How to Become a Nurse Practitioner

How to Become a Nurse Practitioner

How to become a nurse practitioner is not as complicated as you might think. Like most nursing specialties, it involves additional schooling beyond that of a nurse, but it is worth the hard work. It isn’t easy – but it is possible!

Some people decide to become a nurse practitioner after they are already working as a bedside RN for years, but others have that goal from the very beginning. I fall into the latter, and I worked hard to achieve my end-goal and become a nurse practitioner fast!

This article outlines the “traditional” method of becoming a nurse practitioner – this is the route that I personally took and the one that I know best. If you’re interested in nontraditional NP routes – I have an article coming soon so be sure to subscribe to my email list to be notified when it drops!

1. BECOME AN RN

When wondering how to become a nurse practitioner, being a nurse is the logical first step. This just makes sense. A nurse practitioner is literally an “advanced practice nurse” – meaning there first is some form of nursing education. Yes, there are ways around this, but for most people this is going to be the first step. An RN license is almost always required for traditional nurse practitioner programs.

You can either obtain your BSN or your ADN to obtain your RN license. In short, a BSN is a 4-year degree that offers a bachelor’s of science in nursing. It is the recommended level of education for a nurse and required for entrance in nurse practitioner programs (aside from direct-entry programs).

No matter which RN education route you take, you will be learning how to assess your patients, all about various medical conditions, and your actions as the nurse in their assessment and treatment. You won’t be learning how to diagnose, but you will be learning which treatments are often indicated and how to administer those treatments. This may involve administering various medications, assisting with testing, communicating with other healthcare professionals, as so much more.

You will also be performing clinical within the hospital setting, learning how to become a bedside nurse. Most programs include 800-1000 hours of formal clinical experience.

Once you graduate, pass the NCLEX-RN, and become state-licensed as an RN – you can finally start working as a bedside RN.

2. OBTAIN RN WORK EXPERIENCE

Once you obtain your RN education and pass your board-certification exam (The NCLEX-RN), you will now should start working as a bedside RN! This is usually very exciting as you can finally take what you’ve learned and positively impact your patients, grow in your knowledge, and make some money!

Believe it or not, whether or not RN experience is necessary before attending a nurse practitioner program can become a heated topic. Many people believe that a certain amount of years of experience is necessary prior to matriculation into a nurse practitioner program. Some say 2 years, some say 5, and some others just say any amount of experience is beneficial.

Benefits of RN Work Experience

Obtaining work experience as a bedside RN is absolutely important in your development as a future nurse practitioner. Working as a bedside nurse offers continuous hands-on learning every day you work. The amount of learning in medicine is endless, and I can confidently say that there isn’t a shift that goes by that I don’t learn something. Working as a nurse will expose you to many common acute and chronic medical conditions, and the treatments and therapies involved. In fact – you’ll be the one administering and helping with them! Through your experience, you will improve your assessment skills, as well as your communication with your patients, and your colleagues within the hospital or clinic that you work. First-hand work experience will give you a deeper understanding of the healthcare system and just “how it all works”. This will become invaluable in your pursuit of becoming a nurse practitioner.

Is work RN experience required to get into an NP program?

Most nurse practitioner programs do not have a minimum amount of RN experience required – at least with family or adult primary care NP specialties. Some sub-specialty’s like Acute care, Pediatric, Psychiatric, and Neonatal programs will require specific nursing experience in a relevant clinical setting. This is often 1-2 years. Many program admissions pages will “recommend” but not require experience, so a lack of experience may negatively impact your admission.

So yes, you can totally become an NP without any bedside RN experience. But I do believe this will negatively impact your clinical competency as a new Nurse Practitioner when you graduate. However, I don’t believe bedside RN experience is as important as some people seem to think. A Nurse practitioner must think like a provider, using great history-taking, advanced physical assessments, and evidence-based medicine. As a nurse you will learn so much – but you will not learn how to think like a provider.

My personal recommendation is to work as a bedside RN for 1-5 years before starting an NP program and to work throughout your program if possible. The number of years of RN experience someone needs to help them become a great nurse practitioner is going to vary based on each individual. I only had 1 year of Full-time RN experience before I started my NP program. However, I worked full-time throughout most of the program and by the time I started my first nurse practitioner job – I had about 4 years of full-time RN experience, most of which were in the ER.

Are there those who will excel at Nurse practitioner school and being a new nurse practitioner without any RN experience? Maybe. But I think not obtaining any bedside RN experience would do your future patients a disservice, and you would miss out on so much hands-on learning.

3. ATTEND A NURSE PRACTITIONER PROGRAM

How to become a Nurse practitioner: NP specialties

When you are ready to start your NP education, you can apply and get into a nurse practitioner program of your desired specialty. Unlike PA programs that train generalists, NP programs are population-specific. This means that you have to apply to a specific patient-population specialty. This helps your education be tailored to the patients that you will be seeing in your future NP job. Nurse practitioner specialties include:

  • Family Nurse Practitioner (FNP)
  • Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
  • Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)
  • Emergency Nurse Practitioner (ENP)
  • Psychiatric Mental health Nurse Practitioner (PMHNP)
  • Women’s Health Nurse Practitioner (WHNP)
  • Pediatric Nurse Practitioner (PNP)
  • Neonatal Nurse Practitioner (NNP)

The difference between each specialty is an entirely different article, but which one you choose will depend on which clinical setting you plan to practice in one day. If you want to work with adults within the hospital – obtain your AGACNP. If you want to work in a primary care office – get your FNP or AGACNP depending on which ages you want to see. Understand that some specialties are somewhat flexible, and many facilities will hire an FNP or AGPCNP for both inpatient and outpatient roles, as well as within the ED.

How Long will it take?

The amount of time a nurse practitioner program will take will depend on which degree you choose to obtain. There is the more traditional Master of Science in Nursing (MSN) degree, as well as the newer Doctorate of Nursing Practice (DNP) option. MSN programs will take about 2-3 years to complete, and DNP programs will take 3-4 years. To currently work in a clinical setting, there isn’t much difference in terms of clinical education, job role, or salary at this current time – although that may change in the future.

Nurse Practitioner Program Curriculum

The courses you take will depend on your selected specialty. All NP programs will include some basic fundamental classes such as advanced pathophysiology, advanced pharmacology, and advanced health assessment. Then depending on your specialty, you will have various classes specific to each population which outlines various medical conditions and diseases that will present in that population, along with the assessment, diagnosis, and treatment of each one.

Just like as an RN, you will also obtain clinical experience during your NP program. The number depends on the program, but most NP programs will require 600-800 hours. Again, this ended up being about 16 hours per week for me. A common misunderstanding is that NP students are just observing during clinical – however, this could not be further from the truth.

During clinical, it is expected that you are seeing the patient alone, conducting a thorough history, performing your physical assessment, and then presenting the patient to your preceptor (an experienced NP or physician). You will recommend a plan of care, and you and your preceptor will formulate a plan together. This is essential in connecting the dots and preparing you to become a great nurse practitioner.

Full-time and part-time program options

Many programs will offer both full-time and part-time tracks which you can use to fit into your lifestyle. Nurse practitioner programs can be intense and most people cannot work full-time and complete a full-time NP program simultaneously. I myself attended a part-time 24-month program which helped me work throughout most of my program, continuing to financially support myself.

As mentioned above, continuing to work also helps in your learning. You can see firsthand everything you are learning about in your NP education. You might not be formulating the plan of care, but this piece was essential in my development as a competent new NP graduate.

4. Pass Your Board Certification Exam

Once you successfully graduate from your NP program, you are eligible for national certification as a nurse practitioner. To be certified, you must first pass a board-certification exam. Depending on your specialty, these are offered through the AANP or the ANCC.

Once you take your exam and pass, you are officially a nationally board-certified nurse practitioner. BUT you can’t start working yet.

5. Nurse Practitioner Licensing and Credentialing

After being certified either through the ANCC or the AANP, you can apply for state licensure within your specific states in which you intend to practice. The steps involved here are state-dependent, but a quick “Nurse practitioner license in (insert your state here)” should be able to illuminate the next steps.

Even so, this process can be confusing so I have another article outlining these steps which outlines your license, as well as additional necessities like an NPI number or your DEA. Once licensed, you need to get a job within your scope of practice. Once hired, your job will need to credential you. This basically involves background checks and a lot of paperwork being filed with insurance companies. This must be done before you can start practicing as an NP at their clinical site. Be warned – this can take 3-6 months! In 2018 I was hired in February and wasn’t able to start until July for my first NP job.

On average, the Nurse Practitioner education and training can take a minimum of 6 years to complete, although most will take longer if they obtain more RN experience first or if they attend a part-time track. And just like that – you can be a nurse practitioner too! It’s a long and difficult road, but definitely doable. And I can personally tell you that it is 1000% worth it. If you find yourself wondering how to become a nurse practitioner – this might just be the perfect career for you!

Related Articles:

How to Find Nursing Jobs

How to Find Nursing Jobs

Finding nursing jobs can be stressful – especially finding the right nursing job. You’ve spent hours of effort and time in learning how to be in the nursing profession, but now you need to actually start working and making some money! Let’s be real – those loan payments are coming in 6 months! While finding nursing jobs is easier than other fields, it can still be difficult, especially in certain oversaturated areas. Below you’ll find 5 tips for finding nursing jobs.
  1. Job Search Engines

    Back in the day, they had to look at newspapers and rely on word-of-mouth to find job offers. Nowadays, thanks to the internet, there are multiple sites and apps to help you find nursing job offers in your area! Job search engines are an easy and quick way to scout your area of interest to see what kind of nursing jobs are available.

    Glassdoor and Indeed are two common job search engines where you can find nursing jobs pretty easily. My personal favorite is Glassdoor as it offers great information about the companies including employee reviews, interview information, benefits, and salary insights. However, it seems as though Indeed and Glassdoor share much of the same info regardless. Personally, I recommend using both sites while searching for prospective jobs.

    Search your desired job role “Registered Nurse”, “Nurse”, or “Nurse Practitioner”, and input your desired location. There are filters you can set up to narrow down your search including salary, distance radius, etc. However, I recommend NOT using the salary filter as Glassdoor’s salary estimator isn’t always accurate. You can favorite or save jobs which you are interested in.

    These sights also offer great insight into the company including employee reviews. Previous interview candidates can also say how the interview is structured, what types of questions were asked, and how their overall experience went.

    Additionally, you can get a good idea of what type of salary you can expect at the current role. To do a bit more research, you can go into the company and search for how much they pay other people who perform the same job as you in your specific location.

    There are also great apps for Glassdoor and Indeed for both Android and iOS.

    Related Content: “How Much Do Nurse Practitioners Make?”

  2. Website Job Postings

    One great way to find nursing jobs that weren’t posted to job search engines is to go to the hospital or health system’s website directly. Not every hospital or network will post their jobs on job search engines, so this is a great way to make sure you aren’t missing any great nursing job opportunities.

    You can find both inpatient and outpatient jobs using this format. In fact, this method is how I found my current job as an inpatient Nurse Practitioner.

    Go to the hospital or health networks website. Somewhere on the homepage, you should see a link that says “careers” or “jobs”. This may be at the top of the web page or in the footer at the bottom. It can sometimes be hard to find but 99% of the time it is there.

    If they are a small network, they may list all available jobs. Most sites will have some type of job search function where you can pick your role (i.e. RN or NP), and it will give all available jobs within their network. Click on the jobs you are qualified for and apply using the link provided.

    If you do not see any jobs for you, sometimes you can find the nursing recruiters email. If so, send a professional email letting them know your interest in working for their system, and attach an updated resume to the email.

  3. Nursing Jobs on LinkedIn

    If you didn’t know, LinkedIn is a social media for professionals to grow their professional network and even find jobs. LinkedIn is overall underutilized by the healthcare industry, especially by nurses. However, healthcare recruiters definitely use this platform, and if you are searching for nursing jobs this may be just the route for you!

    LinkedIn lets you create a professional profile that essentially functions as your digital resume. Once your profile is top-notch, LinkedIn has a job search function that lets you search for jobs much like Indeed or Glassdoor. You might find some nursing jobs on LinkedIn that aren’t posted elsewhere. For most of the jobs, you can apply directly using your LinkedIn profile alone. This makes the application process super easy and is why it is so imperative for you to start your LinkedIn now and start creating a great profile.

    Make sure you go into your settings and set “open to job opportunities”. Healthcare recruiters will literally find you and message you details of nursing jobs that they want you to fill.

    Overall LinkedIn is a great way to professionally connect with other healthcare providers as well. As with many things in life – landing your dream job may be all about who you know within your professional network.

    Follow me on LinkedIn here!

  4. Word of Mouth

    With the internet being so easy to use, sometimes we forget about the good ole faithful methods of finding a job. Word of mouth and can be a great way of finding nursing jobs that may not be posted online. Ask your professional connections within the healthcare industry if they know of any nursing job needs. Sometimes they may know of internal employment issues or upcoming vacancies. They may be a hiring manager or know a hiring manager, and can put in a good word for you. This can have a huge impact on your nursing job search process.

    Sometimes if no full-time positions are available, companies are willing to accept new per-diem applicants which helps them “test” your work before actually committing to hiring you full-time.

  5. Find Nursing Jobs In-Person

    Once again – don’t forget about non-internet methods of finding jobs. Going in-person to a hospital or clinic can help you secure a nursing job. Don’t underestimate the value of face-to-face interaction with a potential employer. Presenting yourself professionally and handing in your resume can help give them a great first impression of you that an internet application could never do. While this method is definitely not the norm nowadays, it can definitely be effective.

    Again, make sure you look professional, are best-dressed, are polite, and smile! You never know who you will be making an impression on or who will go to bat for you. Try to make connections with people at your desired working location and see what comes of it.

    This method may work better for smaller places of employment such as outpatient clinics or urgent care centers.

 

Hopefully, you found these tips useful in your nursing job search. If you like professional development articles like this – let me know in the comments below. If there are other useful methods of finding nursing jobs – let us know!

 

Welcome!

Will Kelly, MSN, FNP-C
Thank you for visiting my site! I help nurses and nurse practitioners improve their clinical knowledge by providing high-quality content to turn their nursing education into practical application!  Read More

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How to Become a Nurse Practitioner

How to Become a Nurse Practitioner

How to become a nurse practitioner is not as complicated as you might think. Like many nursing specialties, it involves additional schooling beyond that of a nurse, but it is worth the hard work. It isn’t easy – but it is possible!

How to Find Nursing Jobs

How to Find Nursing Jobs

Finding nursing jobs can be difficult – especially in certain oversaturated areas. Here you’ll find 5 tips for finding nursing jobs on your nursing job hunt!

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AANP vs ANCC: Nurse Practitioner Certification

AANP vs ANCC: Nurse Practitioner Certification

When Nurse Practitioners graduate, they must take a national exam that certifies them to practice in their specific specialty. Once they have this board-certification and obtain their state licensure – they can legally practice as a Nurse Practitioner.

These exams can be likened to the NCLEX-RN that RNs have to take to become a  certified Registered Nurse. The only difference with nurse practitioner certification is that there are TWO to choose from, from two different certifying bodies – so you must choose between the AANP vs ANCC. But what exactly are they?

If you’d rather watch the full video, click the image below!

American Nurses Credentialing Center (ANCC)

The American Nurses Credentialing Center (ANCC) is an independent credentialing branch of the American Nurses Association (ANA) which certifies nurses to become advanced practiced registered Nurse (nurse practitioners!) This is the largest nurse credentialing organization in the U.S. and is not limited to Nurse Practitioners. They also certify nurses in informatics, professional development, case management, and various nursing specialties.

ANCC Exams

Regarding Nurse practitioner certification, the ANCC provides certification for the following specialties:

  • Family Nurse Practitioner (FNP-BC): 175 questions (150 graded)
  • Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-BC): 150 questions (135 graded)
  • Adult-Gerontological Acute Care Nurse Practitioner (AGACNP-BC): 200 questions (175 graded)
  • Psychiatric-Mental Health Nurse Practitioner (PMHPNP): 175 questions (150 graded)
  • Pediatric Primary Care Nurse Practitioner (PPCNP-BC): 200 questions (175 graded)

The ANCC exams questions will have a majority of clinical assessment, diagnosis, and management, but will have about a 25% or more of non-clinical questions. This means questions on research, ethics, professional responsibility, leadership, the scope of practice, regulatory guidelines, etc.

Time allotted is generally about 4 hours – including time for check-in, instructions, and a practice session on the computer. If you fail an ANCC exam, you can retake the exam in 60 days, but you cannot test more than 3 times in 12 months.

Cost

The cost for the nurse practitioner certification exam through the ANCC is $395 for non-members of the ANA, and $295 for members.

ANCC Pass Rates (2018)

The following pass-rates for each ANCC exam are as follows:

  • FNP = 86.2%
  • AGACNP = 89.5%
  • AGPCNP = 79.0%
  • Peds = 85.7%
  • Psych = 88.5%

American Academy of Nurse Practitioners (AANP)

The American Academy of Nurse Practitioners (AANP) is a relatively new organization formed in 2013 for the nurse practitioner certification. Their certification board offers examinations for Nurse practitioners similar to the ANCC, however, there are significant differences between the AANP vs ANCC.

AANP Exams

The AANP currently only has the following three nurse practitioner certification exams:

  • Family Nurse Practitioner (FNP-C)
  • Adult-Gerontology Primary care Nurse Practitioner (A-GNP)
  • Emergency Nurse Practitioner (ENP)

Unlike the ANCC (and a major plus in my personal opinion) is the fact that the AANP exams are 100% clinical. This means it will focus on the assessment, diagnosis, plan, and evaluation of various clinical scenarios and patient cases. The only difference is that the Emergency Nurse Practitioner certification exam does have some non-clinical content, including a small percentage of professional, legal, and ethical practice questions.

All three exams have 150 questions, 135 of which actually count toward your grade.

Cost

The AANP exam costs $315 for non-members of the AANP, and $240 for members.

AANP Pass Rates (2018)

The 2018 pass-rates for the AANP nurse practitioner certification exams are as follows:

  • FNP = 85%
  • AGPCNP = 83%
  • ENP = 87%

AANP vs ANCC: What’s the difference?

Both the AANP and the ANCC exams are taken on the computer at a testing center. Every few years new editions of the tests are created, and multiple alternate versions exist. These exams differ from the NCLEX-RN in that they do not finish based on your score (i.e. it won’t shut off at 75 questions). You must complete the entire test.

The Number of Questions

The number of questions is going to differ depending on which exam you are taking. ANCC exams vary from 150-200 questions over 3-4 hours, and all AANP exams are 150 questions. Both tests will have 15-25 “pretest” questions – meaning they won’t count for your grade – they’re just testing the questions to see if they’re okay to add to future versions of tests.

The Question Style

The style of the test questions is another major difference. ANCC exams will have four different question formats: multiple-choice, multiple response questions, drag and drop, as well as “hot spot” questions. AANP is 100% multiple choice with 4 possible options (aka NO select all that apply!).

The Question Content

The content of the questions is also a major difference between the AANP vs ANCC. It’s going to vary depending on which exam you’re taking, but the ANCC exams tend to have a lot more “non-clinical” questions related to topics like nursing research, legal and ethical considerations, scope of practice, regulatory guidelines, etc. AANP is 100% clinical, so it is going to focus on assessment, diagnosis, treatment, and evaluation. As stated above, the ENP test is a bit different and does have some non-clinical questions.

The Difficulty

There have been some rumors that AANP is easier than the ANCC – although there really is no way to truly know. The pass-rates used to be lower for the ANCC so people just assumed it’s harder. However, now if you look at the most recent data for FNP (2018), the AANP actually had a lower pass rate (85% VS 86.2%). I think it’s going to depend on the individual which one is easier based on their preferred testing style and testing content. The only true way to know is to take both yourself which I do not recommend!

The cost

The cost is also slightly different. Non-members will end up paying $315 for the AANP vs ANCC paying $395, making AANP $80 cheaper. If you are members of the ANA, the ANCC will only be $295. On that same note, members of the AANP will pay only $240 for an AANP exam.

AANP vs ANCC: Factors to Consider?

Which exam you choose will depend on your specific professional goals as a future NP.

1. Which Specialty is your program in?

This one is great because all the work is done for you. In order to apply for certification, you have to have graduated or will be graduating from an accredited Nurse practitioner program in that specific specialty. So, if you’re program was FNP – you need to apply for FNP certification. Obvious right?

For certain specialties – this choice will be made for you because both the ANCC and the AANP have certification exams that the other does not.

If your program is for Acute care, Psych, or Peds – you must go through the ANCC.

If your program is an Emergency NP program   – you must go through the AANP.

Where the real choice lies is if you went to a Family Nurse Practitioner (FNP) program or an Adult Primary Care (AGPCNP) program. And if that’s the case, then the next question you’re going to want to ask yourself is what your specific testing preferences are. What do I mean? Keep reading!

2. What are your testing preferences?

The AANP vs ANCC has very different test styles and question content as stated above. If you’re someone like me who HATED research, ethics, leadership (insert more fluff classes here), then you are more likely to want to take the AANP. In fact, that’s the main reason that I chose to certify through the AANP! If you are really good at non-clinical questions like that – maybe you should take the ANCC!

Additionally, the AANP is 100% multiple choice with four possible answers. The ANCC exams are multiple-choice, but do include alternate questions including the dreaded multiple response questions, drag and drop, as well as “hot spot” questions.

3. Which facilities are you planning on applying to?

So nowadays most facilities and locations look at AANP vs ANCC certified NPs as pretty much the same. This is because both are nationally recognized and reimbursed by Medicare and Medicaid in any clinical setting in almost all states.

Think of this like DO vs MD – both are now considered equally great. So, most facilities don’t’ really care – they just want to see that you passed your boards.

However, rarely there are facilities that prefer ANCC candidates because it’s older, more established, and isn’t 100% clinical.

So if by the rare chance that the facility you want to work in only accepts ANCC – consider taking that exam instead. In general, magnet hospitals do NOT require ANCC over AANP.

4. What are your future career goals?

The last consideration is what are your future career goals? Do you plan on obtaining any post-master certifications? You totally can be certified in one specialty by the AANP and certified in the other by the ANCC – but this just might complicate things a bit. You’ll likely feel more comfortable with the certification process if you have already done it once. So, if you’re in an FNP program and want to one day become ENP certified – AANP might be the more logical choice for you. On the other hand, if you want to one day get your ACNP or PMHNP post-masters certifications, consider the ANCC!

Additionally, if you plan on getting into academics – some universities may prefer ANCC NPs. However, to teach at the nurse practitioner level, you will need to be pursuing or have obtained your doctorate degree anyway.

What did I choose?

I chose the AANP exam. What it came down to was the fact that I love clinical questions and really did not like all the other types of questions (research, ethics, etc). I also don’t like alternative question formats, so a normal multiple-choice exam sounded perfect to me. I didn’t foresee any problems with having my AANP nurse practitioner certification vs an ANCC certification, and I haven’t experienced any drawbacks. There is one local hospital system that prefers ANCCs, and they explicitly state so on their job applications. But – who wants to work there anyway.

If you are in NP school and about to graduate, I want you to check out my NP certification steps, where I walk you through the process of getting licensed, certified, and credentialed as an NP! Heads up – it can take longer than you think!

Nurse Practitioner vs Physician Assistant

Nurse Practitioner vs Physician Assistant

Advanced Practice Providers (APPs) are an integral part of the healthcare team. They both perform very similar jobs, oftentimes the same one! But what exactly is the difference between them? In this article, I am going to walk you through and compare the education and training, job role, physician collaboration, as well as the salary of both NPs and PAs.

If you’d rather watch the full video, click the image below!

Education and Training

Both Nurse practitioners (NPs) and Physician Assistants (PAs) are considered Advanced Practice Providers or APPs, and they both often work alongside physicians in many facilities and practice settings. This tends to lead to some confusion over what the difference actually is.

Please note that there are various alternative methods of obtaining your NP including direct-entry programs and RN-MSN bridge programs, but I will not be going over these within this article. Additionally, this article compares master’s prepared NPs vs master’s prepared PAs. Of course, there are many NPs who obtain their Doctorate of Nursing Practice (DNP), but that will not be talked about in this article.

Related content: “NP vs MD: Which one is better?”

Undergraduate Degree

PAs will first obtain an undergraduate bachelor’s degree in a whichever degree they desire, but they must complete their prerequisites for PA school. At the same time, a future NP will typically obtain their Bachelor’s of Science in Nursing (BSN). Both of these undergraduate degrees typically take about 4 years to complete, although some direct-entry PA programs complete the Bachelor’s degree portion in closer to 3 years.

During this part of their education, PA students won’t typically perform any formal clinical, but will often have to complete between 1000-4000 hours of direct patient healthcare experience which is required for PA school. This is usually experience being an EMT or paramedic, a patient care technician or Certified Nurses Assistant (CNA), or a medical scribe. BSN students, on the other hand, will complete between 800-1000 clinical hours on average within the hospital learning how to be a bedside nurse.

After Graduation

Upon graduation, PAs should have already applied and been admitted to a PA program to obtain their Master’s degree, and they will immediately move on to their graduate education. The NP, however, will pass their board certification once they graduate, the NCLEX-RN. They then begin working as a bedside nurse. There are some RNs who immediately go right into their NP studies, but most will work for as little as a year to as long as 20+ years before pursuing their master’s degree.

The PA/NP Programs

PAs  will complete a Master’s degree in any of the following, depending on their program:

  • Master of Physician Assistant Studies
  • Master of Health Science
  • Master of Medical Science (MMSc)

NPs will complete a Master of Science in Nursing (MSN). During their program, PAs are trained as generalists, so they can essentially work in any clinical setting so long as they have appropriate physician supervision. Instead, NPs must choose a specific patient population to focus on. When entering the program of their choice, the NP will have to choose one of the following patient populations:

  • Family (across the life-span)
  • Adults and Geriatrics (ages 13 and up)
    • Primary Care
    • Acute Care
  • Behavioral/Mental Health
  • Pediatrics (ages 0-18)

Program Structure:

Most PA programs last about 2 full-time years of study (24-26 months). The first half they’ll go through didactic material learning in-depth medical sciences. Think of this as the first half a medical school but compressed into only 1 year. In the last half, they’ll complete clinical clerkships in pediatrics, OBGYN, family practice, general surgery, and emergency medicine, totaling about 2,000 hours of clinical experience.

NP programs are structured differently and usually have Full-Time, Part-time, and online options. Most programs will start out with solely didactic material including advanced pathophysiology, advanced pharmacology, and advanced health assessment. You’ll then start clinicals but at the same time continue didactic material simultaneously. It’s common to have to complete 16 hours per week fo the semester in clinical, so two 8-hour days each week.

Where you do your clinicals is going to depend on the program specialty, so FNPs will do rotations in primary care clinics, women’s health clinics, and pediatric clinics, whereas Acute care NPs would do most of their rotations within the hospital in the ICU. Some programs offer optional specialty rotations, where you can get experience in something other than your “typical” locations (like the ER for FNPs). NPs will complete an estimated 600-800 hours of clinical by graduation.

Licensure

Once they graduate from their APP programs, PAs must pass the PANCE (Physician Assistant National Certifying Examination) in order to become a certified PA. NPs will have to pass their board certification exam in their specific specialty (either through the AANP or the ANCC). They both then apply for state licensure and can start practicing as APPs once credentialed

Related content: “Nurse Practitioner: Steps after graduation”

Job Role

The actual job role of an NP and a PA regarding what they actually do is VERY similar if not the same at almost any location and specialty.

Both PAs and NPs:

  • Obtain health histories from patients
  • Perform a physical assessment
  • Order diagnostic tests and interpret them
  • Prescribe treatments such as medications and therapies
  • Perform bedside procedures
  • Consult appropriate specialists

They both work in pretty much every specialty including:

  • Outpatient primary care
  • Outpatient and inpatient specialty offices
  • Inpatient hospitalists or ICU
  • Emergency Department or Urgent Care Clinics
  • Home Health / Hospice
  • Surgery
  • More!

Regarding surgery, NPs can become a first-assist with a surgeon but its much less common – usually they’ll do admissions and discharges for the surgical team instead of actually scrubbing in. PAs are more likely to scrub in and assist with surgery. NPs generally do not receive any surgical rotations throughout their program, so this just makes sense.

Collaboration/Supervision

APPs often work in close collaboration with physicians – but this is where the main difference lies between the two.

NPs have full practice authority (FPA) in 23 states and counting. What this means is that State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing.

This means there is no required supervision or collaboration with a supervising physician. They practice medicine under their own license without any oversight. However, just because an NP might practice in an FPA state, this does not mean that they do not consult or collaborate with other experienced NPs and physicians when appropriate – it just means they have the legal authority not to.

NPs who do not live in an FPA state will require varying degrees of physician collaboration depending on their state and practice setting. This degree of physician collaboration is explicitly stated in a collaborative agreement, which outlines joint practice protocols, documentation review/oversight, and prescriptive authority. In practice, this often just involves occasional chart reviews and availability for consultation via electronic consultation via text or phone call. This doesn’t require an on-site physician.

Alternatively, PAs are always required to work under the direction and supervision of a physician or a group of Physicians. However, State-level laws influence more specific aspects of supervision including prescriptive authority, prescription co-signatures, collaborative agreements, and other various aspects of scope of practice.

So what does this mean?

Basically, PAs have more required oversight by physicians, but this does not mean that the physician is looking over their shoulder. Typically, this may involve the PA consulting the doctor with medical management of a complicated case, and the physician co-signing their charts and prescriptions for controlled substances. But this will look different in every State and practice setting, and the physician often won’t be required to even be on-site – just usually needs to be reachable.

All states will vary for both NPs and PAs in terms of who is legally able to sign death certificates, POLST forms, and/or order physical therapy.

As a general rule, the NP career offers more opportunity for autonomy. This is especially useful if you plan on opening your own practice or clinic, especially in an FPA state. PAs, at this time, are more limited in their ability to perform medicine autonomously.

Both NPs and PAs are a great part of the healthcare team, and both are very competent and able to take care of their patients within their respective scope of practices.

Salary

When looking at salary – both NPs and PAs make similar salaries and many locations and facilities will pay their counterparts the same. However, when looking at national data – NPs make on average $117,292, and PAs make $107,179 (Glassdoor). Keep in mind that this is national data. The fact that some NPs have the autonomy to open up their own practices typically means higher revenue, which will skew the national NP salary upwards.

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And that is basically the difference between PAs and NPs. They are both very different paths, but essentially perform the same job role and have similar career outlooks. Some physicians and hospitals will prefer one type of APP over the other, and I’ve seen this go both ways. However, most places of employment will recognize the value of both an NP and a PA as integral members of the healthcare team.

 

NP vs PA

NP vs MD – Which Path to Choose?

NP vs MD – Which Path to Choose?

Working as a Nurse Practitioner (NP), I frequently am asked: “What exactly is the difference between an NP and a doctor?”. While there definitely are differences between them, both function similarly in within many specialties, so it is not always an easy question to answer.

The education and training of physicians is very different than that of an NP. Additionally, their job role and the autonomy/scope of practice with which they practice will vary depending on the state and facility of practice.

If you’re trying to decide which path you want to take, or maybe you are a patient who’s wondering which Provider you should be seeing – this article should help clear up any confusion.

Comparing the Education and Training

To compare NPs with physicians, we must first look at the differences in their education and training.

Physician Education and Training

The Physician education pathThe path to becoming a physician is a long and difficult. First, they must obtain their undergraduate bachelor’s degree – usually in a science such as chemistry or biology. However, the actual degree does not usually matter, so long as they complete the pre-requisites for Medical school. This can be ensured by enrolling in a Pre-med track. During this part of their education, they are not learning any specific medical information. While the science courses that they take will invariably help them in medical school, they are not gaining exposure to the medical field directly. However, most students will be required to obtain a decent amount of shadowing or “real-world” experience with healthcare exposure – whether working as a patient care assistant, EMT, medical scribe, etc. 

Upon graduation, they attend medical school which is typically a 4-year degree. They learn in-depth medical sciences as well as clinical information for practice. During the final 1-2 years, they also complete clinical clerkships in just about every specialty there is. This provides well-rounded medical knowledge, and the depth of knowledge obtained is unmatched. By graduation, they have performed an estimated 6,000 hours of clinical experience, directly learning how to be Providers. Upon graduation, they receive their MD or DO degrees, and are officially “Doctors”. But their training doesn’t stop there.

After graduating from medical school, a physician will then match into a residency – which is on-the-job training for a set amount of years depending on their specialty. This usually is 3-4 years but can be as long as 7+ years with some specialties (i.e. Neurosurgery), and physicians can choose to perform a fellowship year that offers an additional year of specialized training. In general, residencies will provide an averaging of at least 10,000 hours of training. During this time, resident physicians are working in close collaboration with other senior residents as well as attending physicians. They have to take certain board certifications along the way, but once they complete their residency – they are officially attending physicians. This means that they are officially independent providers and can practice without any oversight.

Nurse Practitioner Education and Training

The Nurse Practitioner education pathThe path of a Nurse Practitioner looks very different from that of a physician. Nurses dive right into learning clinical information and medical treatment in their undergraduate nursing education, where they obtain a Bachelor of Science (BSN) in Nursing. During nursing school, they complete a set number of clinical hours within the hospital learning how to be bedside nurses. This will depend on the program, but most will complete around 800 -1000 hours of clinical.

Once they graduate and pass their board certification (the NCLEX-RN), they begin immediately working as a bedside Registered Nurse (RN). If they make the decision to obtain their NP degree, most will choose to begin after an estimated 5-15 years of bedside nursing experience – however for most programs, there really is no minimum years of experience required for matriculation. The NP program will be population-specific. This means that instead of rotating through each specialty – they will obtain 600-800+ clinical hours in their specific specialty under an experienced NP or physician. Most will complete their master’s degree in 2-3 years, and many are able to work at least part-time while doing so. Some choose to get their Doctorate of Nursing Practice (DNP), which instead takes about 4 years to complete. Once they graduate, there is no required residency program. While some residencies are available, this is by far not the norm. Once they pass their board certification (via ANCC or AANP), they can immediately begin practicing as an NP. In most states, they will be working in close collaboration with experienced NPs and physicians, at least until they get more experience as a practicing NP. 

Side by Side

Both routes are difficult – but I won’t deny that the physician route is more rigorous and definitely offers more hours of education, training, and supervision. However, I won’t completely disregard the benefits that the NP route can have.

Firstly, there’s earlier exposure to healthcare and medical conditions through education and clinicals during their undergraduate nursing degree. Pre-med students usually have little if any healthcare exposure. Additionally, NPs usually have years of bedside nursing experience. As previously stated – this should not be equated with formal education, but shouldn’t be ignored either. This experience exposes them to medical conditions and management, improves their assessment skills, and helps improve their communication not only with their patients but also with their medical colleagues. Those of us working in the hospital system can see firsthand just how smart and capable good bedside nurses can be.

When directly looking at them side-by-side, please keep in mind that these are all general estimations as each program, specialty, and specific situation is going to impact the amount of formal education and training.

To illustrate the difference in education between Nurse Practitioners and Physicians.

Looking at these numbers, it is clear that our formal education and training is less than that of a physician. However, I do believe our education is sufficient for us to provide great care to our patients. While an NP is not equivalent to a physician, we have proven ourselves to be knowledgeable and capable Providers in various specialties.

Comparing the Actual Job Role

The actual job role of NPs and physician will vary greatly depending on state and facility. However, usually the specific job duties are very similar.

Both physician and NPs:Provider Job Role

  • Obtain health histories from patients
  • Perform a physical assessment
  • Order diagnostic tests and interpret them
  • Order treatments such as medications and therapies
  • Consult appropriate specialists

In some locations and settings, you will have a difficult time telling the difference based on their job role. This is especially true in primary care or outpatient offices. In many settings and locations, NPs work in close collaboration with physicians. This means they usually work with them and consult them if they have any questions. This is especially true for new NPs, as even in states with full practice authority, new NPs still have so much to learn.

21 states offer full practice authority for NPs. While I do support full practice authority, I also recognize the need for close collaboration with other NPs and physicians, especially as new providers. The health and wellbeing of our patients are more important than anyone’s egos.

Overall, either path is commendable and offers excellent education and training, but the differences in each cannot be ignored. Physicians clearly have extensive education and training, starting out very broad and narrowing down to their specific patient population within residency. They are continuously learning under other knowledgeable physicians and have a rigorous and long-standing educational format. This is no easy path.

 NPs first get great bedside nursing experience – connecting with patients and being exposed to medical conditions and treatment plans. Then they choose a specialty and focus on their specific patient population. So no, they may not be able to tell you in-depth information about virology or the cytokine p450 system. However, they are educated and trained to treat their specific patient population appropriately. Any research studies comparing and contrasting NPs and physicians show that NPs have not been found to provide inferior care.

The best thing for all of us to work together, swallow our egos, work within our scope and capabilities, and provide top-notch care to all our patients.

How Much Do Nurse Practitioners Make?

How Much Do Nurse Practitioners Make?

If you are thinking about or working towards becoming a Nurse Practitioner, the thought of an increased salary has probably crossed your mind. Advancing your nursing career not only can have a positive impact on your job satisfaction, but also tends to positively impact your pay. When I was a broke college student, I would obsess about my future and how much money I would be making as an NP. While money should not be the only factor to consider – it is an important one! Besides – Grad school costs a lot of money – it better be worth it on the other end.

When I would constantly try to figure out how much money I would be making as a future NP, I had trouble finding the right answers that I was looking for. Online forums gave inconsistent answers. Some salaries would seem much too low, and others seemed so high it was unrealistic. I needed an open, honest answer – and I honestly feel as though I never really found it.

Now that I am a practicing NP, I hope to be able to give exactly what I was looking for as a future NP – an honest answer! Not only will I tell you how much I make as an NP, I am going to highlight 4 factors which can help you determine how much you can make as a new graduate NP in your specific situation.

I also made a YouTube video about this above – if you’re not into reading articles the video might be more your style!

Four Factors in Determining NP Salary

Many variables will determine your salary in the healthcare field. I attempt to simplify these into four factors that can help you determine a good estimate on just how much you can get paid as an NP.

1. Experience

This one is pretty much a no-brainer. As in all professions, the more experience you bring to the table – the more value your company will perceive. This tends to mean higher pay. You have put in the work, you company recognized your experience and knowledge, and they reward that.

Glassdoor will tell you that the average NP salary with 0-5 years of experience is approximately $105,000 per year. At the same time, NPs with greater than 15 years of experience make approximately $122,000 per year. This is a $17,000 per year difference. While Glassdoor is a great way to estimate salary, it shouldn’t be looked at alone. Medscape released a 2018 NP Compensation Report which actually supported these numbers. Average NP with 1-5 years of experience had a salary of $106,000, whereas those with 11-20 years of experience had an average salary of $123,000.

This can sometimes be a little frustrating when those who have “put in their time” do lower quality work than you – who might be new but who works very hard. Unfortunately, this is life. You too can reap the benefits in 10-20 years down the road. While the above numbers are great averages to go by, these do not factor in anything other than experience. Instead of how long you’ve been working as an NP, what type of work you do will impact your salary even more.

2. Clinical Setting

Where you work as a nurse practitioner – as in which type of clinical setting – will have a major impact on your salary as a Nurse Practitioner. Acute hospital settings – such as the Emergency Department or Inpatient care – have the highest salary of all the clinical settings. These sites tend to have less desirable hours, higher stress levels, and a worse schedule overall. At the same time – they bring in more revenue. Due to this, Nurse Practitioners working within these acute settings tend to have higher pay. According to the same MedScape Compensation report, in 2017 NPs in these settings made an average of $120,000 per year, whereas those in non-hospital affiliated outpatient offices made an average of $108,000. Even lower paid are academic professionals (education or research), who make $105,000. The lowest setting appears to be college health, which makes $95,000. In general, if you are planning on working for outpatient offices you can estimate $10-15,000 less than you would make if working ED/inpatient.

Each clinical setting has its pros and cons. College health may have the lowest paying salary, but they also tend to have great hours, holiday breaks, and tuition assistance perks. Knowing which clinical setting you want to work in will definitely help you estimate how much you can make as an NP. However, another important factor to consider is what area you will be working in.

In some instances, pay may be higher in rural areas who have trouble maintaining staffing – so keep that in mind.

3. Location

Where you work – as in what geographical location – is another major factor to consider in determining your NP salary. According to MedScape, the best areas for the highest NP salary is the Pacific coast, where it averages $130,000. The more central, generally the less pay you can expect. The lowest paying area is East South Central, which includes Tennessee, Kentucky, Mississippi, and Alabama – averaging $103,000.

Something to keep in mind is that where you work will also determine your cost of living. When I used to work as a Nurse in Western Pennsylvania, my 1-bedroom apartment cost me $435/month. Now I live in Urban New Jersey, 1 hour south of NYC. That same 1-bedroom apartment would cost me TRIPLE what it did in rural PA. Food, drinks, property taxes, and events (such as weddings) can all add up. So while you may be making a higher salary, you may not be earning more effective income.

4. Contract

What type of employee you are will definitely play a part in your overall pay. Full-time employees have standard pay, but they also have many benefits which increase their overall package. They often receive Paid Time Off (PTO) for vacations and holidays, Medical, dental, and vision insurance, malpractice insurance, Continued Medical Education allowance, life insurance, retirement, license reimbursement, etc. These all really add up. As a Part-time employee, you may receive some of these benefits, but your pay will likely not increase.

As a Per-Diem employee, your hourly pay will likely be somewhat more than Full-Time employees. This is because the company is not contributing any benefits to you, but you basically just work occasionally. Locum Tenens, which is basically just a temporary travel NP, has the greatest opportunity to make money. Rates can be $75-150/hr – however the latter being more rare. These usually require you to be willing to travel often, be very confident in your skills, and to be comfortable working alone. Many critical access hospitals will pay big bucks for you to be the solo Provider for a limited amount of time.

How Much Do I Make as an NP?

I hope the above information you found useful and can use to help you determine your future NP salary. To give you some reference, I will share my salary as an NP.

When interviewing for jobs last year, I had offers of about $100,000/year plus benefits for outpatient primary care offices. However, I ended up taking a job as an inpatient hospitalist working nightshift. I work in urban NJ, three 12-hour shifts per week, 7P-7A, and do receive shift differential. I do get paid hourly, but my yearly salary ends up being between $110-120,000/year. This is great pay for a new graduate NP. Keep in mind though that I do live and work in a high-cost area and I work in the acute inpatient setting. These two factors are really the main reasons why my salary is what it is. I am a FT employee and do receive hospital benefits as well.

I hope you found this article useful! I just know that when I was an aspiring NP, reading something like this would have been motivational and would have offered clarity and perspective. Hopefully this can do the same for you!

 

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