What Does it Take to Become a Family Nurse Practitioner (FNP)?

Family nurse practitioners care for their patients from infancy to old age.

nurse practitioner high fiving smiling young patient with parent
nurse practitioner high fiving smiling young patient with parent

Much like a primary care physician, family nurse practitioners (FNPs) care for patients over their lifespans, from infancy through adulthood.

“It’s a step up from a traditional registered nurse role,” says Joel Shouse, FNP-C, a family nurse practitioner who works at Allergy and Asthma Care of Indiana, a multi-office specialty clinic located in Central Indiana. “We can make diagnoses, order and interpret labs, and prescribe medications. In some states, family nurse practitioners can even open their own practices.”

While some nursing schools allow students to study straight through undergraduate to graduate school, others require students to have one to two years of registered nursing experience before returning to school to be a family nurse practitioner.

That’s the route Shouse took, working for 12 years as a registered nurse (RN) in various health care settings—intensive care, cardiac intensive care, and emergency room care—before deciding to further his education and become a nurse practitioner. It’s a path he recommends. “I would advocate to really get into the nursing field first, so you get an inside look of what it means to be a provider.”

What Does a Family Nurse Practitioner Do?

According to the American Association of Nurse Practitioners, family nurse practitioners focus mainly on three clinical areas: primary care, urgent care, and internal medicine.

As an FNP you will provide your patients with direct and preventive healthcare, such as:

  • Performing physical exams
  • Prescribing medications
  • Ordering diagnostic tests 
  • Developing treatment plans
  • Treating chronic and acute illnesses
  • Maintaining health records

Much like a family physician, family nurse practitioners partner with their patients throughout their patients’ lives, serving as a trusted medical provider.

You may also decide to become certified in a specific subspecialty. Shouse, for example, subspecializes in asthma and immunology.

Other subspecialties include:

  • Medical-Surgical
  • Cardiac
  • Endocrine/Diabetes
  • Renal/Urology
  • Post-Partum
  • Perinatal
  • Long-Term Care
  • Orthopedics
  • Pulmonary
  • Pediatrics
  • Gerontology
  • ER/Trauma
  • Critical Care
  • Psychiatric
  • Rehabilitation

“That’s the beauty of the nursing model: Once you’re an FNP you can take your path where you like,” says Shouse.

In addition to clinics, FNPs can be found in hospices or palliative care centers, nurse-managed health centers, schools and universities, nursing homes, and even their own private offices.

What’s the Difference Between a Nurse Practitioner and a Medical Doctor?

A visit to the doctor’s office doesn’t always mean you’ll see a doctor of medicine (MD). To keep up with rising healthcare demands, nurse practitioners are often the providers who will address your concerns instead. While the two types of providers offer a comparable quality of care, the jobs do differ.

An MD requires four years of medical school following a four-year undergraduate degree, plus a multi-year internship and residency. Most MD educational paths take about 12 years.

NPs, on the other hand, typically start with a Bachelor of Science in Nursing (BSN) degree and add on a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree, followed by a certification exam. This path usually takes around six years. (One thing to note: The National Organization of Nurse Practitioner Faculties (NONPF) will require NPs to have a doctoral degree starting in 2025, so a master’s degree will no longer be sufficient for newcomers.)

The philosophical approach to healthcare also differs between an MD and an NP. An MD’s studies focus on curing disease, while an NP’s approach is more holistically focused on the wellness of the whole body and mind, although there’s plenty of overlap.

Degrees and Educational Requirements

A family nurse practitioner is a nurse practitioner who has chosen to specialize in family medicine. Both FNPs and NPs are considered advanced practice registered nurses (APRNs).

To pursue studies as a family nurse practitioner, you must first be an RN. While some programs will allow you to go directly from undergraduate to post-graduate courses, others will require at least one year of real-life work experience.

DNP by 2025?

While earning a master’s degree has long been sufficient for the nurse practitioner role, the industry is shifting toward the requirement of a doctorate. The National Organization of Nurse Practitioner Faculties released a statement in 2018 that places it at the forefront of a push to make the DNP the new educational minimum for nurse practitioners by 2025.

The association is joined by other industry stakeholders as well. Those pursuing studies as a nurse practitioner or family nurse practitioner (as well as those looking to become a nurse anesthetist, as the Council on Accreditation of Nurse Anesthesia Educational Programs is also committing to advance their requirements by 2025) should make note of this impending change when deciding on which degree—an MSN or DNP—to pursue.

If You’re Seeking a Master’s

In general, admission requirements for a master’s program in nursing are a Bachelor of Science in Nursing (BSN) degree, although select programs also accept an Associate Degree in Nursing (ADN) or undergraduate degrees in other areas of study. A state RN license in good standing is also required, as well as a strong undergraduate grade point average (typically 3.0 and above), academic/professional references, and minimum Graduate Record Examination (GRE) scores, although requirements will vary by program. Most programs will also expect applicants to have completed prerequisite undergraduate courses, such as anatomy, statistics, and general chemistry.

Many nurses who have earned an associate’s degree and hold an RN license opt for the RN-to-MSN bridge program, which helps you achieve a master’s degree without having to spend four years earning a separate BSN degree. According to the American Association of Colleges of Nursing (AACN), the number of RN-to-MSN programs has more than doubled in the past 25 years.

If You’re Seeking a Doctorate

To be admitted to a DNP program, you will be required to have a BSN from an accredited college or university with a strong GPA (3.0+) and minimum GRE scores. You will also be required to have an RN license in good standing, letters of recommendation, a CV or resume, and a personal statement. Typically, a DNP will take between three and four years of full-time study. Regardless of whether you complete your degree on campus or online, you will need on-site clinical experience.

Earning an Online Degree

Most nursing programs are offered online—including family nurse practitioner programs. This is a desirable option for people working full time, those with young children or other family responsibilities, or those who live far from a brick-and-mortar educational facility.

Every program’s online curriculum will look a little different, so be sure to do your research. Also note that not all aspects of your degree will be completed virtually: Your clinical hours will still need to be fulfilled in a hospital, clinic, or other appropriate healthcare setting.

How Important Is My School’s Accreditation?

There are many benefits to choosing accredited schools—such as increased access to jobs, grants, or financial aid. Accreditation is a process that ensures a school and its programs are held to universally high-quality standards. It ensures that nursing school graduates across the country are educated on the same level, resulting in a consistent level of care for patients no matter where they live.

The two nationally recognized accreditation organizations are the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN). It’s important to note that a program’s accreditation isn’t earned and maintained in perpetuity. Accreditations are usually awarded for a certain amount of time, usually between five and 10 years, and are different for each school. It’s a good idea to check with your school about the length of time your program is accredited for.

What Licenses and Credentials Do I Need?

After earning your MSN or DNP degree with a focus on the nurse practitioner role, you will need to take a national certification examination to be credentialed as an NP. Most FNP programs are designed to meet the standards for national FNP certification. To practice in your state, you’ll need to consult your state’s board of nursing to determine which national certification bodies it accepts: American Nurses Credentialing Center (ANCC) and/or American Association of Nurse Practitioners (AANP).

Getting Your National Certification

The ANCC’s FNP-BC certification exam features alternative test item types and covers nursing theory, while the AANP FNP-C exam is multiple choice and focuses primarily on the clinical aspect. Both are timed and computerized at contracted testing centers.

To take the exams, you must have:

  • An active RN license
  • A master’s, doctorate, or post-graduate degree from an accredited program
  • A minimum of 500 faculty-supervised clinical hours
  • Coursework in advanced physical/health assessment, advanced pharmacology, and advanced pathophysiology

The AANP examination blueprints, as well as those for the ANCC examination, can be found online.

Getting Your State License

With your degree and national certification in hand, it’s time to seek licensure in your state as an advanced practice registered nurse (APRN) by your state’s board of nursing.

While all family nurse practitioners may prescribe medications, some states require that you apply for prescriptive authority. If you are going to prescribe controlled substances, you must register with the Drug Enforcement Administration’s Diversion Control Division.

Depending on the state, you may need to establish a practice agreement with a licensed physician, although 21 states and the District of Columbia allow nurse practitioners to practice independent of physician oversight.

Maintaining Your National Certification and State License

You must maintain your national certification and state APRN license by fulfilling a certain number of clinical practice hours and/or continuing education hours every five years or so. These requirements vary by state.

How Much Can I Make as a Family Nurse Practitioner?

While the U.S. Bureau of Labor Statistics does not cite average salaries specifically for family nurse practitioners, it does offer salary information for nurse practitioners. According to the BLS, the mean (average) annual wage for a nurse practitioner is $111,840, or $53.77 per hour. Moreover, the projected 10-year job growth through 2029 is 52%—much faster than other occupations.

Salaries range from $81,410 for those in the lowest 10% of their field, to $152,160 for those in the highest earning bracket.

As the number of primary care physicians decreases but the need for primary care increases (thanks to an aging population, a prevalence of chronic illnesses, and the requirements of the Affordable Care Act), the demand for family nurse practitioners will continue to grow, particularly in rural and underserved communities.

Average Salaries by Workplace

Where you work also can be a factor in your salary. Here are some BLS examples of average salaries for nurse practitioners by workplace:

Outpatient care centers$119,920
General medical and surgical hospitals$115,790
Physicians’ offices$108,930
Colleges, universities, and professional schools$105,310
Source: U.S. Bureau of Labor and Statistics, Occupational Employment Statistics, May 2019

How Do Other Nursing Jobs Compare?

See how the salary of a nurse practitioner stacks up against those of other types of nurses:

Licensed practical nurse/licensed vocational nurse$48,500
Registered nurse$77,460
Nurse midwife$108,810
Nurse anesthetist$181,040
Source: U.S. Bureau of Labor and Statistics, Occupational Employment Statistics, May 2019

How to Stay Informed as a Family Nurse Practitioner

As a family nurse practitioner, it will be up to you to direct your continued education—both formally and informally. Fortunately, the field offers plenty of support to stay current with trends.

The American Association of Nurse Practitioners offers 17 specialty practice groups, including acute care, entrepreneur, health informatics and telehealth, and occupational and environmental health. There is also the International Council of Nurses’ Nurse Practitioner/Advanced Practice Nursing Network and organizations at the state level.

“Your journey doesn’t stop with school; it just gets started,” says Shouse. “Your school can only handle so much—it’s up to you to become more proficient, to always be learning. The education never stops; every day you will see something new come up.”

In addition to a strong education and clinical skills, traits that hiring managers look for in a family nurse practitioner include flexibility, time management and organizational skills, and the ability to communicate effectively. Shouse recommends that you also take the time to ensure that you “have the heart of a nurse” before you take your career to the next level of knowledge and responsibility.

“It’s a beautiful field; it’s a holistic approach—more patient focused,” Shouse says, “but as a family nurse practitioner, you have to make life-saving or life-altering decisions for people in your care. So, you have to make sure that nursing is your calling.”


teresa kenney

Written and reported by:

Teresa Kenney

Contributing Writer

With professional insight from:

Joel Shouse, FNP-C

Board-Certified Family Nurse Practitioner


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