Nurse Practitioner Career Paths

woman nurse taking patient vitals
nurse practitioner with patient

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.

NPs specialize in areas that allow them to narrow their focus on certain patient populations. Depending on their specialty, they might work with children, people who have diabetes, in acute care environments, or with other populations.

What Kind of Work Does a Nurse Practitioner Do?

Primary care responsibilities differ depending on the specialty, but 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 physicians’ offices, but there are also jobs for NPs in hospitals, rehabilitation centers, home healthcare, long-term care, universities, and more. NP roles are continuing to grow: the U.S. Bureau of Labor Statistics (BLS) predicts an astounding 46 percent growth in the field through 2032. That growth might include new opportunities for NPs in places like urgent care centers and corporate settings.

Nurse practitioners can work in many places, including physicians’ offices, hospitals, rehabilitation centers, long-term care, and more.

One of the most popular, and common, 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 (Doctor of Nursing Practice). “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).

An RN background gives nurses a base of knowledge that can help smooth the path to an advanced NP role.

“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.”

Jobs You Can Hold as a Nurse Practitioner

Part of what will determine your career path as a nurse practitioner is the specialty you choose:

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.

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: Act as a primary care provider for adults. You’ll perform exams, diagnose conditions, prescribe medication, and provide treatments.

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.

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

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.

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

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.

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’s Behind the Demand for Nurse Practitioners?

The BLS projects that over 112,000 NPs will join the workforce over the next nine years. Some of the growth can be tied to the overall growth in healthcare roles as the large baby boomer generation continues to age and need care. However, nurse practitioner job growth is projected to far outpace even the projected overall healthcare job growth rates.

The BLS projects that an additional 112,000 NPs will join the workforce over the next nine years.

This is especially true in rural areas, where the loss of one provider can mean community members have to travel much farther for healthcare. With fewer primary care physicians stepping into these rural primary care roles, there is ample opportunity for NPs willing to relocate.

“I have actually worked in a few rural communities, and you’re generally one of only a few healthcare providers out there,” says DeGarmo. “Then, if they retire, or a couple of them retire, you need people to fill those spots.”

Nurse practitioners are also filling the need left open by family physicians who often leave the field for other specialties.

“There is huge demand for primary care providers, like family medicine, but few physicians are choosing family medicine and staying in primary care,” says Sara Hunt DNP, MSN, FNP-C, PHN, a family nurse practitioner and health policy instructor. “The opposite is true for nurse practitioners. The majority of nurse practitioners specialize in primary care and the majority of nurse practitioners stay in primary care.”

Hunt also suspects the popularity of nurse practitioner study is growing with students, particularly since the course of study is shorter than that of a medical doctor (MD).

“They are seeing it as an attractive alternative to medical school, because there is great flexibility in work once you obtain an (advanced) RN license,” she says.

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 (MSN) degree to practice as an NP. MSN degrees have long been the standard in the profession, but there is a trend toward earning the more advanced DNP degree.

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 before 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.

You’ll need at least a Master of Science in Nursing (MSN) degree to practice as an NP.

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 2021, there are 24 states (plus Washington, D.C.) that allow NPs to practice independently:

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

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?

Nurse practitioners can earn considerably more than their RN counterparts, reflective of the additional education and responsibilities the job entails. The salary you can earn as an NP, however depends on the specialty you pursue, where you live, and regional demand.

An NP has considerably more responsibility than other nurses, such as RNs. Since you’ll often be serving as a patient’s primary care provider, you’ll need to be confident, authoritative, and able to sometimes make difficult decisions.

You Should Be:

  • Analytical
  • Compassionate
  • Supportive
  • Dependable
  • A clear communicator
  • Good-natured
  • An excellent listener

You Should Have:

  • Problem-solving skills
  • Computer skills
  • Good decision-making skills
  • Good ethical standards
  • Critical thinking skills
  • Good interpersonal relationship skills

Written and reported by:

Stephanie Srakocic

Contributing Writer

With professional insight from:

sara hunt

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

Family Nurse Practitioner

sean degarmo

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)