Nurse practitioners (NP) are advanced practice registered nurses (APRN) who are educated and

trained to provide health promotion and maintenance through the diagnosis and treatment of acute
illness and chronic condition. According to the International Council of Nurses, an NP/advanced
practice registered nurse is "a registered nurse who has acquired the knowledge base, decisionmaking skills, and clinical competencies for expanded practice beyond that of an RN, the
characteristics of which would be determined by the context in which he or she is credentialed to
practice."[1]
Contents
[hide]

1 Overview

2 History

3 Scope of practice
o

3.1 United States

4 Education, licensing, and board certification

4.1 United States

4.2 Australia

4.3 France

4.4 Other countries

5 Salary

6 Increasing need for NPs in the US

7 See also

8 References

9 External links

Overview[edit]
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Nurse practitioners (NPs) manage acute and chronic medical conditions, both physical and mental,
through history and physical exam and the ordering of diagnostic tests and medical treatments. NPs
are qualified to diagnose medical problems, order treatments, perform advanced procedures,
prescribe medications, and make referrals for a wide range of acute and chronic medical conditions
within their scope of practice. In addition to building upon and expanding their nursing knowledge
and skills, the nurse practitioner also learns medicine and uses medical diagnoses and medical
treatments in their practice. NPs work in hospitals, private offices, clinics, and nursing homes/long
term care facilities. Some nurse practitioners contract out their services for private duty.
In the United States, depending upon the state in which they work, nurse practitioners may or may
not be required to practice under the supervision of a physician. In consideration of the shortage of
primary care/internal medicine physicians, many states are eliminating "collaborative practice"
agreements and nurse practitioners are able to function independently.[2] NPsparticularly in the
area of primary care/internal medicinefulfill a vital need for patient healthcare services, and the
nurse practitioner works with physicians, medical/surgical specialists, pharmacists, physical
therapists, social workers, occupational therapists, and other healthcare professionals to achieve the
best outcomes for patients.
NPs may serve as a patient's primary healthcare provider and they may treat patients of all ages
depending upon their specialty. With commensurate education and experience, nurse practitioners
may specialize in areas such as cardiology, dermatology, oncology, pain management, surgical
services, orthopedics, women's health, and other specialties. Similar to all healthcare professions,
the core philosophy of the nurse practitioner role is individualized care that focuses on a patient's
medical issues as well as the effects of illness on the life of a patient and his or her family. NPs tend
to concentrate on a holistic approach to patient care, and they emphasize health promotion, patient
education/counseling, and disease prevention. The main classifications of nurse practitioners are:
adult (ANP); acute care (ACNP); gerontological (GNP); family (FNP); pediatric (PNP); neonatal
(NNP); and psychiatric-mental health (PMHNP). Adult-gerontology primary care nurse practitioner
(AGPCNP) is a classification that has recently evolved.
In addition to providing a wide range of healthcare services, nurse practitioners may
conduct research, teach, and are often active in patient advocacy and in the development of
healthcare policy at the local, state, and national level.

History[edit]
The advanced practice nursing role began to take shape in the mid-20th century United
States. Nurse anesthetists and nurse midwives were established in the 1940s, followed
by psychiatric nursing in 1954. The present day concept of the APRN as a primary care provider was
created in the mid-1960s, spurred on by a shortage of medical doctors. The first official training for
nurse practitioners was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965, with

a vision to help balance rising healthcare costs, increase the number of healthcare providers, and
correct the inefficient distribution of health resources.

Scope of practice[edit]
United States[edit]
In the United States, because the profession is state-regulated, care provided by NPs varies and is
limited to their education and credentials. Some NPs seek to work independently of physicians, while
in some states a collaborative agreement with a physician is required for practice. [3][4] The extent of
this collaborative agreement, and the role, duties, responsibilities, nursing treatments,
pharmacologic recommendations, etc. again varies widely amongst states of licensure/certification. [5]
[6][7]

practice.[8][9][10][11]

The "Pearson Report" provides a current state-by-state breakdown of the specific duties an NP may
perform in the state.[12] A nurse practitioner's role may include the following:

Medical diagnosis, treatment, evaluation, and management of a wide range of acute and
chronic diseases

Obtaining patient histories and conducting physical examinations

Ordering and performing diagnostic studies (e.g., lab tests, x-rays and EKGs)

Requesting physical therapy, occupational therapy, and other rehabilitation treatments

Prescribing drugs for acute and chronic illness (extent of prescriptive authority varies by state
regulations)

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 and long care facilities

Performing or assisting in minor surgeries and procedures (e.g., dermatological

biopsies/procedures, suturing, casting, etc.)

Counseling and educating patients on health behaviors, self-care skills, and treatment
options in coordination with occupational therapists and other healthcare providers.

Education, licensing, and board certification[edit]

United States[edit]
The path to becoming a nurse practitioner in the United States begins by earning a Bachelor of
Science in Nursing (BSN) or other undergraduate degree, and requires licensure as a registered
nurse (RN) and experience in the generalist RN role. Then, one must graduate from an accredited
graduate (MSN) or doctoral (DNP) program. The typical curriculum for a nurse practitioner program
includes courses in epidemiology; health promotion; advanced pathophysiology; physical
assessment and diagnostic reasoning; advanced pharmacology; laboratory/radiography diagnostics;
statistics and research methods; health policy; role development and leadership; acute and chronic
disease management (e.g., adults, children, women's health, geriatrics, etc.); and clinical rotations,
which varies depending on the program and population focus. Doctor of Nursing Practice (DNP)
programs include additional, advanced coursework in biostatistics; research methods; clinical
outcome measures; care of special populations; organizational management; informatics; and
healthcare policy and economics. DNP programs also require completion of a research
project/residency. Some nurse practitioners, as well as other APRN roles, may choose to pursue
the Doctor of Philosophy (PhD) as a terminal degree. The PhD in nursing focuses on nursing
research and nursing education, while the DNP focuses more on clinical practice.
There is an initiative to require the DNP as the entry level degree for all APRN roles, including the
nurse practitioner, nurse anesthetist, and nurse midwife. Those who have a MSN but are currently
practicing in an APRN role would be grandfathered into this change. Many universities have started
to phase out MSN programs in lieu of this expected change and have devised BSN-DNP programs.
NPs may elect to complete a postgraduate residency or fellowship. The majority of such programs
focus on primary care; however, specialized programs (e.g., acute care, emergency medicine,
cardiology, general surgery, etc.) also exist.
After completing the required education, the NP must pass a national board certifying exam in a
specific population focus: acute care, family practice, women's health, pediatrics, adultgerontology, neonatal, or psychiatric-mental health, which coincides with the type of program from
which he or she graduated. After achieving board certification, the nurse practitioners must apply for
additional credentials (e.g., APRN license, prescriptive authority, DEA registration number, etc.) at
the state and federal level. The nurse practitioner must achieve a certain amount of continuing
medical education (CME) credits and clinical practice hours in order to maintain certification and
licensure. NPs are licensed through state boards of nursing.

Australia[edit]

In Australia, NPs are required to be registered by the Australian Health Practitioner Regulation
Agency.[13] The Australian professional organisation is the Australian College of. (ACNP)

[14]

France[edit]
The first university diploma of nurse practitioner in France is open in 2015 sept. in "Paris 7
university". It concerns psychiatry and mental health nursing.

Other countries[edit]
There are nurse practitioners in over fifty countries world wide. Although credentials vary by country,
most NPs hold at least a master's degree worldwide.
As of November 2013, NPs were recognized legally in Israel. The law passed on November 21,
2013.[15] Although in the early stages, the Israeli Ministry of Health has already graduated two NP
classes - in palliative care and geriatrics. The law was passed in response to a growing physician
shortage in specific health care fields, similar to trends occurring worldwide.

Salary[edit]
The salary of a nurse practitioner depends on the area of specialization, location, years of
experience, level of education, and size of company. Currently, the annual average earning for a
nurse practitioner in the U.S. is $106,255.[16]

Increasing need for NPs in the US[edit]

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Employment of registered nurses and nurse practitioners is expected to increase immensely in the
next ten years. Much of the growth came from a result of increase in technology, resulting in better
health care and a greater variety of solutions for health problems. Also, life expectancy is getting
longer; therefore more patients are living longer and living more active lives. It is further anticipated
that the need for NPs will increase because of the passage of the Patient Protection and Affordable
Care Act (PPACA).[17][18][19]
Growth is also expected to be much faster in outpatient centers, where the patients do not stay
overnight. Moreover, the increasing number of procedures that were once only able to happen in
hospitals is now able to happen in physicians' offices. This is mainly because of the expansion and
easy access to new and better technology, though the need for NPs is expected to be greatest in
places where people have long-term illnesses such as dementia or head trauma patients that are in
need extensive rehabilitation.

"Nurse practitioners really are becoming a growing presence, particularly in primary care," said
David I. Auerbach, PhD, the author and a health economist at RAND Corp. In addition, this site says
that nurse practitioners are expected to double by 2025. Auerbach also told American Medical News,
"Theres a lot of experimentation going on looking at different ways of working together, and theres a
lot of interest in collaborative team-based models. The new care models, such as the patientcentered medical home and accountable care organizations, really depend on nurse practitioners
and physician assistants."[20]
As a result of the PPACA, hospitals and medical care facilities are forced to rethink the demand for
nurses and medical professionals. This is mainly because this new Act allows millions of people the
opportunity at medical attention that did not have it before, and because there are so many new
people in need of medical attention, the need for medical professionals also grows. With the
combination of this new Act, and the aging Baby Boomer population, there is expected to be a large
increase in the need for medical staff, especially nurse practitioners. According to a study published
in American Medical News, Nurse Practitioners jobs are expected to grow up to 130 percent from
86,000 in 2008 to 198,000 in 2025. Though there is some skepticism to these vast figures, they are
backed up by many studies and the opinions of very well known medical professionals. [21] As a result
of this extreme need for NPs, they are also expected to receive more autonomy, meaning that nurse
practitioners would be able to fill the traditional primary care role like a physician would. For an
example, a nurse practitioner would be able to prescribe medication without the oversight of a
doctor. Many states are passing laws that allow for independent practice of nurse practitioners.
"Currently there are 12 states with active legislation looking at utilizing nurse practitioners at the top
of their education to meet patient care needs," says Tay Kopanos with the American Association of
Nurse Practitioners. Many nurses and other leaders in healthcare are advocating for overturning
laws that require physicians to look over the work of NPs.[22]