Nurse Practitioners

Career summary

Nurse practitioners are registered nurses who have additional training. They see patients for a variety of issues as well as general check-ups. They treat patients and prescribe certain medications.

Nurse practitioners may specialize in areas such as:

• Emergency care
• Family medicine
• Pediatrics
• Women's health
• Geriatrics

Nurse practitioners get information from patients about their medical history. They examine patients and discuss any problems. They also order x-rays and other tests and interpret their results. When needed, they prescribe some medicines or treatments.

Nurse practitioners talk to patients about healthy lifestyles and ways to manage chronic conditions. Sometimes they refer patients to doctors or specialists.

Nurse practitioners usually work with other nurses and medical office staff. They dictate notes about their visits with patients. They often are part of a larger medical practice.

Related careers

This career is part of the Health Science cluster of careers.

Related careers include:

• Acupuncturists
• Adult and Vocational Education Teachers
• Chiropractors
• Family and General Practitioners
• Naturopathic Physicians
• Nurse Anesthetists
• Nurse Midwives
• Occupational Therapists
• Physical Therapists
• Physician Assistants
• Registered Nurses

Military careers

• Registered Nurses

Job duties

Task list

The following list of tasks is specific to nurse practitioners.

• Analyze patients' medical histories, symptoms, and test results to determine the best diagnosis.
• Order, perform, and interpret medical tests such as blood counts, electrocardiograms (EKGs), and x-rays.
• Prescribe medications based on a patient's condition, age, weight, and gender.
• Develop treatment plans.
• Diagnose and treat illnesses, infections, and injuries.
• Counsel patients about medications, especially side effects and interactions with other drugs.
• Recommend behavior and lifestyle changes to improve health and reduce the risk for serious medical concerns.
• Educate patients about how to manage ongoing health conditions.
• Maintain complete and detailed patient health records.
• Perform routine physical examinations. Treat minor wounds and injuries.
• Refer patients to medical specialists.
• Keep up to date on the latest advancements in medicine by reading research, talking to colleagues, and attending medical conferences.
• Schedule follow-up visits with patients to monitor their health and progress.
• Supervise or coordinate support staff.
• Maintain state licensing and continuing education requirements.
• Keep abreast of insurance and Medicare/Medicaid changes.

Common work activities

Nurse practitioners perform the following tasks. These tasks are common to many careers.

• Assist and care for others
• Get information needed to do the job
• Document and record information
• Update and use job-related knowledge
• Make decisions and solve problems
• Establish and maintain relationships
• Identify objects, actions, and events
• Communicate with supervisors, peers, or subordinates
• Use computers
• Explain the meaning of information to others
• Perform for or work with the public
• Organize, plan, and prioritize work
• Develop and build teams
• Analyze data or information
• Monitor events, materials, and surroundings
• Teach others
• Evaluate information against standards
• Coach others
• Communicate with people outside the organization
• Process information
• Resolve conflicts and negotiate with others
• Judge the value of objects, services, or people
• Coordinate the work and activities of others
• Guide, direct, and motivate others
• Provide advice and consultation to others
• Think creatively
• Estimate sizes, quantities, time, cost, or materials needed
• Develop goals and strategies
• Perform administrative tasks
• Schedule work and activities
• Inspect equipment, structures, or materials

Work requirements

Working conditions

In a typical work setting, nurse practitioners:

Interpersonal relationships

• Have a high level of social interaction. They constantly talk to patients, doctors, nurses, and other medical staff.
• Are greatly responsible for the health and safety of others.
• Are often placed in conflict or difficult situations in which others, especially patients and family members, may be rude or angry.
• Are responsible for the work done by other medical staff.
• Communicate daily by phone, letters, memos, and in person. They use e-mail, but less frequently.
• Usually work as part of a team of medical professionals.

Physical work conditions

• Are exposed to diseases and infections on a daily basis.
• Always work indoors.
• Regularly wear surgical gloves and masks to protect themselves.
• Work very near others. They must come into close physical contact with patients during examinations.

Work performance

• Must be very exact and accurate when performing the job. Patient health depends on their ability to diagnose and treat.
• Often repeat the same mental and physical tasks throughout patient appointments.
• Make decisions on a daily basis that substantially impact patients and their families.
• Make nearly all their decisions and set their daily tasks and goals independently.
• Work in a moderately competitive, stressful atmosphere where they must meet daily deadlines.

Hours/travel

• Usually work more than 40 hours per week.
• Generally work a set schedule.
• May be "on-call," which means available to work on short notice to handle emergencies.

Physical demands

Nurse practitioners frequently:

• Stand for long periods of time.

It is important for nurse practitioners to be able to:

• See details of objects that are less than a few feet away.
• Understand the speech of another person.
• Speak clearly so listeners can understand.
• Use fingers to grasp, move, or assemble very small objects.
• Hold the arm and hand in one position or hold the hand steady while moving the arm.

It is not as important, but still necessary, for nurse practitioners to be able to:

• See details of objects that are more than a few feet away.
• See differences between colors, shades, and brightness.
• Move two or more limbs together (for example, two arms, two legs, or one leg and one arm) while remaining in place.
• Hear sounds and recognize the difference between them.
• Focus on one source of sound and ignore others.
• Use one or two hands to grasp, move, or assemble objects.
• Make quick, precise adjustments to machine controls.
• Use muscles to lift, push, pull, or carry heavy objects.
• Use stomach and lower back muscles to support the body for long periods without getting tired.
• Be physically active for long periods without getting tired or out of breath.
• Bend, stretch, twist, or reach out.
• Coordinate movement of several parts of the body, such as arms and legs, while the body is moving.

Skills and abilities

Nurse practitioners need to:

Communicate

• Understand spoken information.
• Understand written information.
• Speak clearly so listeners can understand.
• Listen to others and ask questions.
• Read and understand work-related materials.
• Write clearly so other people can understand.

Reason and problem solve

• Notice when something is wrong or is likely to go wrong.
• Understand new information or materials by studying and working with them.
• Use reasoning to discover answers to problems.
• Combine several pieces of information and draw conclusions.
• Analyze ideas and use logic to determine their strengths and weaknesses.
• Recognize the nature of a problem.
• Judge the costs and benefits of a possible action.
• Follow guidelines to arrange objects or actions in a certain order.
• Develop rules that group items in various ways.
• Identify what must be changed to reach goals.
• Think of new ideas about a topic.
• Make sense of information that seems without meaning or organization.
• Recognize when important changes happen or are likely to happen in a system.
• Remember information such as words, numbers, pictures, and procedures.
• Think of original, unusual, or creative ways to solve problems.

Use math and science

• Use scientific methods to solve problems.
• Choose a mathematical method or formula to solve problems.

Manage oneself, people, time, and things

• Check how well one is learning or doing something.
• Manage the time of self and others.
• Motivate, develop, and direct people as they work.

Work with people

• Be aware of others' reactions and understand the possible causes.
• Look for ways to help people.
• Change behavior in relation to others' actions.
• Teach others how to do something.
• Use several methods to learn or teach new things.
• Persuade others to approach things differently.
• Solve problems by bringing others together to discuss differences.

Work with things

• Analyze needs and requirements when designing products.

Perceive and visualize

• Identify a pattern (a figure, object, word, or sound) that is hidden in distracting material.
• Quickly and accurately compare letters, numbers, objects, pictures, or patterns.

Education and training

Educational programs

The programs of study listed below will help you prepare for the occupation or career cluster you are exploring.

Programs of study directly related to this occupation

• Advanced Nursing
• Nurse Practitioner
• Registered Nursing

Other programs of study to consider

• Anatomy
• Chemistry
• Gerontology
• Nurse Anesthetist
• Nursing Education
• Pharmacology
• Physician Assisting
• Physiology
• Pre-Nursing

Training

To work as a nurse practitioner, you typically need to:

• have a high school diploma or equivalent;
• have a bachelor's degree in nursing;
• graduate from a nurse practitioner degree program;
• be licensed as a registered nurse; and
• be certified as a nurse practitioner.

Education after high school

Most nurse practitioners begin by earning a bachelor's degree in nursing. Then they spend another few years earning a graduate degree. Some graduate programs for nurse practitioners take one to two years to complete. You learn diagnostic and general health assessment skills. You can also focus in a particular area.

There is a growing national movement to require all NPs to earn a Doctor of Nursing Practice (DNP) degree. DNP programs require three to four years study beyond a bachelor's degree in nursing.

Work experience

Working as a registered nurse or a licensed practical nurse provides good experience for this occupation. Volunteering at a clinic or hospital is also helpful.

On-the-job training

A significant part of studying to become a nurse practitioner is spending time in clinical settings. During this period you work with patients directly.

Military training

Some branches of the military offer training in nursing specialties to people who are already licensed as a registered nurse. Training lasts 14 to 27 weeks, depending on your specialty. Additional training occurs on the job.

Helpful high school courses

In high school, take classes that prepare you for college. A college preparatory curriculum may be different from your state's graduation requirements.

You should also consider taking some advanced courses in high school. This includes Advanced Placement (AP) and International Baccalaureate (IB) courses if they are available in your school. If you do well in these courses, you may receive college credit for them. Advanced courses can also strengthen your college application.

Helpful electives to take in high school that prepare you for this career include:

• Anatomy and Physiology
• Computer Applications
• Health Education
• Introduction to Health Care
• Nursing
• Safety and First Aid

The courses listed above are meant to help you create your high school plan. If you have not already done so, talk to a school counselor or parent about the courses you are considering taking.

You should also check with a teacher or counselor to see if work-based learning opportunities are available in your school and community. These might include field trips, job shadowing, internships, and actual work experience. The goal of these activities is to help you connect your school experiences with real-life work.

Join some groups, try some hobbies, or volunteer with an organization that interests you. By participating in activities you can have fun, make new friends, and learn about yourself. Maybe one of them will help direct you to a future career. Here are examples of activities and groups that may be available in your high school or community.

Things to know

All states require that nurse practitioners complete a formal training program. Most employers look for experience or clinical rotations in their specialty area. Some NPs are hired by the doctors who supervised their clinical rotations. Hiring usually means that a practitioner joins an existing medical practice.

Employers look for practitioners who have leadership skills and emotional stability. NPs must be willing to study throughout their career. Studying keeps them up to date on medical advances.

Employers prefer to hire nurses who have a strong desire to help others and a genuine concern for patients' welfare. Because work with the sick and injured can be stressful, employers look for nurses who are emotionally stable.

Tips

Observe a nurse practitioner at work to see what his or her job is like. While in school, get as much practical or clinical experience as possible. Some ARNPs recommend getting a bachelor's degree rather than a two- or three-year degree when starting in the nursing field. It is helpful to work as a registered nurse before entering a nurse practitioner educational program. Volunteer and get training as an emergency medical technician (EMT). Look at case studies on the Internet. Read medical and nursing books.

Costs to workers

Many nurse practitioners join professional associations, which may have annual dues. Most practitioners pay for malpractice insurance. Additional expenses include continuing education classes to keep informed of changes in the nursing field.

Licensing/certification

Nurse practitioners must be licensed by the State Board of Nursing.

General licensing requirements include:

• a current registered nurse license;
• a master's degree in advanced practice nursing;
• proof of successful completion of national certification exam from an approved certifying body for the area of specialization;
• enrollment in Nursys national nursing database and completion of related survey; and

• completion of seven hours of HIV/AIDS education.

For license renewal, nurse practitioners must complete 30 hours of continuing education within their specialty every two years and be involved in active practice. If licensed nurse practitioners have not yet enrolled in and completed the survey for the Nursys national database, they must do so when they renew their license.

Nurse practitioners who wish to prescribe medications (excluding narcotics) must have an Advanced Registered Nurse Practitioner (ARNP) Registration with prescriptive authority granted by the Nursing Commission.

General licensing requirements are:

• advanced Registered Nurse Practitioner license;
• national certification in an approved specialty; and
• completion of 30 hours of contact education in the approved specialty area and 15 hours in pharmacotherapeutics related to licensee's area of practice every two years to renew license.

For more information, contact:

Washington State Department of Health
Health Systems Quality Assurance
Customer Service Center 
PO Box 47864
Olympia, WA 98504
360.236.4700

#2/5/20

Wages

Pay varies by employer, area of the country, and the worker's level of experience.

Nurse practitioners who work full time may receive benefits. Typical benefits include health insurance, sick leave, and paid vacation.

Employment and outlook

#According to licensing information from the State of Washington Department of Health at the time this career was updated, there are about 7,296 nurse practitioners actively licensed in Washington.

#Updated licensing number 5/5/09, cj. Sent email to medical commission & hsqa customer svc ctr for licensing #'s 5/16/11, cj. Rec'd new licensing #from Kari Johnston (Kari.Johnston@doh.wa.gov) 5/18/11, cj. Judy Haenke at DOH sent slightly different figures 5/19. I sent them to Kari to ask why and she sent this,"Yes there is an explanation for the variance in licensed nurses: each day the number of licensees change. Some do not renew, so they are expired and therefore not counted in the number of current licensed nurses. Some are expired and have been renewed the day before, so the number would increase by checking the following day. We issue new licenses daily, so this also affects the count." Requested licensing info 5/16/13 & again 8/7/13 cj. Rec'd new data from Thomas Bolender (Thomas.Bolender@DOH.WA.GOV) 8/7/13 cj. Rec from Corrado 3/11/14 lh & from Teresa Corrado (Teresa.Corrado@DOH.WA.GOV) 3/11/15 cj. Sent email to nursing@doh.wa.gov for new data 3/6/17 cj; sent again 4/5/17 & rec'd data same day.

Washington outlook

#Between 2014 and 2024, it is estimated that there will be 71 openings annually due to new positions and 69 openings annually from workers leaving this career.

#Updated outlook 06.16 sd

Changes in the delivery of health care services have increased the demand for nurse practitioners. Nurse practitioners can provide many of the same services as primary care physicians without a physician's supervision. Demand for nurse practitioners in primary care may increase as physicians focus more on providing complex medical care.

Increasingly, patients with minor or chronic health problems are being treated at hospitals as outpatients or at community clinics, ambulatory care centers, or nursing homes. This is partly due to cost-reduction measures being undertaken by many hospitals, including reductions in staff. These changes should increase the need for nurse practitioners in other facilities where primary care is provided.

The demand for nurse practitioners is also expected to rise due to technological changes that allow more medical problems to be treated, a growing and aging population, nurse practitioners' ability to provide cost-effective primary and preventive care in rural areas, and for people in programs for the uninsured. A decrease in the age group which usually provides the most nursing students will influence demand.

The table below provides information about the number of workers in this career in various regions. It also provides information about the expected growth rate and future job openings.

National employment

Major employers:

• Physician's offices
• Federal, state, and local government agencies
• Hospitals

National outlook

Demand for this occupation is very strong. Growth is expected as the aging population gets larger and the need for medical procedures increases. New federal health insurance laws also create more need for health care services. States are giving nurse practitioners more authority to perform procedures that only physicians used to perform.

Job prospects are best in rural and other underserved areas.

Other resources

American Academy of Allergy Asthma & Immunology (AAAAI) 
555 East Wells Street, Suite 1100
Milwaukee, WI 53202
414.272.6071

American Association of Nurse Practitioners 
PO Box 12846
Austin, TX 78711

American College of Nurse-Midwives 
8403 Colesville Road, Suite 1550
Silver Spring, MD 20910
240.485.1800

American Nurses Association 
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910
800.274.4262
301.628.5000

ARNPs United of Washington State 
10024 SE 240th Street, Suite 102
Kent, WA 98031
253.852.9042

Clinical Nurse Leader Association 

Explore Health Careers: Nurse Practitioner 

Gerontological Advanced Practice Nurses Association 

Hospice and Palliative Nurses Association 

National Association of Pediatric Nurse Practitioners 
5 Hanover Square, Suite 1401
New York, NY 10004
917.746.8300

National League for Nursing 
The Watergate, 2600 Virginia Avenue NW
Eighth Floor
Washington, DC 20037
800.669.1656

Northwest Organization of Nurse Executives 
4000 Kruse Way Place, Suite 2-100
Lake Oswego, OR 97035
503.479.5834

Nurse Practitioner Central 
10024 SE 240th Street, Suite 102
Kent, WA 98031
253.852.9042

Nursing 
From Johnson & Johnson

Puget Sound Nurse Practitioner Association 

Society of Trauma Nurses 
446 East High Street, Suite 10 446 East High Street, Suite 10
Lexington, KY 40507

Washington Center for Nursing 
1101 Andover Park West, Suite 105
Tukwila, WA 98188
206.787.1200

What is a Midwife? 

Who are Pediatric Nurse Practitioners? 

Your Nursing Career: A look at the facts 

References

Career cluster

• Health Science

Career path

• Social

O*Net  occupation

• Nurse Practitioners (29-1171.00) 

O*Net job zone 

• Job Zone 5 - Extensive preparation needed. Extensive skill, knowledge, and experience are needed for these occupations. Many require more than five years of experience.

DOT occupation

• Nurse Practitioner (075.264-010) 

Strong Interest Inventory

• Registered Nurse

Holland occupational cluster

• Social/Investigative/Realistic

COPSystem

• Service Professional