FAQ

A. A nurse practitioner is an experienced registered nurse who has completed advanced academic education beyond their basic nurses training that then prepares them to assume some of the diagnostic and treatment responsibilities traditionally reserved only for physicians. Under the Nurse Practice Act of each state, these nurse practitioners are legally authorized to provide health care in a variety of settings. The majority of nurse practitioners have a primary care focus and most work in collaboration with physicians.

B. Nurse practitioners have also been called "midlevel health care providers", "non-physician providers," "nurses working in the expanded role," or "physician extenders." In the past, nurses with roles that assumed some of the tasks of physicians (nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists) often called themselves "advanced practice nurses." Under recent changes initiated by the American Association of Colleges of Nursing, most nurses who return to graduate education and receive a masters degree are now called advanced practice nurses. Thus, nurse practitioners prefer to be called "nurse practitioners" and not "advanced practice nurses" and clarify that they are the nurses with diagnosis and treatment ability.

C. There is general agreement that the term "nurse practitioner" may be confused with Licensed Practical Nurse, and thus, may not be the best title to describe this nursing role. However, because "nurse practitioner" has received some degree of acceptance and growing credibility among both consumers and legislators, nurse practitioners themselves have been reluctant to change the title. TOP

What do nurse practitioners do?

A. A nurse practitioner is an experienced registered nurse who has completed advanced academic education beyond their basic nurses training that then prepares them to assume some of the diagnostic and treatment responsibilities traditionally reserved only for physicians. Under the Nurse Practice Act of each state, these nurse practitioners are legally authorized to provide health care in a variety of settings. The majority of nurse practitioners have a primary care focus and most work in collaboration with physicians.

B. Nurse practitioners have also been called "midlevel health care providers", "non-physician providers," "nurses working in the expanded role," or "physician extenders." In the past, nurses with roles that assumed some of the tasks of physicians (nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists) often called themselves "advanced practice nurses." Under recent changes initiated by the American Association of Colleges of Nursing, most nurses who return to graduate education and receive a masters degree are now called advanced practice nurses. Thus, nurse practitioners prefer to be called "nurse practitioners" and not "advanced practice nurses" and clarify that they are the nurses with diagnosis and treatment ability.

C. There is general agreement that the term "nurse practitioner" may be confused with Licensed Practical Nurse, and thus, may not be the best title to describe this nursing role. However, because "nurse practitioner" has received some degree of acceptance and growing credibility among both consumers and legislators, nurse practitioners themselves have been reluctant to change the title. TOP

What is the scope of practice of a nurse practitioner?

A. The scope of practice is broad as the nurse practitioner often serves as a gatekeeper to other health care services, facilitating access into the health care system, providing continuity of care, and coordinating care as patients move from one part of the system to another.

B. Unlike physician assistants, nurse practitioners are already directly licensed as professionals, and as such, are legally accountable for their actions. While physician assistants work under the supervision of the physician, on the physician’s license and malpractice insurance, in most states nurse practitioners carry separate licensure or certification as a nurse practitioner, in addition to their licensure as a registered nurse.

For components of the client relationship involving traditional nursing practice, nurse practitioners engage in independent decision making. In the performance of role components traditionally reserved for physicians, the state Nurse Practice Act determines how close their relationship with a physician must be.

Many nurse practitioners independently manage many clients without consultation with a physician; however, nurse practitioners are educated to work within their specialty focus and experience level. Just as physicians and other types of providers do not work without collaboration, nurse practitioners also seek consultation, collaboration, and referral, as necessary.

C. As independent professionals, nurse practitioners carry their own professional malpractice insurance. Rates are relatively low as the incidence of litigation against nurse practitioners is almost nonexistent. TOP

What is the educational preparation of nurse practitioners?

A. The original program preparing nurse practitioners started in 1965 at the University of Colorado as a master’s degree program for pediatric nurses.

Graduate programs require students to already have a B.S. preparation in nursing. Most require applicants to have two or more years of experience as a registered nurse. NP program applicants are required to meet the same requirements for entry into graduate school as other applicants. At the conclusion of the program, they receive a Master of Science degree.

NP programs usually require 1 1/2 to 2 years of full time study, build on the basic arts and science courses of the baccalaureate programs, and teach content at an advanced level. Many require a research sequence, or thesis. Courses have both didactic and theory content as well as clinical assignments where the student nurse practitioner practices diagnostic and treatment skills with clients while under direct supervision of physicians or nurse practitioner faculty or preceptors. The number of nurse practitioner programs being offered in schools has almost doubled in the last three years. This has led to questions by many observers about the quality of the faculty, the nature of the clinical experience the students receive, and the rigor of the curriculum.

B. The success of the nurse practitioner concept in the late 1960’s quickly led to the development of certificate programs, which accepted registered nurses without the baccalaureate degree. These programs do not award academic degrees. They require a minimum of 9 months of study, usually followed by a clinical internship in which NPs practice their new skills under close supervision of a physician or other nurse practitioner. While about 50% of the practicing nurse practitioners originally came from this type of program, few of these certificate programs remain.

C. Why there were two types of NP educational programs with different curricular formats and degrees has often been difficult to explain to observers. Seeking to eliminate this dual entry problem, the American Nurses Association House of Delegates passed a resolution establishing 1992 as the target date by which all nurse practitioner programs should be at the master’s level.

D. Due to the great applicant demand, many universities are accepting into their NP programs, students who already have masters degrees in another area of nursing. Because of courses they had previously taken, many of these students are able to complete the NP clinical and theory courses in one or one and a half years. These students do not earn a second master’s degree, but receive a certificate from a Post-Masters program.

E. In order to achieve standardization among programs and to insure quality in preparation, the National Organization of Nurse Practitioner Faculties has developed guidelines for nurse practitioner programs. A copy of these guidelines are available through the NONPF office at 202-452-1405. TOP

Where can I find information about how to become a nurse practitioner?

A detailed listing of all schools that offer nurse practitioner programs may be found at http://www.allnursingschools.com/?src=goto10

The American Association of Colleges of Nursing maintains an updated list of current schools offering nurse practitioner programs. Contact them at 1 Dupont Circle, NW, Suite 530, Washington, DC 20036 Phone 202-463-6930.

The American College of Nurse Practitioners has a fact sheet on how to become a nurse practitioner. Contact them at:

American College of Nurse Practitioners
503 Capitol Court, NE, #300
Washington, DC 20002

202-546-4825
Fax 202-546-4797
e-mail ACNP@nurse.org
http://www.nurse.org/acnp TOP

How many nurse practitioners are there?

A. Due to variation in state laws licensing nurse practitioners, it is difficult to document the exact number of nurse practitioners. According to the National Sample Survey of Registered Nurses (Health Resources Services Administration, 2001), in March 2000, there were an estimated 102,829 nurse practitioners. 14,643 of these NPs also were prepared as clinical nurse specialists (CNS).

B. Between 1992 and 1996 there was a dramatic increase in NP graduates. At that time, about 44 percent of the individuals received their NP education in post-RN certificate programs; 46 percent came from master’s degree programs and 8 percent from post-master certificate programs. About 31% of NPs came from family NP programs, 18% from adult NP programs, and 18% from pediatric NP programs. The remaining 33% of graduates were from geriatric, women’s health, neonatal, acute care, or other specialty programs.

Type of Nurse Practitioner Preparation

_______________________________________

Family Nurse Practitioners 31%

Adult Nurse Practitioners 18%

Pediatric Nurse Practitioners 18%

Other types Nurse practitioners 33%

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C. It has been estimated that about 90% of the nurses with NP preparation are working in nursing. Fifty eight percent or 63,500 of those prepared as nurse practitioners are employed in positions with the NP title. Another 10 percent, or about 6,600 were employed in nursing education positions. The remaining nurses were distributed among a variety of other nursing positions.

D. It has been estimated that about 50,090 of the 63,500 employed nurse practitioners had national nurse practitioner certification and/or State recognition as an advanced practice nurse or nurse practitioner. The number with national certification was estimated at 41,600. Those with State recognition were estimated at 36,700. About 45 percent of the 50,090, or 26,600 NPs, had both national certification and state recognition (Moses, E.B. June 1997; National Sample Survey Registered Nurses, March 1966, US Federal Government, HHS, HRSA, Bureau of Health Professions, Division of Nursing).

E. Many states require nurse practitioners to obtain and keep national certification as a nurse practitioner. The major certifying agency is the American Nurses Credentialing Center (ANCC). Other certifying bodies include the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCB), National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC), American Academy of Nurse Practitioners (AANP) and Nurse Practitioners in Women's Health (NPWH). TOP

Where do nurse practitioners work?

A. What nurse practitioners do and where they do it varies widely. They are extremely versatile and creative. They may practice is almost any setting in which health care is provided. Most NPs do not work alone in independent practice.

The majority of the 36,800 nurses with the title NP work in ambulatory care settings. Among these, 36 percent were in physician practice sites; 16 percent in public or school health sites; 14 percent in various types of community health centers; 10 percent in hospital out-patient departments and almost 4 percent in HMOs. Thirteen percent were employed in hospital in-patient units and about 7 percent in other types of settings. About 24 percent of the 36,800 NPs work in rural or non-metropolitan statistical areas. (Moses, E.B. June 1997; National Sample Survey Registered Nurses, March 1966, US Federal Government, HHS, HRSA, Bureau of Health Professions, Division of Nursing).

Nurse practitioners are commonly employed in ambulatory settings in clinics or in joint practice with physicians in family practice, geriatrics, family planning, adult, ob-gyn or women's health, school health, pediatrics and psychiatry settings (Waters & Arbeiter, 1985). Nurse practitioners often work more than one job, and frequently have a blend of educational, clinical, research, and administrative duties.

B. Substantial federal funding has been used to educate nurse practitioners for practice in shortage areas. Nurse practitioners have been prepared and willing to relocate and provide care in rural and under-served areas (U.S. Government, Office of Technology Assessment, 1986). However, nurse practitioners have been under-utilized in these areas due to conflicting laws mandating physicians be on-site for reimbursement under Medicare and Medicaid.

C. Health Maintenance Organizations have historically employed a high number of NPs, since they generate lower costs than higher salaried physicians; the HMO system then receives the savings (Sweet, 1986). In recent trends, managed care organizations (MCO) may impanel nurse practitioners as primary care providers, or may exclude NPs from employment altogether. TOP

How much money do nurse practitioners make?

A. This is a difficult question to answer. Almost all nurse practitioners have a salary arrangement with the physician or agency that employs them. Services provided by the nurse practitioner are typically billed to the payer in the name (and at the rate) of the physician. Because of this reimbursement process, it is difficult to collect data about how much care is actually provided by nurse practitioners, what revenue they generate, and how that relates to what they are paid. The term "shadow provider" has been used to describe the nurse practitioner services data that is imbedded in data collected about physicians. (For information on reimbursement for nurse practitioner services see Buppert, 1998.)

Most nurse practitioners generate three to four times their salary in practice revenue. This ratio may be much higher if there are substantial billable procedures provided in addition to the regular visits. Although there is considerable geographic variation, nurse practitioners commonly receive $15 to $40 an hour for their services. Some nurses make less in their nurse practitioner role than in their previous registered nurse positions. The huge influx of nurses into the nurse practitioner role has driven down nurse practitioner salaries in many states over the last three years.

B. There is a movement among many states to accept nurse practitioners as Medicaid or medical assistance providers, and reimburse them directly at the same rate as physicians. Current legislation has also been passed in Congress that would allow direct reimbursement of nurse practitioners under Medicare, at a percentage of what physicians receive. The Health Care Finance Administration (HCFA) is currently developing regulations for the implementation of this legislation. Nurse practitioners have mandated third party reimbursement in some states; are recognized providers by CHAMPUS and the Federal Employees Benefit Package. TOP

Must NPs have national certification?

Using 1996 data, it was been estimated that about 50,090 of the 63,500 employed nurse practitioners had national nurse practitioner certification and/or State recognition as an advanced practice nurse or nurse practitioner. The number with national certification was estimated at 41,600. Those with State recognition were estimated at 36,700. About 45 percent of the 50,090, or 26,600 NPs, had both national certification and state recognition (Moses, E.B. June 1997; National Sample Survey Registered Nurses, March 1966, US Federal Government, HHS, HRSA, Bureau of Health Professions, Division of Nursing).

Some states require NPs to have national certification is their area of preparation as a condition of state recognition/licensure as a NP. In this respect, certification is a condition of licensure rather than being recognition of professional competence as with medical specialty board certifications. TOP

What are the types of nurse practitioners?

There are three major types of nurse practitioners:

Family Nurse Practitioners 31%

Adult Nurse Practitioners 18%

Pediatric Nurse Practitioners 18%

Other types Nurse practitioners (Women's health NP, School health NP, Occupational Health NP, Geriatric NP) 33%

It has been estimated that about 90% of the nurses with NP preparation are working in nursing. Fifty eight percent or 63,500 of those prepared as nurse practitioners are employed in positions with the NP title. Another 10 percent, or about 6,600 were employed in nursing education positions. The remaining nurses were distributed among a variety of other nursing positions. TOP

Does this website meet JAMA core standards for websites?

Yes. NPA, Inc. complies with the Journal of the American Medical Association's minimal core standards for responsible print by including the following information:

Authorship: Materials included on this website are written and/or edited by Marilyn W. Edmunds, PhD, NP or Laurie Scudder, MS, NP. Information about contacting either of these individuals is found under "Contact information".

Attribution: All bibliographic material or copyright information is appropriately cited using AAPA format.

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