What’s the Difference Between a Registered Nurse and a Nurse Practitioner?

Written and reported by:

Stephanie Behring

Contributing Writer

registered nurse and nurse practitioner talking
registered nurse and nurse practitioner talking

Registered nurses (RNs) and nurse practitioners (NPs) both provide patient care, but there are significant differences between these two important nursing roles. While RNs provide direct care to patients in a variety of settings, NPs hold a graduate degree and can take on additional tasks such as diagnosing patients and, in many states, prescribing medication.

“Nurse practitioners focus on health promotion and illness prevention to inform their practice as an independent healthcare provider,” says Erin M. Alving, MSN, ARNP, CDCES, a pediatric nurse practitioner and diabetes educator at Seattle Children’s Hospital. “One can build on the physical assessment skills and patient care interactions learned as a registered nurse to strengthen their nurse practitioner practice.”

RN and NP Roles and Responsibilities

Registered nurses can be found in just about every healthcare setting and provide direct care to patients. Responsibilities can vary widely depending on where you work.

“Many of your daily responsibilities or duties as a nurse are going to depend largely on your specialty or what floor you work on,” says Alaina Ross, RN, BSN, a full-time RN with more than 10 years of experience. “For example, an ICU nurse is going to have a very different set of daily tasks than a school nurse,” Ross says.

However, there are some duties RNs share across specialties and workplaces, such as:

  • Counseling patients and their family members
  • Checking patient vitals
  • Administering medications
  • Charting patient data and behavior
  • Managing other medical professionals, such as CNAs, medical assistants, and nurse aides

“But I would just say that your greatest responsibility, no matter what, is patient care,” says Ross. “As an RN, you’re the primary point of contact for a patient in any setting, so making sure patients feel comfortable, safe, and at ease is your biggest duty.”

Nurse practitioners have an advanced scope of practice and can take on a wider range of duties. They can act as primary care providers in a variety of settings and specialties. In some states, NPs even run their own medical offices. This can make care more accessible for people who have trouble accessing large medical practices, such as those who live in rural areas or underserved urban areas. NPs deliver primary care from a nursing perspective that is focused on education, wellness, and preventive measures.

The exact responsibilities of an NP will depend on their specialty, work setting, and state. While many states allow NPs to work completely independently, some states require NPs to work under the supervision of a physician. Similarly, some states grant NPs prescriptive authority (the ability to write prescriptions for medications) but other states do not.

Typical responsibilities of NPs across states and specialties include:

  • Providing primary care to patients within the scope of practice allowed in their state
  • Diagnosing illnesses, injuries, and infections
  • Performing in-office treatments for acute injuries and infections
  • Ordering and reviewing the results of diagnostic tests, such as electrocardiograms (EKGs) and X-rays
  • Gathering thorough patient data for patient records
  • Designing treatment plans for each patient
  • Educating patients about their health
  • Prescribing medication in states that grant prescriptive authority to NPs

Direct Care Vs. Primary Care: What’s The Difference?

One of the biggest differences between RNs and NPs is that RNs are responsible for direct patient care, while NPs are responsible for primary patient care. What makes each type of care distinct? Direct care is care patients receive to address a need, relieve pain, or treat a condition. For example, when an RN cleans and applies prescription creams to a wound before carefully covering it, they are providing direct care. 

Primary care is care that assesses, diagnoses, and orders treatments for injuries or illnesses. When an NP diagnoses a patient and writes a prescription, they are providing primary care. Often, primary care and direct care go hand-in-hand. An NP providing primary care might write prescriptions for a medication or treatment, and an RN providing direct care might administer medication or treatment.

Workplaces

You likely think of hospitals or medical offices when you think of workplaces for either RNs or NPs. While those standard workplaces are always an option, they’re not your only choice.  RNs and NPs can find work in a wide variety of healthcare settings.

RNs can find work in:

  • Hospitals
  • Specialty clinics
  • Health systems
  • Medical offices
  • Mental health facilities
  • Rehabilitation facilities
  • Community health clinics
  • Home healthcare agencies
  • Long-term care facilities
  • Urgent care centers
  • Health insurance companies
  • Law offices
  • Correctional facilities
  • Colleges and universities
  • Schools
  • Athletic facilities

NPs can find work in:

  • Hospitals
  • Specialty hospitals
  • Health systems
  • Medical offices
  • Independent practice
  • Community health clinics
  • Long-term care facilities
  • Urgent care centers
  • Health insurance companies
  • Corporations and industrial complexes

Experienced NPs can also find work in specialty care centers. Specialty care is healthcare that goes in-depth on a specific condition. This is different from primary care, which is focused on overall health and wellness.

“NPs have many opportunities in specialty care in addition to primary care,” says Alving. “For example, my practice is in the specialty of pediatric endocrinology. Most of my colleagues also work in specialty care.”

Specialties

RNs and NPs specialize in different areas of care. For RNs, this often means specializing in patient care delivered in a specific unit or medical setting. For NPs, this means specializing in the population you’ll provide care to.

Common RN specialists and the type of care they provide:

Unlike RNs, NPs are required to choose a specialty before they can earn licensure. Some common NP specializations and the care they provide:

  • Family nurse practitioners (FNP)s provide primary care to patients of all ages and offer education, counseling, and more to the patients they see.
  • Adult nurse practitioners provide primary care such as assessments, diagnoses, and treatments for adults.
  • Geriatric nurse practitioners work with older adults and their families by providing primary care and education.
  • Pediatric nurse practitioners provide primary care to children ranging from a few months old to teenagers.
  • Neonatal nurse practitioners provide advanced care in labor and delivery units and in neonatal ICUs.
  • Women’s health nurse practitioners provide primary care with an emphasis on reproductive and gynecological health.
  • Acute care nurse practitioners provide advanced care to injured or ill patients in hospital or urgent care settings.

What Degree does Each Job Require?

There are a few paths to nursing licensure at either the RN or the NP level. Aspiring RNs can choose from an Associate Degree in Nursing (ADN) or Bachelor of Nursing Science (BSN) degree. Either degree will prepare you to take the NCLEX-RN and apply for licensure in your state. The path to RN licensure is up to you. An ADN can generally be earned in half the time and might be much less expensive. However, a BSN might prepare you for higher-level roles and help you advance your career.

RNs can earn an ADN or a BSN. An NP must hold a master’s or doctoral degree.

Conversely, you’ll need at least a Master of Science in Nursing (MSN) degree to earn NP licensure, and it’s not uncommon to earn a Doctor of Nursing Practice (DNP) degree. In fact, it’s likely that a DNP will soon be required.

Several nursing organizations, including the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties (NONPF), have announced support for the DNP becoming the entry-level degree for NPs in the near future.

For now, you can choose either an MSN or DNP as a path to NP licensure. You’ll need an RN license in good standing to enter an MSN program. Some programs will ask that you have a BSN, but some schools offer RN-to-MSN bridge programs that allow students with ADNs to enroll.

You can also go directly from a BSN to a doctorate through a BSN-to-DNP bridge if you know that’s the path you want to take. Once you figure out the structure and program that works for you, you can choose a specialty and begin your NP education.

You don’t always need years of RN experience to enter an MSN or DNP program, but it can be a huge help.

“Most NPs have some RN experience,” says Alving. “For me, having some RN experience was important in preparing me for the NP role. However, there are many talented and competent NPs who were direct entry into NP programs with no RN experience.”

Licenses and Certifications

Both RNs and NPs need to be licensed before they can work.

Pathways

Becoming an RN:

  1. Earn your ADN or BSN degree
  2. Take the NCLEX-RN
  3. Apply for licensure in your state

Becoming an NP:

  1. Earn your RN license
  2. Earn your MSN and/or DNP degree
  3. Take a certification exam in your specialty
  4. Apply for licensure in your state

RN Requirements

RNs must complete an educational program, pass the NCLEX-RN exam, and get licensed before they can practice. Most states will also ask for information such as a criminal background check and complete educational record when you apply for licensure. Once you’re working, you’ll need to take steps to maintain your RN license through continuing education classes.

RNs aren’t required to earn specific certifications. However, there are multiple certifications available, and earning them is a smart career move. Certification is a great way to prove your dedication and demonstrate your education and skills to employers. They can help you advance your career.

The right certification for you is often the one best aligned with your specialty. There are certifications for critical care RNs, emergency room RNs, operating room RNs, and more.

NP Requirements

NPs need to complete their MSN or DNP and then take the certification exam for their specialty. Certifications are offered by the American Association of Nurse Practitioners Certification Program (AANPCP), American Nurses Credentialing Center (ANCC), Pediatric Nursing Certification Board (PNCB), and National Certification Corporation (NCC).

Once you’ve taken and passed the certification exam in your specialty, you can apply for licensure in your state. In some states, you’ll need to apply separately if you want prescriptive authority. You’ll then need to maintain both your certification and your state license to keep working as an NP. Requirements vary by certification and state, but normally involve both clinical practice and continuing education hours.

RN and NP Salaries

Both RNs and NPs are in high demand and are well paid for their education and experience. RNs earn a median income of $77,600, according to the U.S. Bureau of Labor Statistics (BLS). As you might imagine, NPs earn significantly more, thanks to their advanced responsibilities and education. You can compare median annual salaries nationally or by state below.

Registered Nurses

National data

Median Salary: $77,600

Projected job growth: 9%

10th Percentile: $59,450

25th Percentile: $61,790

75th Percentile: $97,580

90th Percentile: $120,250

Projected job growth: 9%

State data

State Median Salary Bottom 10% Top 10%
Alaska $99,110 $77,450 $127,020
Alabama $60,510 $47,390 $78,670
Arkansas $61,530 $47,510 $79,440
Arizona $78,260 $60,750 $100,200
California $125,340 $78,070 $165,620
Colorado $78,070 $60,550 $100,870
Connecticut $83,860 $61,470 $110,580
District of Columbia $95,220 $62,700 $129,670
Delaware $75,380 $59,900 $99,780
Florida $75,000 $49,680 $95,630
Georgia $75,040 $58,400 $98,410
Hawaii $111,070 $75,380 $129,670
Iowa $61,790 $48,290 $79,260
Idaho $75,560 $59,640 $98,030
Illinois $77,580 $59,640 $100,650
Indiana $62,400 $48,400 $90,260
Kansas $61,790 $47,630 $79,360
Kentucky $62,480 $48,000 $82,410
Louisiana $64,450 $48,920 $94,360
Massachusetts $94,960 $61,180 $151,310
Maryland $78,350 $60,420 $101,650
Maine $75,040 $59,640 $98,780
Michigan $76,710 $60,120 $98,510
Minnesota $79,100 $60,850 $101,610
Missouri $61,920 $47,350 $94,690
Mississippi $60,790 $47,210 $78,670
Montana $75,000 $60,320 $97,260
North Carolina $72,220 $51,420 $95,360
North Dakota $73,250 $59,810 $95,360
Nebraska $64,000 $55,040 $84,910
New Hampshire $77,230 $59,900 $99,580
New Jersey $94,690 $70,920 $117,990
New Mexico $78,340 $60,320 $98,660
Nevada $79,360 $61,790 $119,530
New York $96,170 $61,260 $127,080
Ohio $74,080 $59,540 $94,690
Oklahoma $62,170 $47,960 $79,940
Oregon $99,410 $76,180 $127,680
Pennsylvania $76,940 $59,640 $98,680
Rhode Island $78,900 $61,340 $101,650
South Carolina $72,650 $47,860 $86,820
South Dakota $60,550 $47,470 $77,360
Tennessee $62,390 $48,190 $81,950
Texas $77,320 $59,780 $99,070
Utah $75,000 $59,640 $95,160
Virginia $76,900 $59,170 $100,990
Vermont $75,380 $59,640 $98,030
Washington $96,980 $74,070 $127,320
Wisconsin $76,560 $60,060 $98,970
West Virginia $62,390 $47,450 $87,440
Wyoming $75,000 $59,650 $98,140

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2030. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Nurse Practitioners

National data

Median Salary: $120,680

Projected job growth: 52.2%

10th Percentile: $79,470

25th Percentile: $99,540

75th Percentile: $129,680

90th Percentile: $163,350

Projected job growth: 52.2%

State data

State Median Salary Bottom 10% Top 10%
Alaska $123,140 $48,670 $164,840
Alabama $99,750 $76,290 $128,460
Arkansas $99,910 $77,770 $130,770
Arizona $121,070 $95,850 $162,820
California $149,910 $103,910 N/A
Colorado $102,370 $78,230 $131,970
Connecticut $125,360 $79,470 $163,710
District of Columbia $121,470 $96,420 $164,900
Delaware $121,470 $90,280 $152,130
Florida $101,110 $61,990 $130,630
Georgia $101,690 $77,660 $141,880
Hawaii $131,000 $80,130 $167,750
Iowa $121,470 $94,590 $163,080
Idaho $102,060 $47,490 $152,710
Illinois $122,960 $97,950 $141,200
Indiana $104,020 $96,040 $131,000
Kansas $100,590 $78,480 $128,550
Kentucky $100,260 $78,380 $130,630
Louisiana $103,610 $77,940 $152,960
Massachusetts $128,160 $98,860 $167,980
Maryland $104,550 $95,710 $141,140
Maine $119,550 $96,040 $135,150
Michigan $102,060 $94,430 $130,630
Minnesota $127,690 $92,710 $163,360
Missouri $101,180 $61,820 $129,510
Mississippi $101,840 $77,940 $154,130
Montana $122,100 $96,040 $130,630
North Carolina $102,370 $95,460 $133,790
North Dakota $103,550 $95,970 $129,970
Nebraska $103,340 $93,020 $133,840
New Hampshire $121,070 $96,040 $153,070
New Jersey $129,240 $100,660 $163,420
New Mexico $121,070 $78,660 $159,790
Nevada $127,620 $95,530 $164,070
New York $128,220 $96,420 $167,750
Ohio $103,310 $95,280 $135,180
Oklahoma $109,660 $80,280 $152,130
Oregon $127,690 $96,040 $165,520
Pennsylvania $106,700 $84,940 $165,900
Rhode Island $125,540 $96,550 $167,750
South Carolina $100,020 $76,490 $130,200
South Dakota $102,060 $80,650 $129,270
Tennessee $99,630 $48,060 $129,510
Texas $121,010 $81,160 $154,080
Utah $105,220 $60,280 $163,350
Virginia $102,860 $78,660 $152,130
Vermont $101,790 $78,690 $152,920
Washington $128,980 $98,500 $164,900
Wisconsin $121,310 $97,090 $131,100
West Virginia $100,020 $77,720 $129,480
Wyoming $102,370 $93,720 $148,870

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2030. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

No matter which path you choose, nurses are in demand. The BLS is predicting 9% growth in RN roles by 2030. Some specialties are likely to see an even higher demand.

NPs are predicted to see even faster growth: a massive 52% increase in roles by 2030, according to the BLS. Primary care roles are opening up all around the country, and NPs will be needed to fill them.

Do RNs and NPs Ever Work Together?

RNs and NPs sometimes work together to provide quality patient care. This can happen in a variety of settings and situations.

“Similar to how MDs and RNs work together, NPs take on the medical decision making while RNs support patient care and carry out the medical plan,” says Alving.

“Not every RN works alongside nurse practitioners,” adds Ross, “but it does happen frequently in many settings. A lot of NPs work in family medicine or alongside internists, so the RNs in these settings often work with NPs daily. It’s not uncommon at all to see RNs working in tandem with NPs in family medicine private practices and urgent care centers.”

The right path for you is a personal decision. You might consider factors such as the time and money you’re able to dedicate to your education, the types of nursing roles you want to hold, and the type of care you want to provide. It’s also a good idea to consider if an RN role or NP role is a better fit for your skill and personality.

“In my opinion, the best (RNs) are the ones that are organized, confident, and pay attention to the details,” says Ross. “So much of nursing is process-based, meaning working off checklists, and you can’t miss a single step. You must be detail-oriented and not mind charting. In addition, sometimes you need to make quick decisions and respond to difficult situations, so you have to be analytical and confident. You’ve got to be able to use your best judgment and move swiftly without trying to make everyone happy.”

As for NPs, Alving says, it’s important to have strong problem solving and leadership skills, medical acumen, and a sense of inquiry. “Additionally, self-driven individuals who want to expand their medical knowledge and continue lifelong learning do best.”


With professional insight from:

erin alving

Erin M. Alving, MSN, ARNP, CDCES

Pediatric Nurse Practitioner and Certified Diabetes Educator

alaina ross

Alaina Ross, RN, BSN

Registered Nurse



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