A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications, and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion.
History
United States The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. The first formal graduate certificate program for NPs was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965. In 1971, the US Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation for expanding the scope of nursing practice to be able to serve as primary care providers. In 2012, discussions arose between accreditation agencies, national certifying bodies, and state boards of nursing about the possibility of making the Doctor of Nursing Practice (DNP) degree the new minimum standard of education for NP certification and licensure by 2015.
Canada Advanced practice nursing first appeared in the 1990s in Ontario. These nurses practiced in neonatal intensive care units within tertiary care hospitals in collaboration with pediatricians and neonatologists. Although the role of these nurses initially resembled a blended version of clinical nurse specialists and NPs, today the distinction has been more formally established.
Nurse practitioners in the United States
Education requirements Becoming a nurse practitioner in the United States requires either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training in addition to the clinical hours required to obtain their RN. Upon completion of the graduate program, they must pass the National NP Certification Board Exam, specific to their specialization. After passing this exam, candidates must apply for NP licensure, which varies by state regulations. During the Master’s degree program, the nursing students are challenged with extensive amount of clinical training hours to have the experience and understand the reality of nurse practitioner duties. Certification readiness is tested throughout the clinical hours and study which lay the ground of diagnosis of patients and treatments. These exams are called academic clinical partnerships (ACPs) and integrate diagnostic readiness tests (DRTs) help development of the education and skills required of the curriculum that sets them up for field responsibility. Although nurse practitioners are required to be licensed as registered nurses prior to obtaining their advanced practice registered nurse certification, there are several programs that combine a nursing undergraduate degree with nurse practitioner training. Some US nurse practitioner programs are highly selective, with admission rates as low as 6% of applicants at University of California, Irvine in 2020, and others are more inclusive, with up to 100% acceptance rates in 2019 at public universities such as Northwestern State University of Louisiana and the online branch of Purdue University.
Training pathways There are many types of nurse practitioner programs in the United States, with the vast majority being in the specialty of a family nurse practitioner (FNP). There are also psychiatric, adult–geriatric acute care, adult–geriatric primary care, pediatric, women's health, and neonatal nurse practitioner programs. Many of these programs have their pre-clinical or didactic courses taught online with proctored examinations. Once the students start their clinical courses, they have online material but are required to perform clinical hours at an approved facility under the guidance of an NP or physician. Each clinical course has specific requirements that vary depending on the program's degree or eligibility for certification. For instance, FNPs are required to see patients across the lifespan during their training, whereas adult geriatric NPs do not see anyone below the age of 13. Nurse practitioners may pursue dual or multiple certifications by completing additional graduate-level training, such as post-master's certificates or Doctor of Nursing Practice (DNP) programs. Upon satisfying the educational and clinical requirements for these secondary specialties, they become eligible for further board certification and expanded clinical practice. For instance, a family nurse practitioner (FNP) may obtain a post-master's certificate in psychiatric-mental health to qualify for dual certification as an FNP/PMHNP.
Quality of care A 2011 review of studies comparing outcomes of care by NPs and physicians in primary care and urgent care settings found that outcomes were generally comparable, although the strength of the evidence was generally low due to limited study duration and participant numbers. A 2020 study showed nurse practitioners practicing in states with independent prescription authority were more than twenty times more likely to overprescribe opioids than nurse practitioners in prescription-restricted states. The same study identified that both nurse practitioners and physician assistants were more likely to overprescribe opioids compared to physicians. Nurse practitioners and physician assistants were also associated with more unnecessary imaging services than primary care physicians, which may have ramifications on care and overall costs. A 2017 systematic review suggested "that the implementation of advanced practice nursing roles in emergency and critical care settings improves patient outcomes in emergency and critical care settings".
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