Nurse Practitioner Career Paths

Nurse practitioner is fast becoming a popular nursing career choice. Learn what you’ll do on the job.

woman nurse taking patient vitals
woman nurse taking patient vitals

Nurse practitioners (NPs) are advanced practice registered nurses who provide primary care. Their advanced education allows them to take on some tasks generally associated with physicians, such as diagnosing conditions, treating illness or injury, and prescribing medications. In communities with limited healthcare access, especially rural communities, NPs often serve as primary care providers for the area.

NPs specialize in areas that allow them to work with a variety of patients. Popular NP specialties include:

  • Acute care nurse practitioner
  • Adult nurse practitioner
  • Adult gerontology acute care nurse practitioner
  • Adult gerontology primary care nurse practitioner
  • Adult psychiatric mental health nurse practitioner
  • Family nurse practitioner
  • Gerontological nurse practitioner
  • Pediatric primary care nurse practitioner
  • Psychiatric mental health nurse practitioner
  • School nurse practitioner

You’ll need at least a Master of Science in Nursing (MSN) degree to work as an NP (although by 2025 the Doctor of Nursing Practice—or DNP—will be the standard.) No matter what path you take, your program will prepare you to work in the specialty you choose.

What Kind of Work Does a Nurse Practitioner Do?

Nurse practitioners provide primary care to patients in their area of specialty. Primary care will look a little different depending on what your specialty is, but it will generally include:

  • Performing patient assessment and exams
  • Reading patient test results
  • Diagnosing conditions
  • Prescribing medications
  • Treating illness and injury
  • Providing patient health education

Many NPs work in physician offices. There are also jobs for NPs in hospitals, rehabilitation centers, home healthcare, long-term care, universities, and more.

Strong 10-year Job Growth Predicted for NPs

NP roles are continuing to grow well above the average job growth rate. The U.S. Bureau of Labor Statistics (BLS) predicts an astounding 52% growth in the field by 2029. That growth might include new opportunities for NPs in places like urgent care centers and corporate settings.

52%

Nurse practitioner job growth by 2029 per the U.S. Bureau of Labor Statistics

One of the most popular, and common, nurse practitioner specialties is family nurse practitioner, or FNP.

“This offers the most career flexibility and broadest scope of practice,” says Sara Hunt, DNP, MSN, FNP-C, PHN, a health policy instructor who is also a family nurse practitioner and holds a DNP. “You are trained to care for people throughout the lifespan, from newborns, children, adults, pregnancy, and through the dying process.”

Are Nurse Practitioners Registered Nurses?

A nurse practitioner is an advanced practice registered nurse (APRN). That means an NP is an RN with advanced education and more job responsibilities. NPs have more autonomy and a wider scope of practice than RNs. However, many NPs start as RNs and incorporate their RN experience into their role as an NP. It’s not necessary to work as RN before earning your NP license, but it can help, according to Hunt.

“The extent that it will help depends on your experience and NP specialty and if they are in alignment,” explains Hunt. “ICU experience would be excellent if you planned on working in the ICU as an NP, but it’s not going to be particularly helpful if you plan on specializing in, say, dermatology.”

An RN background gives nurses a base of knowledge that can help smooth the path to an advanced NP role, explains Sean DeGarmo, PhD, RN, ENP-BC, FNP-BC, ACNS-BC and director of APRN Initiatives for the American Nurses Association’s (ANA) American Nurses Credentialing Center (ANCC).

“You’re taking that prior nursing knowledge of treating the human response, and you’re adding the advanced knowledge of treating the disease process,” says DeGarmo. “So you’re treating at 360 degrees. You’re treating both.”

What Career Paths Can I Take as a Nurse Practitioner?

Part of what will determine your career path as a nurse practitioner is the specialty you choose. Check out some popular focuses below to see where your NP career could take you.

Acute care nurse practitioner


Where you’ll work: Emergency rooms, trauma units, and urgent care centers

What you’ll do: Diagnose and treat injuries and illness. You’ll provide direct care from the time a patient is admitted until they are discharged. This might include stabilizing patients with serious injuries who are experiencing medical emergencies like a stroke.

Specialty certification(s) you’ll need: The Acute Care Nurse Practitioner Certification (ACNP-BC) from the ANCC or the ACNPC-AG from AACN.

Other things you should know: You’ll also provide education to family members of patients in this role and help them decide on any next steps.

Adult nurse practitioner


Where you’ll work: Physicians’ offices, corporate offices, urgent care centers, hospitals

What you’ll do: You’ll provide care during medical emergencies for adults, including geriatric patients. You’ll respond to acute illnesses and injuries and provide exams, diagnoses, and treatments.

Specialty certification(s) you’ll need:

The ANCC no longer offers an adult NP certification. However, you can earn the Adult-Gerontology Primary Care Nurse Practitioner Certification  (AGPCNP-BC) to practice in this specialty.

Other things you should know: This is generally a primary care role. You might find work in rural communities, where you’ll act without the supervision of a physician in many cases.

Adult gerontology acute care nurse practitioner


Where you’ll work: Urgent care centers and hospitals

What you’ll do: You’ll provide care during medical emergencies for adults, including geriatric patients. You’ll respond to acute illnesses and injuries and provide exams, diagnoses, and treatments.

Specialty certification(s) you’ll need: You can earn either the Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC) from ANCC or the AGACNP-BC from AACN.

Other things you should know: You’ll be trained to handle the specific care needs of older adults with this specialty. For example, falls are generally much more serious for older adults than middle-aged or younger adults.

Adult gerontology primary care nurse practitioner


Where you’ll work: Physician’s offices, corporate offices, urgent care centers, hospitals

What you’ll do: You’ll be a primary care provider for adults, including geriatric patients.

Specialty certification(s) you’ll need: The Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC).

Other things you should know: You might also see patients in long-term care facilities with this specialty.

Psychiatric-mental health nurse practitioner


Where you’ll work: Mental health offices, psychiatric hospitals

What you’ll do: Assess patients to diagnosis mental health conditions, determine a plan of treatment, prescribe medications as appropriate, provide patient counseling.

Specialty certification(s) you’ll need: The Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) from AANC allows you to treat patients of all ages.

Other things you should know: Twenty-three states allow NPs to open their own practices. This means, in those states, you could have your own office where you’ll see patients and provide counseling and treatment.

Family nurse practitioner


Where you’ll work: Physicians’ offices, hospitals

What you’ll do: Work with patients of all ages as a primary care provider. You’ll do exams, diagnose any conditions, provide treatments, and prescribe medications.

Specialty certification(s) you’ll need: You can choose either the Family Nurse Practitioner Certification (FNP-BC) from ANCC or the Family NP certification from the American Academy of Nurse Practitioners Certification Board.

Other things you should know: This is the most common NP specialty, since it allows for such a broad scope of practice.

Gerontological nurse practitioner


Where you’ll work: Hospitals, physicians’ offices, urgent care centers, rehabilitation centers, long-term care centers

What you’ll do: You’ll act as a primary care provider for older adults. You’ll assess, diagnose, and treat conditions with a focus on conditions that affect older adults.

Specialty certification(s) you’ll need: ANCC no longer offers a specific certification in gerontological nursing. However, you can earn the Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC).

Other things you should know: You’ll study conditions that primarily affect older adults in your program. You’ll also learn about long-term care and end-of-life care.

Pediatric primary care nurse practitioner


Where you’ll work: Physicians’ offices, schools, hospitals

What you’ll do: You’ll see pediatric patients from infancy through their teen years. You’ll perform exams, diagnose any conditions, and recommend treatments. You’ll also prescribe medications and provide education.

Specialty certification(s) you’ll need: The Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC) exam from the Pediatric Nursing Certification Board (PNCB).

Other things you should know: You’ll be a provider of care during life milestones. You’ll give vaccinations and make sure children are developing and growing healthily.

What Education Will I Need to Become a Nurse Practitioner?

woman medical professional talking to female patient

You’ll need at least a Master of Science in Nursing, or MSN, to earn licensure as an NP. MSN degrees have long been the standard in the profession, but there is a move toward the more advanced DNP degree.

DNP degrees have been recommended by the American Association of Colleges of Nursing (AACN) since 2004, and in 2018 the National Organization of Nurse Practitioner Faculties (NONPF) committed to DNPs as an entry-level standard for NPs by 2025.

This means that right now you can choose whether you want to earn an MSN or DNP degree. However, in the future, DNPs are likely to become the standard. No matter what path you take, your first step will be to earn an RN license. You’ll need an RN license in good standing to enter any NP program, and many will want you to have a few years of clinical RN experience when you apply. From there, you’ll need to earn an advanced degree, take an exam in your specialty, and apply for licensure in your state.

The steps will vary a little depending on your background, program, specialty, and state. However, you’ll generally need to:

1. Choose an MSN or DNP program

You can enter an MSN program with either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). You’ll need a BSN or MSN to enter a DNP program. An MSN will take two to three years, while a DNP will take three to six.

2. Take a certification exam in your specialty

The exam you’ll need depends on your specialty. Most NP certification exams are offered by either the American Association of Nurse Practitioners Certification Program (AANPCP) and the American Nurses Credentialing Center (ANCC). However, pediatric and women’s health nurse practitioners can earn certification from the Pediatric Nursing Certification Board (PNCB) and National Certification Corporation (NCC).

3. Apply for licensure from your state

You’ll need to apply for licensure from your state before you can begin working as NP. You’ll need to pay any required fees and send in proof of your exam results and education. You’ll also need to maintain your license through continuing education and clinical practice hours.

Which States Allow Nurse Practitioners to Practice Independently?

In some states, nurse practitioners can open their own office and see patients without a physician present. In other states, an NP needs to work under the supervision of a physician. In these states, NPs often work in large offices owned by a physician. They see patients independently but are employed by or work under a physician. As of 2020, there are 23 states that allow NPs to practice independently:

  • Alaska
  • Nebraska
  • Arizona
  • Nevada
  • Colorado
  • New Hampshire
  • Connecticut
  • New Mexico
  • District of Columbia
  • North Dakota
  • Hawaii
  • Oregon
  • Idaho
  • Rhode Island
  • Iowa
  • South Dakota
  • Maine
  • Vermont
  • Maryland
  • Washington
  • Minnesota
  • Wyoming
  • Montana

Your state also regulates the “prescriptive authority” you have as an NP. Prescriptive authority is your ability to prescribe medication. In some states, NPs have full prescriptive authority, while other states restrict things like the ability to prescribe controlled substances. For example, Pennsylvania, North Carolina, and Illinois only allow NPs to prescribe up to a 30-day supply of schedule II controlled substances. These include fentanyl, hydromorphone, methadone, and oxycodone.

What Can I Expect to Earn?

According to the BLS, the average annual NP salary is $111,840. That’s significantly more than RNs, who earn an average of $77,460, and comparable to physician assistants, who earn an average of $112,410. Your salary can vary. The BLS reports that the lowest-paid 10% of NPs earn an average of $81,410, while the highest 10% earn an average of $152,160.

NP average annual salary

$111,840

Lowest 10% earned $81,410

Highest 10% earned over $152,160

Source: U.S. Bureau of Labor Statistics Occupational Employment Statistics

Where will you fall in that range? It depends. Your salary as an NP can depend on multiple factors such as your degree, experience, specialty, employer, and location.


stephanie behring

Written and reported by:

Stephanie Behring

Contributing writer

With professional insight from:

sara hunt

Sara Hunt, DNP, MSN, FNP-C, PHN

Family Nurse Practitioner and Health Policy Instructor

Sean DeGarmo, PhD, RN, ENP-BC, FNP-BC, ACNS-BC

Director of APRN Initiatives for the American Nurses Association’s (ANA) American Nurses Credentialing Center (ANCC)


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