioner training program at Duke believed that nurse practitioners could perform many of the time-consuming tasks then restricted to physicians, thus free­ing up the physicians to handle more complex cases.

Nurse Practitioner CareerThe nurse practitioner has also fulfilled a need to focus more on health maintenance and illness preven­tion. In 1986, a study carried out by the U.S. Congress Office of Technology Assessment found that “within their areas of competence, nurse practitioners provide care whose quality is equivalent to that of care provided by physicians.” In preventive care and communication with patients, nurse practitio­ners were found to outperform doctors. Nurse practitioners are assuming an increasingly important role in the health care industry.

Nurse Practitioner Job Description

A nurse practitioner’s responsi­bilities depend on the work set­ting and area of specialization. A nurse practitioner may work in close collaboration with a physician at a hospital, health center, or private practice office. Sometimes, as in the case of rural health care providers, they many have only weekly telephone con­tact with a physician. Eighteen states allow nurse practitioners to function entirely independent of a physician. In all states, a nurse practitioner may write prescrip­tions, but a physician’s signature is often required to validate the prescription.

Family nurse practitioners are often based in community health clinics. They provide primary care to people of all ages, assess­ing, diagnosing, and treating common illnesses and injuries. Their interactions with patients have a strong emphasis on teach­ing and counseling for health maintenance. Nurse practitio­ners recognize the importance of the social and emotional aspects of health care in addi­tion to the more obvious physical factors.

Nurse practitioners in other specialties perform sim­ilar tasks, although they may work with different age groups or with people in schools or institutional settings. Just as physicians do, nurse practitioners select a field of specialization. A pediatric nurse practitioner provides pri­mary health care for infants through adolescents. Geron­tological nurse practitioners are often based in nursing homes and work with older adults. School nurse-practitio­ners work in school settings and provide primary health care for students. Occupational health nurse practitioners focus on employment-related health problems and inju­ries. Psychiatric nurse practitioners work with people who have mental or emotional problems. Women’s health care nurse practitioners provide primary care for women from adolescence through old age and may provide services from contraception to hormone replacement therapy.

Nurse Practitioner Career Requirements

High School

If you want to become a nurse practitioner, you will first need to become a registered nurse. To prepare for this career, you should take high school mathematics and sci­ence courses, including biology, chemistry, and physics. Health courses will also be helpful. English and speech courses should not be neglected because you must be able to communicate well with patients.

Postsecondary Training

You must be a registered nurse (RN) before you can become a nurse practitioner. There are three basic kinds of training programs that you may choose from to become a registered nurse: associate’s degree, diploma, and bachelor’s degree. Which of the three training pro­grams to choose depends on your career goals. A bache­lor’s degree in nursing is required for most supervisory or administrative positions, for jobs in public health agencies, and for admission to graduate nursing pro­grams. A master’s degree is usually necessary to prepare for a nursing specialty or to teach. For some specialties, such as nursing research, a Ph.D. is essential.

A master’s degree is required to become a nurse prac­titioner. Admission to good nurse practitioner programs is very competitive. Nurse practitioner programs last one to two years and provide advanced study in diagnostic skills, health assessment, pharmacology, clinical man­agement, and research skills. Usually the student begins with generalist work and later focuses on a specific nurse practitioner specialty.

Certification or Licensing

Not all states require nurse practitioners to be nationally certified; however, certification is strongly recommended by those in the profession. Certification in a variety of specialties is offered by such organizations as the Ameri­can Nurses Association, the American Academy of Nurse Practitioners, the Pediatric Nursing Certification Board, and the Society of Urologic Nurses and Associates. Cer­tification typically involves passing a written exam, and requirements for recertification usually include com­pleting a certain amount of continuing education. Exact requirements vary according to the certifying group.

All states and the District of Columbia require a license to practice nursing. To obtain a license, gradu­ates of approved nursing schools must pass a national examination. Nurses may be licensed by more than one state. In some states, continuing education is a condition for license renewal.

State requirements for licensing and registration of nurse practitioners vary. All states except Georgia license them to prescribe medications independently, although some states have restrictions regarding the prescription of controlled substances. For specifics, contact your state’s nursing board. (See the National Council of State Boards of Nursing Web site at for contact information.)

Other Requirements

To be a good nurse practitioner you should enjoy work­ing with people and be strongly committed to making a positive difference in people’s lives. You must develop excellent communication skills and should have patience, flexibility, and the ability to remain calm in an emer­gency. Since you may work independently much of the time, you need to be able to take active responsibility in health care situations and have good judgment regard­ing these situations. Your role will be strongly focused on health maintenance and prevention, so you should enjoy teaching and counseling as well.

Exploring Nurse Practitioner Career

The Internet is a helpful research tool to learn more about nursing careers. Visit the Web sites of nursing programs and professional associations for tips on planning your education and career goals. In addition to your research, talk to people about your interest in nursing. Your school’s career guidance counselor can give you advice on picking a nursing program and may even help you find contacts in the medical field. Visit a local hospital or other medical facility and ask if you can speak to a member of the nurs­ing staff about his or her career. If the facility accepts vol­unteers, don’t hesitate to sign up. Hands-on experience is the number one way to explore a career in health care.


Approximately 115,000 nurse practitioners are employed in the United States. They are employed in hospitals, clin­ics, physicians’ offices, community health centers, rural health clinics, nursing homes, mental health centers, educational institutions, student health centers, nursing schools, home health agencies, hospices, prisons, indus­trial organizations, the U.S. military, and other health care settings. In the states that allow nurse practitioners to practice independently, self-employment is an option.

The particular specialty a nurse practitioner pursues obviously is a major factor in determining their employ­ment setting. Another important factor is the degree of autonomy they desire. Nurse practitioners in remote rural areas have the most autonomy, but they must be willing to spend a lot of time on the road visiting patients who are unable to get to the clinic, to be on call at all hours, and to make do with less than optimal facilities and equipment.

Starting Out

The placement office of your nursing school is a good place to begin the employment search. Contacts you have made in clinical settings during your nurse practitioner program are also useful sources of information on job opportunities. Nursing registries, nurse employment services, and your state employment office have infor­mation about available jobs. Nursing journals and news­papers list openings. If you are interested in working for the federal government, contact the Office of Personnel Management for your region. Applying directly to hos­pitals, nursing homes, and other health care agencies is also an option for nurse practitioners.


Nurse practitioners have many avenues for advancement. After gaining experience, they may move into positions that offer more responsibility and higher salaries. Some choose to move into administrative or supervisory posi­tions in health care organizations or nursing schools. They may become faculty members at nursing schools or directors of nursing at hospitals, clinics, or other health agencies.

Some advance by doing additional academic and clinical study that gives them certification in specialized fields. Those with an interest in research, teaching, con­sulting, or policy making in the nursing field would do well to consider earning a Ph.D. in nursing.


Geographic location, experience, and specialty area of practice are all factors that influence salary levels for nurse practitioners. The U.S. Department of Labor reports the median annual income for registered nurses as $48,090 in 2002. NPs, however, tend to earn more than this amount. According to Nurse Practitioner Support Services, an online information provider, nurse practitio­ners (including all specialties) working full-time averaged an annual income of $71,140 in 2003. According to the 2003 National Salary Survey done by Advance for Nurse Practitioners, a news magazine for NPs, the average sal­ary for nurse practitioners (all specialties) was $69,203.

Details of the survey show that average salaries vary by specialties and settings. For example, NPs working in their own private practice earned on average $94,313, and those specializing in emergency department medi­cine earned $80,697 annually. At the other end of the pay scale, however, were NPs working in family practice, who averaged $66,276, and those in college health service settings, who averaged $56,725 annually. The survey also found that NPs working in New Jersey had the highest average earnings by state, making $78,214. Some practi­tioners earned even more than this amount, with salaries in the $100,000s.

Full-time nurse practitioners’ benefits may vary by employer. For example, those in their own practices must provide their own retirement plans. Generally, though, NPs employed by hospitals, clinics, and schools receive health insurance, paid vacation and sick days, and retire­ment plans. Some employers also pay for continuing education.

Work Environment

The work environment depends on the nurse practitio­ner’s specialty. Some work in remote, rural settings in small, local health care clinics. Others work in modern hospitals or nursing homes. Some nurse practitioners may work with patients who are fearful of any type of health care provider or who may have never been to a clinic before. Some patients may resent being seen by “just a nurse” instead of the doctor. Others may work with medical staff who are uncooperative and who feel threatened by the role of the nurse practitioner. All of these situations require tact, patience, and maturity. Nurse practitioners must often work long and incon­venient hours, especially if they are involved in rural health care.

Nurse Practitioner Career Outlook

The U.S. Department of Labor predicts employment for registered nurses to grow faster than the average through 2012, and the job outlook for nurse practitioners is espe­cially good. One reason for this is that the nurse practi­tioner is increasingly being recognized as a provider of the high-quality yet cost-effective medical care that the nation’s health care system needs. In addition, more and more people are recognizing the importance of preven­tive health care, which is one of the nurse practitioner’s greatest strengths. There should be an especially strong demand for gerontological nurse practitioners as the per­centage of the U.S population in the over-65 age group increases.

Some health care professionals report increasing frus­tration with recent cutbacks in the health care industry that make it difficult to persuade insurance companies to approve some health care treatments. However, nurse practitioner organizations are working to promote leg­islation that will increase the degree of autonomy avail­able to nurse practitioners and make it easier for them to receive insurance company reimbursement. This should make the profession an even more attractive advance­ment route for RNs.

For More Information: