what is a nurse practitioner?

I work as a nurse practitioner. NPs are becoming much more common, more respected, and more understood, but I still often get questions about what being an NP means– questions from patients, acquaintances, even physicians. So I thought I’d go over some common questions here– both because you’ll understand me better, and because NPs will be integrally involved in the future of health care, and if you’re lucky, we’ll be involved in your care.

The NP will see you now.
The NP will see you now.

Q: What does it mean to be a Nurse Practitioner?

A: An NP is an advanced-practice registered nurse. We are educated in universities, and all NPs have a regular nursing license as well as an advanced practice permit. NPs must pass a certification exam before applying for the permit. NPs work in different roles, and the scope of practice varies by state– in some places, NPs practice independently like a physician would, and in others, they work only as part of healthcare teams. We can work in outpatient clinics, hospitals, or community settings. We practice with more autonomy than RNs, and are generally trained to diagnose and treat certain illnesses or injuries, which includes performing procedures and prescribing medications.

Q: How long do NPs have to be in school and how much clinical training do you get?

A: Currently, you need a master’s degree to get an NP license. That’s generally at least two years beyond the 4-year bachelor’s degree in nursing (although there are some programs that don’t do it quite this way). At least 500 hours of supervised clinical experience are required, but often more are included. There is also a doctorate for nurse practitioners, called the Doctor of Nursing Practice, or DNP. This degree is becoming more common and some organizations are calling for this to be required for entry to NP practice. It’s not without its detractors, but the idea is to strengthen competencies in translational research, evidence-based practice, and leadership. A DNP takes about two more years. There is no post-graduation residency required for entry to NP practice– this is one major difference from physician training.

Q: Why didn’t you just go to med school?

A: Not to bust out a cliche, but. . . apples and oranges. They’re both fruits, they’ll both fill you up when you’re hungry, but they’re not the same, and even though they overlap, they’re good at different things. You want an orange pie on thanksgiving? NPs and physicians both provide healthcare and they can both diagnose and treat many ailments. But NPs are trained with a different philosophy– we are taught to approach people as wholes, and to focus on peoples’ health in the context they live in. Some physicians may do this also, but this approach is really central to nursing practice. In my opion, NPs are typically very good communicators, educators and problem-solvers, and those skills are invaluable in promoting health. That said, if you have serious, complex health issues, like those that require surgery, having a physician on the team is important. There’s certainly a need for both practice models.

Q: Can’t I see the real doctor?

A: Probably, if you are willing to wait. But know that NPs have comparable outcomes, and often higher patient satisfaction*. If your problem is outside the NPs expertise, she’ll consult, or get you in with someone who can help ASAP.

Q: Where do NPs work? What do you specialize in?

NPs work in all kinds of healthcare settings. Certification is done by patient population: NPs may be certified as Adult/Geriatric acute care NPs, Adult/Geriatric primary care NPs, as family NPs, as psych/mental health NPs, or as pediatric NPs. There are not sub-specialty certifications, though NPs may receive additional training and experience and work in these areas, such as dermatology, GI, cardiology, or others. A lot of retail clinics and urgent cares are staffed by NPs (often family NPs). They often work as part of hospitalist teams or may work in specialists offices with more routine cases. Many (like me!) work as primary care providers.

So, folk, I hope this helps clear up some of the confusion!

*Some medical groups have tried to discredit the notion that NPs provide comparable care in certain clinical settings, such as primary care. It is my belief that such attempts are politically motivated and not directed towards achieving high-quality, high-value care. Arguments against NP use tend to be emotionally motivated rather than data-driven– e.g., claims such as “when you’re sick don’t you want to see a real doctor?” And “the fewer hours of training clearly mean NPs are not prepeared”. I made sure to include references here from both medical and nursing sources.

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